1. Surgical Removal of Caries Flashcards
Dentinal Caries Progress more \_\_\_\_ than enamel Tubules are natural \_\_\_\_ for bacteriologic migration \_\_\_\_ is first defense coagulation of \_\_\_\_ at orifice absorption of \_\_\_\_ Softened dentin may be \_\_\_\_ Denatured collagenous matrix= impossible to \_\_\_\_
rapid channels intratubular fluid fluid minerals remineralized remineralize
Infected Dentin- ____ dentin with ____ bacterial infection
Affected Dentin- ____ dentin with ____ infection
softened
significant
slightly softened
minimal
Criteria for Deep Lesion Therapy
- ____ carious teeth without a history of ____ pain, pain on percussion and only to ____ stimuli (cold or heat)
- Teeth with no ____
- No ____on radiograph
- Teeth that could be ____ by a rubber dam
deep spontaneous provoked percussion sensitivity periapical pathology isolated
How do we decide what is decay in the cavity preparation?
____- compressive force Spoon excavator
____ rotating ____ bur
Dyes
How much \_\_\_\_? How sticky is sticky? How \_\_\_\_ do we scoop? What is the ideal \_\_\_\_ of dentin? of enamel?
explorer
slowly
round
force
hard
color
Round Bur \_\_\_\_ speed handpiece \_\_\_\_ rotating \_\_\_\_ pressure Select the \_\_\_\_ bur that will fit in the preparation, slowly rotating
slow
slowly
light
largest
Caries Removal
Open cavity to allow ____
Remove all decay from ____
Excavate decay pulpally, but do not ____
Determine how ____ remaining dentin is
If dentin is extremely soft continue ____
If dentin is leathery or firm, decide whether or not
dentin should remain based on pulp ____, ____ and likelihood of pulp ____
access periphery expose soft removal health demineralization exposure
Occlusal Caries
Carious process accompanied by enamel decalcification on lateral walls of ____
Visible with ____ air drying of the tooth
Dessicated demineralized enamel is ____
fissures
5 sec
opaque
Early or Occlusal
Carious process not apparent with: ____ inspection
May or may not be visible with ____ drying
Lesion may be arrested
These difficult to discern on ____
visual
extensive
radiograph
Carious Pulp Exposure
Is it ____?
What are the ____?
What are the important ____?
necessary
alternatives
decisions
How do we remove caries
____ invasive lesion access
Must be adequate for appropriate ____ caries instrumentation and creation of a peripheral ____
Avoid ____ to adjacent teeth and pulp dentin complex
Potential for caries ____ excavation techniques
minimally peripheral seal iatrogenic limiting
How much caries do we remove Peripheral caries (DEJ & peripheral dentin) Caries removal to clinically sound \_\_\_\_ to achieve a peripheral seal is essential.
hard enamel/dentin
How much caries do we remove Peripheral caries (DEJ & peripheral dentin) Caries removal to clinically sound hard enamel/dentine to achieve a peripheral seal is essential.
Pulpal caries
Remove carious tissue to optimize ____ (minimal thickness needed for material
restoration performance
How much caries do we remove
Leaving infected, demineralized, stained dentin is proven and ____ scientifically
____ dentin should be removed
____should be avoided
Every tooth should be assessed for pulp ____ …no ____
…no sensitivity to ____
accepted soft "mushy" pulp exposure health periapical pathology percussion
Deep Caries Lesion Management
Indirect Pulp Cap
____ Caries Removal
To ____ or not re-enter
What is the ideal ____ for both?
Direct Pulp Cap (for caries)
What is the ideal ____?
stepwise
re-enter
medication
medication
Deep Caries Lesion Management
Pulp Cap
Indirect Pulp Cap Indication- \_\_\_\_ caries lesion Caries near \_\_\_\_ No Sensitivity to \_\_\_\_ No \_\_\_\_ “\_\_\_\_” dentin NO \_\_\_\_
deep pulp percussion periapical pathology leathery caries exposure
Deep Caries Lesion Management
Pulp Cap
Indirect Pulp Cap
Technique- Excavate periphery to ____
Excavate ____ wall to 0.5mm
Place ____ and/or base
clean
axial
liner
Deep Caries Lesion Management
Pulp Cap Indirect Pulp Cap Medication- \_\_\_\_ \_\_\_\_ \_\_\_\_
CaOH
glass ionomer
composite
Deep Caries Lesion Management
Pulp Cap
Indirect Pulp Cap
Technique- Excavate ____ to clean
Excavate axial wall to____mm
Place ____ and/or base
Close with ____ then re-enter and restore with
____!…. Or just restore with ____
periphery 0.5 liner temporary amalgam amalgam
Deep Caries Lesion Management
Pulp Cap
Indirect Pulp Cap
Technique- Excavate periphery to clean Excavate axial wall to 0.5mm
Place liner and/or base What was the hitch… “leaving ____”
decay
Deep Caries Lesion Management
Direct Pulp Cap
Indications: ____ exposure…ONLY
Exposure of
mechanical
0.5
Deep Caries Lesion Management
Direct Pulp Cap Medication
- ____
____
____
CaOH
glass ionomer
composite
Deep Caries Lesion Management
Direct Pulp Cap Medication- CaOH
Glass Ionomer Composite
The final restoration was “____”
amalgam
Deep Caries Lesion Management
Where has the science led us?
‘it is better that a layer of ____ should be allowed to remain for the protection of the pulp rather than run the risk of sacrificing the tooth’
discolored dentin
Deep Caries Lesion Management
Where has the science led us?
‘it is better that a layer of discoloured dentine should be allowed to remain for the protection of the pulp rather than run the risk of sacrificing the tooth’ (John Tomes-1859),
‘… it will often be a question of whether or not the pulp will be exposed when all decayed dentine overlaying it is removed … it is better to expose the ____ of a tooth than to leave it covered only with ____’ (G.V. Black-1908)
pulp
softened dentine
Deep Caries Lesion Management
Where has the science led us?
10-year follow-up of occlusal restorations placed over moist, soft, infected dentine left both at the enamel- dentine junction and over the pulp. Lesion progression was ____ and there were no more ____ failures in this group than in control groups with conventional caries removal
arrested
clinical
Deep Caries Lesion Management Where has the science led us? Indirect Pulp Cap/ Incomplete Dentin Caries Removal/Stepwise Excavation Medication- \_\_\_\_ \_\_\_\_ \_\_\_\_ \_\_\_\_
CaOH
glass ionomer
composite
MTA - mineral trioxide aggregate
Deep Caries Lesion Management
Where has the science led us?
Indirect Pulp Cap/ Incomplete Dentin Caries Removal/Stepwise Excavation
____% success rates- no need to ____(M. Maltz, E.F. Oliveira, V. Fontanella, G. Carminatti Deep Caries Lesions after Incomplete Dentine Caries Removal: 40-Month Follow-Up
Study. Caries Res 2007;41:493–496)
(Ricketts D, Kidd E, Innes NPT, Clarkson JE. Complete or ultraconservative removal of decayed tissue in unfilled teeth. Cochrane Database of Systematic Reviews 2006, Issue 3)
88-95
re-enter
Deep Caries Lesion Management
Where has the science led us?
Direct Pulp Cap (____ OR Mechanical)
Advantage: avoidance of more ____ treatment, such as root canal
____ or extraction
Decreased ____
carious
extensive
treatment
cost
Deep Caries Lesion Management Where has the science led us? Direct Pulp Cap (Carious OR Mechanical) Medication- CaOH Glass Ionomer Composite \_\_\_\_
MTA- mineral trioxide aggregate
CaOH- Calcium Hydroxide Advantages Provides \_\_\_\_ \_\_\_\_ Environment- stimulates remin \_\_\_\_ Easy to apply-sets \_\_\_\_, convenient package
Disadvantage \_\_\_\_ Can not be used \_\_\_\_ Does not bond to \_\_\_\_ Low \_\_\_\_ strength
calcium
basic
cheap
fast
soluble
wet
tooth
compressive
Glass Ionomer
Advantages
____ Environment
Cheap
Seals well- bonds to ____, does not mind moisture(?) Leaches ____- helps ____
High ____ strength
Easy to apply-sets ____, convenient package
Disadvantage
Not ____
____ must be stopped
acidic tooth fluoride remineralization compressive fast soluble bleeding
Glass Ionomer
____ plus Polymaleic Acid
silicate glass
Composite
Advantages
Seals well- bonds to tooth, does not mind ____ (?)
Very high ____ strength
Not ____
____
Easy to apply-sets ____, convenient package
Disadvantage
____ must be stopped
moisture compressive soluble cheap fast bleeding
MTA- Mineral Trioxide Aggregate
____ in the form of ____, dicalcium silicate, tricalcium aluminate, and ____ oxide for ____
Developed for ____ (Mahmoud Torabinejad 1993) Similar to ____ (Joseph Aspdin 1824)
calcium oxide tricalcium silicate bismuth radiopacity dentistry portland cement
MTA- Mineral Trioxide Aggregate
Advantages \_\_\_\_ Environment Seals well- bonds to tooth, does not mind \_\_\_\_ \_\_\_\_ \_\_\_\_ compressive strength \_\_\_\_ must be stopped Not \_\_\_\_
Disadvantage
Difficult to apply-sets ____ Expensive
____ must be stopped
acidic moisture hydrophilic high bleeding soluble
slow
bleeding
Deep Caries Lesion Management
Where has the science led us?
Direct Pulp Cap (Carious OR Mechanical)
Medication- CaOH
Glass Ionomer
Composite
MTA- Mineral Trioxide Aggregate Multiple studies have indicated ____% success rates with mixed
data MTA v CaOH (Cochrane review- No Difference, Ferrecane- MTA superior)
70-97
When Direct Pulp Caps Fail- \_\_\_\_% require extraction, \_\_\_\_% treated with endodontics (T.J. Hilton, J.L. Ferracane, and L. Mancl, Comparison of CaOH with MTA for Direct Pulp Capping: A PBRN Randomized Clinical Trial JDR July 2013)
2
98
Deep Caries Lesion Management
Technique
Pre-treatment
1. Deep carious teeth without a history of ____ pain,
pain on percussion and only to ____ stimuli (cold or heat) 2. Teeth with no ____ sensitivity
3. No ____ on radiograph
4. Teeth that can be ____ by a rubber dam
spontaneous provoked percussion periapical pathology isolated
Deep Caries Lesion Management
Technique
Pre-treatment
1. Excavate to clean, firm, well supported enamel at
periphery of lesion
2. Excavate axially without ____
3. Pulp cap with “appropriate” ____
4. Restore ____
5. Discuss with patient that they need to see Dentist
____ if sensitivity to hot/cold/percussion/spontaneous pain develops
exposing
material
tooth
immediately
Deep Caries Lesion Management
Technique
Pre-treatment 1. Excavate to clean, firm, well \_\_\_\_ enamel at periphery of lesion Avoid \_\_\_\_ and discomfort Preserve non-demineralized and \_\_\_\_ tissue Achieve good \_\_\_\_ of restoration Maintain pulp \_\_\_\_ Maximize restoration \_\_\_\_
supported pain remineralizable seal health longevity
