Pits and Fissure Sealants: Preventive Resin Restorations Flashcards
What are the two limitations that the new caries detection technologies have?
- They are only indicated for use on unrestored pits and fissures
- Their diagnostic accuracy has not been firmly established.
What are the 3 new caries detection technologies currently approved by the FDA?
- Laser-Induced Fluorescence
- Light-induced fluorescence
- AC impedance spectroscopy
What type of device is the DIAGNOdent?
Laser-induced fluorescence
What limits the usefulness of the DIAGNOdent machine?
Increased likelihood of false-positive diagnoses
What type of device is the spectra camera?
Light induced fluorescence
How does the light-induced fluorescence caries detection technology work?
LED light of a specific wavelength stimulates porphyrins that are unique to cariogenic bacteria to appear red, while healthy enamel appears green
What type of technology is the CareScan PRO?
AC Impedance
What is the claim of the CarieScan PRO?
Analyze demineralized tooth structure and report:
Tissue health
If the tissue is in the early stages of demineralization
If the tissue is already significantly decayed
What is Fiber-Optic Transillumination (FOTI)
It is a method of caries detection that uses the translucent nature of the tooth to shine a very bright light through the tooth in order to reveal discolorations and penetration from tooth surface to the inner zone of dentin
Besides discoloration, what else might FOTI be able to detect?
Enamel cracks
What is the main drawback of using caries detection dyes?
They stain anything porous, including debris that might have been left in the pulp.
Also, noncarious deep denting absorb the dye because it has larger tubules compared to more superficial dentin.
What does ICDAS stand for and what is the goal of the organization?
International Caries Assessment and Detection System
ICDAS was developed to serve as a guide for standardized visual caries assessment.
What does ICCMS stand for?
International Carries Classification and Management System
What is the impact of resin bonding in terms of the prep design?
Bonding techniques allow for more conservative preparations
Besides materials and bonding technology what else has reduced the need for extensive preparations?
New research on etiology, diagnosis, and treatment of carious lesions
What is the basic definition of an adhesive?
A material, frequently a viscous fluid that join 2 substrates together by solidifying and transferring a load form one surface to the other.
What are the 4 bonding mechanisms in adhesive dentistry?
Mechanical
Adsorption
Diffusion
A Combo of the first 3
What is mechanical bonding in adhesive dentistry?
Penetration of resin and formation of resin tags
What is adsorption bonding in adhesive dentistry?
Chemical bonding to the inorganic or organic component of tooth structure
What is diffusion bonding in adhesive dentistry?
Precipitation of substances on the tooth surfaces to which resin monomers can bond mechanically or chemically
What must exist for good adhesion?
Close contact between the adhesive and the substrate
What is a major problem with bonding resins to tooth structure?
All methacrylate based resins shrink during free-radical addition polymerization
Why must dental adhesives provide a strong initial bond?
To resist the stress of resin shrinkage
Where are the three areas that typically lead to adhesive failure?
Cohesive failure in the substrate
Cohesive failure in the adhesive
Adhesive failure, or failure at the interface of substrate and adhesive
What phenomenon allows fluid resin to penetrate into tooth structure?
Capillary action
What does acid etching accomplish?
Transforms smooth enamel into an irregular surface and increases its surface free energy
What did the acid-etch technique allow for?
The formation of resin microtags within the enamel surface
What kind of strenghth does resin boding to acid based enamel provide?
Upwards of 20 MPa
What kind of acid is used to etch enamel?
Phosphoric Acid 35%
Why is beveling the enamel rods beneficial to the adhesion process?
The end of rods are more effectively etched then the sides. Beveling exposes many more rod ends to the acid etch that in non-beveled surfaces.
This increases retention of the restoration and prevents microleakage
Besides increases retention, what is another benefit of beveling the enamel?
It helps the restoration blend more aesthetically with the natural tooth structure
Why is gel acid preferred over liquid for etching?
It is easier to control
What is the typical range for phosphoric acid concentration?
35-40%, 37% most common
Why should you follow manufacturer’s recommendations for etching time periods?
Research has shown that 15 second etch times result in similar surface roughness as 60 second etch times
What is the philosophy of minimally invasive dentistry
Integrates prevention, remineralization, and minimal intervention for the placement and replacement of restorations
How does minimally invasive dentistry aim to conserve healthy tooth structure?
Assess patient caries risk factors
Try to detect potential caries disease before cavitation
Restore with max retention of sound tooth structure
Use sealant placement in unaffected areas when indicated
Why must the size of restorations be minimized?
Because the restoration might have to be replaced increasing the chance of fracture in the future
What is meant by the surgical model v medical model?
Surgical model: wait until cavitations were detected and restore
Medical model: treat each individual with unique treatment plan using caries management strategies
What does CAMBRA stand for
Caries Managment by Risk Assessment
What is the CAMBRA risk assessment used for?
To develop an individualized, evidence based caries management plan that would involve all aspects on nonsurgical therapy and surgical interventions.
What is the caries balance model based on?
Minimizing pathological factors while maximizing protective factors to attain a balance that favors no disease occurring
What are the top 6 Health History Carious Risk Factors?
Age Fluoride exposure Smoking Alcohol General health Medication
What are the age groups that are considered risk factors for caries?
Childhood
Adolescence
Senescence
What are the recommendations for a high risk patient?
3 months checkup
Fluoride at each visit
Dietary counseling
BW Radiographs 6-12 mos
According to ICCMS Guidelines, cavitations should be restored if they meet on or more of these criteria?
Need to Restore Esthetics
Need to Restore Functionality
Need to Protect Pulp from progressing caries/decrease sensitivity
Need to Restore Cleanability
Why is a cavitated lesion more likely to progress?
Self-cleaning becomes nearly impossible
For active occlusal lesions what are the treatment summaries?
- Cavitated to dentin = Restore
- Cavitation limited to enamel and plaque retentive + PRR
- Cavitation limited to enamel only, not plaque retentive = Sealant
What does the indication for sealant use depend on?
Patient Caries Risk
Tooth morphology
Presence of incipient enamel caries
What type of xray should be obtained before sealant placment, and why?
Bitewing
To ensure that you aren’t sealing over an existing dentinal or proximal lesions
Why are pits and fissures considered caries-prone?
They are not self-cleansing
They accumulate organic debris and bacteria
What are the goals of a pit and fissure sealant?
Eliminate the geometry that harbors bacteri and to prevent nutrient reaching bacteria in the pits
What is the main requirement for the success of a sealant?
Adequate retention
When must a sealant be adjusted?
If it interferes with normal occlusal contacts or paths
What are the 2 categories of Sealants?
Self curing
Light curing
What is the principal monomer in the sealants?
bis-GMA
What is the difference between self-cure and light cure in terms of application technique?
LC can be applied and allowed to flow for a convenient time before curing
SC have to be applied when fluid enough to penetrate pits so that they begin to cure before flowing out!
