بسم هللا الرحمن الرحيم

Different techniques for caries removal

Mohammad Mutni Al-Mutairi

For more than a century, since the creation of

belt-driven handpieces, dentists have been

removing caries based on the concept of drill,

remove, and restore. The remaining dentin is an

essential feature for long-term pulpal health.

Translated, this realization clearly means that

removing excess dentinal tooth structure and

encroaching on the pulpal tissue directly

correlate to potential negative pulpal outcomes.

INTRODUCTION

The different concepts in caries removal

1-Ozone therapy

2-Air abrasion technique

3-Chemomechanical caries removal

4-Smart bur

5-Stepwise excavation

6-Use of laser in tooth preparation

7-Use of ultrasonic in tooth preparation

Ozone therapyOzone is a gas made up of three

molecules of oxygen. When it is applied

to bacteria and other organisms, the

Ozone completely destroys them.

It is used in dentistry by utilizing a special

delivery system.

The portable apparatus includes a source of

oxidizing gas and a dental hand piece for delivering

the gas/water to the target tooth at a concentration

of 2100 ppm.

A cup attached to the hand piece is provided

for receiving the gas and exposing a selected

area of the tooth to the gas action.

The ozone gas is refreshed in this disposable

cup at a rate of 615cc/minute changing the

volume of gas inside the cup over 300 times

every second.

The cup forms a seal around the lesion being

treated so that ozone cannot leak into the oral

cavity.

Air abrasion technique*

•The use of air abrasion

techniques in dentistry

allows the removal of

decayed tissue without

the removal of the

healthy tooth

substance.

*Reis-schmidt T. Air abrasion cavity-preparation system provide cutting-edge option in restorative dentistery :dent prod report 1998;32(12);57-60,108-9

• The apparatus involves minute abrasive

particles which are too small to be seen by the

naked eye carried to the target tooth by a

stream of air gently and precisely acting to

remove away the decayed tooth structure

• It is recommended for treatment of children,

pregnant women and other medically

compromised patients.

Chemomechanical caries provides painless

and efficient removal of carious dentin and no

administration of local anaesthesia.

Chemomechanical caries removal

This techniques is based on altering the

secondary and /or quaternary structure of

collagen in carious dentin by chlorination

of the collagen.

The hydrogen bonding in the collagen is

disrupted rendering it more friable and

easier to remove by scrapping the carious

fragments away.

Smartprep(Smart bur)

The SMARTPREP Instrument is a medical grade

polymer that safely and effectively remove decayed

dentin, leaving healthy dentin intact.

The polymer instrument is self-limiting and will not

cut sound dentin unless applied with great force, and

then it will only wear away, rather than cut the

healthy dentin.

laser in tooth preparation

Lasers are used toremove decay withina tooth and preparethe surroundingenamel for receipt ofthe filling. Lasers arealso used to "cure" orharden a filling.

Ultrasonics in tooth preparation

The use of ultrasonictips has become analternative for cavitypreparation. However,there are concernsabout this type ofdevice, particularly withrespect to intrapulpaltemperatures and cavitypreparation time.

RefrencesNisha Garg, Amit Garg.Textbook of

Operative Dentistry. Second Edition.2013;ch.5,ch.6

Bjorndal L. in deep cavities stepwise excavation of caries can preserve the pulp.Evid based dent.2011;12(3):68.