lenka.roubalikova@tiscali.cz 1
PreclinicalPreclinical DentistryDentistry
I.I.
DentalDental CariesCaries
NonNon cariouscarious lesionslesions: trauma,: trauma,
erosionerosion,, abrasionabrasion,,wedgewedge shapedshaped
defectsdefects
LenkaLenka RoubalRoubalííkovkováá
lenka.roubalikova@tiscali.cz 2
UnderstandingUnderstanding
dentaldental cariescaries
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crown
neck
root
pulp chamber
root canal
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Dental Tissues
Enamel
Dentin
Cementum
Periodontal ligament
Alveolar bone
Pulp
Gingiva
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tooth
microbs
sugar
time
Dental caries
caries
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DentalDental CariesCaries
InfectiousInfectious microbiologicalmicrobiological diseasedisease ofof thethe teethteeth
thatthat
resultsresults inin localizedlocalized dissolutiondissolution andand destructiondestruction
ofof
thethe calcifiedcalcified tissuestissues
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BiofilmBiofilm –– DentalDental PlaquePlaque
ComplexComplex communitycommunity
SimpleSimple circulationcirculation
Better conditions to survive
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DentalDental BiofilmBiofilm –– DentalDental PlaquePlaque
AA gelatinousgelatinous massmass ofof bacteriabacteria adheringadhering toto thethe
toothtooth surfacesurface..
No shedding
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DentalDental biofilmbiofilm
AdhesionAdhesion
ColonisationColonisation
MaturationMaturation
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SugarSugar
FermentableFermentable (mono(mono--,, didi-- tritri-- sacharidessacharides))
Sucrose, glucose, lactose Acids
Demineralization
Demineralizace
Čas
Ireverzibilní: kavitované l
Reverzibilní: Nekavitované léze
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SalivaSaliva
PlaquePlaque formationformation
MicrobialMicrobial sourcesource
MineralMineral sourcesource
MicrobialMicrobial clearenceclearence
BufferBuffer capacitycapacity
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CariesCaries dangerdanger areasareas
habituallyhabitually ((predictablepredictable)) dirtydirty
placesplaces
PitsPits andand fissuresfissures
ProximalProximal surfacessurfaces
CervicalCervical areaarea
NoNo selfself cleaningcleaning
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PredictablePredictable cleanclean placesplaces
CuspsCusps
ProximalProximal ridgeridge,, obliqueoblique,, transversetransverse ridgeridge
IncisalIncisal edgeedge
BuccalBuccal oror oraloral surfacesurface uponupon thethe maximalmaximal
convexityconvexity
ProximalProximal surfacesurface uponupon tthehe contactcontact pointpoint
SelfSelf cleaningcleaning
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CariesCaries -- depthdepth
SurfaceSurface cariescaries ((cariescaries superficialissuperficialis))
MiddleMiddle cariescaries ((cariescaries media)media)
CariesCaries closeclose to pulp (to pulp (cariescaries pulpaepulpae proximaproxima))
CariesCaries penetratingpenetrating intointo thethe pulp (pulp (cariescaries adad pulpampulpam
penetranspenetrans))
Deep caries
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CariesCaries -- TopographyTopography
CoronalCoronal cariescaries
RootRoot surfacesurface cariescaries
EnamelEnamel cariescaries
DentinDentin cariescaries
CementumCementum cariescaries
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CariesCaries
AcuteAcute
ChronicChronic
ArrestedArrested
PenetratingPenetrating
UnderminingUndermining
Acc to its history
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PrimaryPrimary cariescaries
SecondarySecondary cariescaries
RecurrentRecurrent cariescaries
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PatientPatient assesmentassesment
Clinical examinationClinical examination
DiagnosisDiagnosis
lenka.roubalikova@tiscali.cz
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DiagnosisDiagnosis
ofof dentaldental cariescaries
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InvestigationInvestigation
MirrorMirror
SharpSharp ProbeProbe
IllimunationIllimunation
MagnificationMagnification
XX-- rayray,, otherother methodsmethods i.e.i.e. transilluminationtransillumination,, infraredinfrared
laserlaser fluorescencyfluorescency
Dark spot, hole, defect
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DentalDental CariesCaries -- TreatmentTreatment
NonNon cavitatedcavitated lesionlesion::
OnOn molecularmolecular basisbasis
-- DentalDental hygienehygiene
-- FluoridesFluorides,, CalciumCalcium,, PhosphatesPhosphates
-- DietDiet
-- AntimicrobialAntimicrobial agentsagents
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DentalDental CariesCaries -- TreatmentTreatment
CavitatedCavitated lesionlesion::
PreparationPreparation
FillingFilling
Drill anf fill
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PreparationPreparation
InstrumentalInstrumental treatmenttreatment
RemoveRemove cariescaries
LeaveLeave thethe restrest ofof thethe dentaldental tissuestissues
-- toto bebe restoredrestored
-- toto bebe resistentresistent againstagainst thethe bitebite forcesforces
-- toto bebe preventedprevented againstagainst thethe recurrentrecurrent cariescaries
((BlackBlack 1914)1914)
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ClassificationClassification ofof cavitiescavities
accordingaccording toto BlackBlack
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ClassClass I.I.
CariesCaries inin fissuresfissures andand pitspits –– occlusalocclusal
surfacessurfaces ofof premolarspremolars andand molarsmolars
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ClassClass II.II.
ProximalProximal surfacessurfaces ofof molarsmolars andand premolarspremolars
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ClassClass III.III.
ProximalProximal surfacessurfaces ofof incisorsincisors andand caninescanines
withoutwithout lossloss ofof thethe incisalincisal edgeedge
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ClassClass IVIV
ProximalProximal surfacessurfaces ofof incisorsincisors andand caninescanines
withwith thethe lossloss ofof incisalincisal edgeedge
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ClassClass V.V.
CervicalCervical areaarea
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ClassificationClassification accacc. to. to BlackBlack
ClassClass I.I.
PitPit andand fissurefissure cariescaries
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ClassificationClassification accacc. to. to BlackBlack
ClassClass II.II.
ProximalProximal surfacessurfaces inin premolarspremolars andand molarsmolars
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ClassificationClassification accacc. to. to BlackBlack
ClassClass III.III.
ProximalProximal surfacessurfaces ofof incisorsincisors andand caninescanines
withoutwithout
lostlost anan incisalincisal ridgeridge
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ClassificationClassification accacc. to. to BlackBlack
ClassClass IV.IV.
ProximalProximal surfacessurfaces ofof incisorsincisors andand caninescanines withwith
lostlost anan incisalincisal ridgeridge
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ClassificationClassification accacc. to. to BlackBlack
ClassClass V.V. cervicalcervical lesionslesions
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Charting and recordsCharting and records
thethe mostmost importantimportant notationnotation
CariesCaries //
FillingFilling PP
ToothTooth forfor extractionextraction XX
ExtractedExtracted toothtooth ++
CrownCrown
PonticPontic
ToothTooth inin removableremovable denturedenture 00
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InstrumentsInstruments forfor investigationinvestigation ––
investigativeinvestigative instrumentsinstruments
Explorer (Explorer (probeprobe):):
Sharp,Sharp, straightstraight oror bowbow shapedshaped::
CariesCaries detectiondetection –– lghtlght motionmotion withoutwithout anyany
pressurepressure:: dentaldental surfacessurfaces,, fillingsfillings..
PeriodontalPeriodontal explorerexplorer ((probeprobe): not): not sharpsharp,,
calibratedcalibrated,, investigationinvestigation ofof periodontalperiodontal
pocketspockets
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InstrumentsInstruments forfor investigationinvestigation ––
investigativeinvestigative instrumentsinstruments
MirrorMirror –– flatflat oror concaveconcave
ToTo seesee lessless availableavailable regionsregions
ToTo illuminateilluminate
ToTo movemove offoff softsoft tissuestissues ((cheekscheeks,, tonguetongue
etcetc.).)
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InstrumentsInstruments forfor investigationinvestigation ––
investigativeinvestigative instrumentsinstruments
TweezerTweezer
ToTo gripgrip variousvarious instrumentsinstruments andand suppliessupplies..
lenka.roubalikova@tiscali.cz
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InstrumentsInstruments forfor cavitycavity
preparationpreparation
HandHand instrumentsinstruments forfor cuttingcutting
TwoTwo mainmain materialsmaterials::
StainlessStainless steelsteel ((losesloses keenkeen edgeedge))
CarbonCarbon steelsteel ((corrodecorrode))
ExcavatorExcavator
ChiselChisel-- cleavercleaver
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InstrumentsInstruments forfor cavitycavity
preparationpreparation
PowerPower drivendriven instrumentsinstruments forfor cuttingcutting
-- RotaryRotary instrumentsinstruments
ComonComon designdesign characteristicscharacteristics
lenka.roubalikova@tiscali.cz
shank neck head
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ShankShank
TheThe partpart thatthat fitsfits intointo thethe handpiecehandpiece
AcceptsAccepts thethe rotaryrotary motionmotion fromfrom thethe
handpiecehandpiece
ProvidesProvides aa bearingbearing surfacesurface toto controlcontrol thethe
alignmentalignment andand concentricityconcentricity ofof thethe
instrumentinstrument
lenka.roubalikova@tiscali.cz
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StraightStraight handpiecehandpiece shankshank
SimpleSimple cylindercylinder
heldheld inin thethe handpiecehandpiece in a metalin a metal chuckchuck
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LatchLatch angleangle handpiecehandpiece shankshank
ShorterShorter lengthlength –– accessaccess toto posteriorposterior regionsregions
HandpieceHandpiece –– contracontra angleangle, metal, metal burbur tube.tube.
TheThe endend ofof thethe instrumentinstrument fitsfits intointo DD--shapedshaped
socketsocket atat thethe bottombottom ofof thethe burbur tube.tube. TheThe
instrumentinstrument retainedretained by aby a retainingretaining latchlatch thatthat
slidesslides intointo thethe groovegroove foundfound atat thethe shankshank endend ofof
thethe instrumentsinstruments..
Low and medium speed
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FrictionFriction gripgrip handpiecehandpiece shankshank
SmallerSmaller design,design, simplesimple cylindercylinder..
HeldHeld inin thethe handpiecehandpiece byby frictionfriction inin plasticplastic oror
metalmetal chuckchuck..
lenka.roubalikova@tiscali.cz
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NeckNeck designdesign
IntermediateIntermediate portionportion ofof anan instrumentinstrument thatthat
connectsconnects thethe headhead toto thethe shakshak
TaperedTapered,, shortershorter oror longerlonger..
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HeadHead designdesign
BursBurs –– cutcut ofof steelsteel oror tungstentungsten carbidcarbid
DiamondDiamond ((diamonddiamond burs)burs)–– coveredcovered withwith thethe
diamonddiamond bortbort
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HeadHead designdesign
BursBurs classificationclassification systsystéémm
RoundRound
InvertedInverted conecone
PearPear shapedshaped
StraightStraight fisurefisure
TaperedTapered fissurefissure
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BurBur bladeblade designdesign
RakeRake face (face (towardstowards thethe directiondirection ofof
cuttingcutting))
ClearenceClearence faceface
RakeRake angleangle –– slightlyslightly negativenegative
EdgeEdge angleangle –– apprappr 9090°°
ClearenceClearence angleangle
ClearenceClearence faceface roundedrounded oror twotwo surfacessurfaces..
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HeadHead designdesign
DiamondDiamond classificationclassification systsystéémm
RoundRound
InvertedInverted conecone
PearPear shapedshaped
CylinderCylinder
TaperTaper
LensLens
NeedleNeedle etcetc..
lenka.roubalikova@tiscali.cz
Preparace strojovPreparace strojováá -- nnáástrojestroje
Rotační nástroje jsou konstruovány podle normy ISO
6360
VrtVrtááččkyky
MajMajíí být zhotoveny z vysoce kvalitnbýt zhotoveny z vysoce kvalitníí tvrdokovovtvrdokovovéé
slitiny.slitiny.
SlouSloužžíí k mnohak mnoha úúččelelůůmm
v ordinaci i laboratov ordinaci i laboratořřii
bbřřity odkrajujity odkrajujíí materimateriááll
rýhy odvrýhy odváádděějjíí materimateriááll
Brousky-diamantované
- karborundové
- korundové
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DiamondDiamond abrasiveabrasive instrumentsinstruments
DiamondDiamond bortbort –– smallsmall aharpaharp particlesparticles inin
softersofter matrix.matrix. CuttingCutting occursoccurs atat aa largelarge
numbernumber ofof pointspoints..
MetalMetal blankblank
DiamondDiamond powderpowder
MetallicMetallic bondingbonding materialmaterial
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PreparationPreparation speedspeed
LowLow ((slowslow)) speedsspeeds –– belowbelow 12.00012.000 rpmrpm
MediumMedium oror intermediateintermediate speedsspeeds 12.00012.000 ––
200.000200.000 rpmrpm
HighHigh oror ultrahighultrahigh speedsspeeds aboveabove 200.000200.000
rpmrpm
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1 : 1 Gear assembly
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1:4 až 1:5 Speed increasing gear
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1 Green ring: 2,7:1
2 Green rings: 7,4:1 Speed decreasing gear
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Spitting box
with amalgam
separator
Light
Driving system
Tray
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Hoses lower leading
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Hoses – uper leading
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CavityCavity preparationpreparation
PowerPower drivendriven
HandHand
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400.000400.000 rpmrpm
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Electromotors – maximum 40.000/min
Airmotors – maximum 20.000/min
Gearing to fast speed
Gearing to slow speed
Oscillation
Blue code – gear 1:1
1:5
2,7 :1 or 7,4 :1
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1 : 1 as far as 40.000 rpm
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RedRed codedcoded handpiecehandpiece
1:4 až 1:5 as far as 160.000 – 200.000 rpm
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Preparace strojovPreparace strojováá -- pohonypohony
2,7:1
7,4:1
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BlueBlue andand greengreen codedcoded handpiecehandpiece
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HanpiecesHanpieces combinedcombined
1:1
2:1
nerotuje
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ISO
6360
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FillingFilling materialsmaterials
TemporaryTemporary
ZinkoxidsulphateZinkoxidsulphate cementcement
OneOne componentcomponent cementscements basedbased onon gypsumgypsum andand
organicorganic lutelute
ZinoxidphosphateZinoxidphosphate cementcement
DefinitiveDefinitive
AmalgamAmalgam
CompositesComposites
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FillingFilling materialsmaterials
Amalgam:Amalgam:
MercuryMercury
PowderPowder –– metalmetal alloyalloy::
SilverSilver
TinTin
CopperCopper
ZincZinc
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ChiselChisel –– forfor enamelenamel
CleaverCleaver
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ChiselChisel forfor enamelenamel
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ExcavatorExcavator
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FillingFilling instrumentsinstruments
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BurnisherBurnisher --planeplane
AngularAngular-- troughtrough edgeedge troughtrough
faceface
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BurnisherBurnisher –– angularangular threethree faceface
lenka.roubalikova@tiscali.cz 83
CondensorCondensor andand burnisherburnisher
combinedcombined
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AmalgamAmalgam carriercarrier
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CondensorCondensor forfor amalgamamalgam
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CondensorCondensor forfor guttaprechaguttaprecha -- hoofhoof
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BallBall condensorcondensor
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CondensorCondensor ––stamenstamen
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FosterflaggFosterflagg
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FrahmFrahm
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CarverCarver:: DiscoidDiscoid -- CleoidCleoid