The reversive treatment of an early tooth decay
Two types of fluorides can remineralize enamel caries and help teeth decay removal:
• Neutral sodium fluoride (gels, foams and varnishes)
- Acid phosphate fluoride (gels, foams)
Current guidelines recommend the use of:
– Gel containing: 1.23% Acid phosphate fluoride
– Varnish containing: 2.26% of sodium fluoride
Professional application of fluoride in gel form
+ Using a disposable mouthpiece containing, 1.23% of acidulated phosphate fluoride gel, i.e. 12300 ppm or 2% sodium fluoride.
+ Fluoride must remain on the teeth for 4 minutes.
+ The application is repeated at least every 3 to 6 months.
Patients at high caries risk should:
– receive topical fluoride treatment on a quarterly basis.
– receive a prescription for a toothpaste containing 5000 ppm fluoride for daily use at home.
Application of fluoride in the form of fluoride varnish
A 22600 ppm varnish is recommended to be applied 4 times a week
- It is advisable not to drink for 2 hours after.
- Avoid eating for 4 hours after.
- avoid hard foods and brushing on the first day after.
The CPP-ACP and CPP-AFCP
• More recently, specialties based on CPP-ACP (casein phosphopeptide – amorphous calcium phosphate) and
CPP-AFCP (casein phosphopeptide-amorphous fluoride calcium phosphate) were introduced.
• These molecules are showing promise in the non-invasive management of caries lesions by promoting phosphocalcic remineralization;
• However, the lack of clinical studies currently does not allow firm conclusions to be drawn on the effectiveness of these molecules.
Infiltration of enamel caries lesions with Leon resin from DMG
– The resin fills the porosity due to demineralization.
– It blocks the diffusion of cariogenic acids.
Curative treatment of teeth decay
Tooth decay removal
– Eliminate infected decayed tissue
– Stop the progression of the carious lesion
– Preserve pulp vitality
– Avoid recurrence of caries
• Caries removal should be done after isolationg the tooth from saliva in order to avoid any bacterial contamination.
The use of antiseptics based on chlorhexidine or benzalkonium chloride is recommended:
- during decay drilling
- before obturation to reduce the bacterial load.
• Caries detectives (eg: Rhodamine B) is a very specific dye. It allows you to divide the carious area into two parts:
– the affected dentin is not colored,
– the infected dentin is stained.
• The specific penetration of the caries revealer into the dentine, highlights the infected area only and allows the conservation of the affected area that will potentially remineralize.
decay removal methods
Air abrasion decay removal
Chemical decay removal
Decay removal by sono or ultra sono-abrasion
Laser decay removal
Manual decay removal
- Drilling is used at the end of the process to reduce the risk of pulp exposure on large caries.
- Excavation must be supplemented by rotary, sono-abrasive, because its effectiveness remains limited for large cavities.
- It is made using dental burs.
- The removal of decayed tissue is done using or tungsten burs at slow speed (1000 to 1500 rpm).
Air-abrasion decay removal
– Made by shooting abrasive particles of Alumina (of 27 or 50 μm) on the enamel substrate at very high speed by a flow of compressed air.
– the effect of particle dispersion may lead to abrasion of healthy enamel.
– To limit this effect, the tooth must be protected with 3 coats of varnish.
It is indicated in minimally restorative dentistry (stage 1 and 2).
Chemical decay removal
• The CARISOLV system (Medi Team Sweden) allows the chemical dissolution of decay infected collagen. It combines chemical action and manual curettage thanks to:
• Two specific gels: the first containing 3 amino acids: leucine, lysine and glutamic acid, the second consisting of hypochlorite.
• A set of specific tools for delivering the gel, and foam excavators capable of accessing all areas of the cavity to chip away the dissolved material.
Decay removal by sono and ultra sono-abrasion
• This process is based on the application of an instrument – abrasive diamond insert, animated by sound or ultrasonic energy, under constant irrigation, on the carious lesion.
• The tips are hemispherical or semi-cylindrical or angulated (for posterior sectors) and are characterized by a diamond-coated active face and a smooth non-active surface avoiding any damage to adjacent dental surfaces.
(Example the Komet-SONlC flex system, The EMS System).
Laser decay removal
– The devices on the market are equipped with an internal cooling system based on the spraying of a mixture of air and water at the point of impact of the laser radiation.
– The capacity of Er lasers: YAG (1 = 2 940 nm) or Nd-Yag laser ((1 = 1064 nm) to eliminate decayed tissue leaving a clean, disinfected dental surface (bactericidal effect) and by achieving occlusion of the teeth. dentinal tubuli
-Used to prepare cavities for adhesive restoration.
– Ozone is a disinfectant that works by destroying, neutralizing or inhibiting the growth of microorganisms and viruses.
– The Kavo company introduced the Healozone system on the European market, a system made up of a device delivering a gas: ozone supplemented by a remineralizing treatment based on fluorides, calcium, phosphate and xylitol.
-The process sterilizes the infected dentin layer without removing it.