SMART-Malaysia 0415 Part 1

8/17/2019 SMART-Malaysia 0415 Part 1

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SMART Preventive Restoration for Caries in

Primary Teeth

Prathip Phantumvanit

Thammasat University, Thailand

Former Vice-Chair, Public Health Committee, FDI


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Concept – hy !"#$T% hat !"#$T% Caries removal – Ho& clean%

'lass ionomer – hich material% Practicability – here settin(% hen

!"#$T% Procedure – Ho& !"#$T% #cceptability – ho bene)t%

Overview

Prathip Phantumvanit !"#$T*+ ./.0 *


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%caries

dmft dt mt ft

1apan 2*3 342 +34/ + 0.95

"alaysia 523 635 63 + 0.2

Thailand(5)

78.5 4.37 3.98 0.13 0.26

"yanmar 4/ 2362 230 + 0.!

Vietnam 423/ 32 3+5 +36 0.02

7ao PD$ 4430 5,/ 53/* +3+6 0

Cambodia /63 /3+ 43/ +3 0

./.0Prathip Phantumvanit !"#$T

*+

"enta# Caries Stat$s in yr&o#d

6


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Severe 'ar#y Chi#dhood Caries(s'CC)

De)nition8

◦ $ampant caries in

primary dentitionespecially in theupper anterior teeth,

as ear#y as in

todd#ers andyo$n* chi#dren,

Prathip Phantumvanit !"#$T *+./.0 2


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7ess important due to e9pected e9:oliation o:primary teeth

!everity o: carious lesions due to non-earlydetection and care

Dental :ear in children due to sound and &ater

:rom aeroter drillin( machine ; in


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Overview

Prathip Phantumvanit !"#$T*+ ./.0 0


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Minimum instrument only hand instrument

Minimum procedure Partial caries removal; )lled &ith 'lass

ionomerMinimum pain no anesthetic in


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ART SMART,"eve#o/ment

ART SMART1987 2012(25 years later)

use only hand

instruments to removecaries

use hand instruments

but onlypartial cariesremoval

filled with self-cure

powder-liquid hand-

mixed glass ionomer

filled with self-cure

capsulated glass

ionomer

aimed at permanent

molar

aimed atprimary

dentition

target at primaryschool children target atpre-schoolchildrenPrathip Phantumvanit !"#$T

*+ ./.0 4


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!"#$T phone, !"#$T car, !"#$T TV, etc3 !"#$T preventive dental restoration –

!impli)ed "odi)ed #traumatic $estorative

Techni=ue Phantumvanit P 2012 IJOH

* main components o: !"#$T

◦ partial caries removal◦ capsulated (lass ionomer cement

Prathip Phantumvanit !"#$T*+

SMART /reventiverestoration

./.0 /


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Concept – hy !"#$T% hat !"#$T% Caries remova# 1ow c#ean



Overview

Prathip Phantumvanit !"#$T*+ ./.0 +


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'ven certain amo$nt of softened

and deminera#ied dentine can3e safe#y #eft $nder *#assionomer restorations, providedthe mar(in is completely sealed

around its :ull circum:erence3 Kidd et al 2004

1ow c#ean m$st a cavity 3e

3efore restoration

Prathip Phantumvanit !"#$T*+ ./.0


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Focus o: microbial spread starts to appear alon(the D>1, underminin( the enamel3

The 3acteria# /ro4#e act$a##y decreaseda#on* the "'3

hen the deminerali?ed enamel is removed

alon( the D>1, so$nd ename# is a//arent withno *a/ and no /resence of 3acteria f$rthero$t a#on* the "'3

Kidd !"# J$%&t$n'ehal * + ei,ht$n - 1993

Cario$s #esion at "&'

6$nction



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Remove the one of3acteria# invasionand destr$ction ofcario$s dentine withs/oon e7cavator

"a@e circ$#arscoo/in* movementfrom "' downwards

Protect the pulp at theAoor o: deep cavities

circularmotion

Action of cario$s dentineremova#



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. O$ter #ayer ofirreversi3#e denat$redand deminera#ised8infected dentine3

*-2 Combine to :orm the inner

layer o: reversi3#ydeminera#ised, aBecteddentine

6 Transparent layer o: cariousdentine

2 !ub-transparent layer o:carious dentine

Harder layer o: sounddentine

0 !o:ter layer o: sounddentine adnamel>D1 !ound

Dentin

e

Pulp

Banerjee et al. 2000;

To beremoved

Histolo(ic ?ones o: cariousdentine in an active, appro9imal

lesion

Prathip Phantumvanit !"#$T *+


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Pro*ression of occ#$sa# cario$s#esion(Thylstrup & Fejerskov, 196!

one o: bacterialinvasion and

destruction in:ecteddentineE

one o:deminerali?ation

aBected dentineE!clerotic ?onereminerali?ationE

$eactive dentine

reparative dentineE

./.0Prathip Phantumvanit !"#$T

*+

2

:


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;y /hysica##y removin* the hi*h#yinfected tiss$e itse#f ,

;y restrictin* the n$trient s$//#y tothe remainin* 3acteria in the dentine,

;y $sin* 3acteriostatic restorative

materia#s (e.*. *#ass ionomer cement)to inactivate the remainin* micro3es3

ane/ee !# at&$n T and Kidd !"# 2000

Cario$s /rocess in dentine can

3e arrested,



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Ten articles, si9 studies, three $CTs, one &ith a :ollo&-up to + years, provide evidence supportin( thepractice o: #eavin* 3ehind infected dentine3

Cario(enic bacteria, once iso#ated from theirso$rce of n$trition by a restoration o: sucientinte(rity, either remain dormant or die and thuspose no ris@ to the health o: the dentition3


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;acteria# co$nts consistent#y dec#inedwhen com/ared to the 3ase#ine

Red$ced n$m3er of 3acteria sea#ed inthe minima# intervention a//roach didnot interfere with restoration s$rviva#

;acteria were red$ced or e#iminated 3y

cavity sea#in*, bene)cial chan(es in thelesion environment, :avorable conditions :orthe healin( process in primary teeth

amie -* et al 2007

Micro3io#o*ica# as/ects of thedentine #esions 3y /artia#

caries remova#



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Partial caries removal in symptomless,primary or permanent teeth reduces theris@ o: pulp e9posure3 Go detriment to thepatient in terms o: pulpal symptoms3!tudies that not re-entered do not reportadverse conse=uences3

iette& -J# Kidd !"# Inne& + la&$n J 2006%ohrane

Meta&ana#ysis of /artia# caries

remova#

Prathip Phantumvanit !"#$T*+ ./.0 /


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ased on 602 screened articles, + studiesrepresentin( ,*5 patients &ere included3

"eta-analysis sho&ed ris@ reduction :or bothpulpal e9posure and pulpal symptoms :or

teeth treated &ith or * steps incompletee9carvation

ased on revie& studies, incomplete cariesremoval seems advanta(es to complete

e9carvation, especially in pro9imity to thepulp3

(*h:endi&e et al# 2013 J- 92; 30


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!tep&ise caries removal resulted in a 0 reductionin incidence o: pulp e9posure compared to completecaries removal, the mean incidence o: pulpe9posure &as 6235 in the complete caries removal

(roup and 32 in the step&ise (roups3

Partial caries removal reduced incidence o: pulpe9posure by 55 compared to complete cariesremoval, the mean incidence o: pulp e9posure &as

*3/ in the complete caries removal (roups and in the partial caries removal (roups3

O/erative caries mana*ement in ad$#ts andchi#dren (%ohrane 201'!



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Caries remova# Traditional Operative

Dentistry

Current Biological-

approached Cariology

eliminate softened

infected carious dentine,

demineralized dentineand sclerotic dentine

conservative (partial)

caries removalof

infected soft dentine, onlyat DEJ

apply some agent

(Ca(OH)2) to protect pulp

defense mechanism of

pulp as reparative

dentine

extend removal of

(overhang) enamel and

dentine as cavityrearation for

conservation of enamel

and dentine for adhesive

restorative and preventivematerialPrathip Phantumvanit !"#$T

*+ ./.0 **


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=#ass ionomer -hich materia# Practicability – here settin(% hen

!"#$T% Procedure – Ho& !"#$T%

#cceptability – ho bene)t%

Overview

Prathip Phantumvanit !"#$T*+ ./.0 *6


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Strontium Fluoro Alumino Silicate glass

+ polyacrylic acid

Sr-Al-Ca-polyacrylate chain K F-

(powder) (liquid) (matrix) (release)

chemical bond &ithdentin and enamel

e9chan(e

reminerali?ation

Chemical reaction of Glass ionomer


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3 riva sel: cure,HV

*3 riva silver63 riva li(ht cure

23 riva lutin(

3riva lutin( plus03 riva protect

S"< *#ass

ionomers

Prathip Phantumvanit !"#$T *+./.0 *0


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3 sel: cure Fu9traE

*3 silver

63 li(ht cure Fu


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Polyacrylic acid displaces phosphate andcalcium ions :rom the tooth and ta@en upinto the 'I ad


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=#ass ionomer cement

'lass ionomer cements (ained popularitythrou(h their a3i#ity to 3ond direct#y toename# and dentine and theircontin$o$s @$oride re#eased3

Ge&er versions o: chemically curin( (lassionomers such as Fu


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>9cellent Auoride release onds to enamel, dentin ; metals 'reat mar(inal inte(rity F- rechar(eable Go :ree monomers Can bul@ )ll >9cellent biocompatibility $adiopa=ue

Advanta*es of conventiona# =#assionomer

Prathip Phantumvanit !"#$T*+ ./.0 6+


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=reat mar*ina# ada/tation

Nsel:-cure (lass ionomerbases &ere more eBective inreducin( microlea@a(e in

both the occlusal andpro9imal cavo sur:aces thana Ao&able resinO

Duon( T et al, Tu:ts University, Ge&

rleans I#D$ *++5, #btractQ+600Prathip Phantumvanit !"#$T *+./.0 6

Cario$s #esions at mar*ins


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Cario$s #esions at mar*insof restorations, systematic

review 'lass ionomer cement restored cavitiessho& less recurrent carious lesions oncavity mar(ins than cavities &ith amal(am

"ienaut&h et al u$ean J Paediati -ent 2009

'lass ionomer cement has a hi(her caries

preventive eBect than amal(am :or

restorations in permanent teeth, nodiBerent &as :ound in primary dentition3 "ienaut&h + =en,$al " e& $te& 2011# 4;58

Prathip Phantumvanit !"#$T*+ ./.0 6*


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Com/arative /ro/erties ofrestorative materia#s

Materia#s Tensi#estren*th(MPa)

Com/ressivestren*th(MPa)

#e7$ra#stren*th(MPa)

#mal(am 2-0 6+-*+ +-+

Compositeresin

6-0+ *+-24+ ++-2

'lass ionomerHi(h

stren(thE

2-*6 dayE *2+-*0 5daysE

*-6 dayE

Dentine 65-* *4-624 *05

>namel + *5+-22+ na



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0

20

40

60

80

100

120

1 10 100

Immersed time / day

V i c k e r s

h a r d n

e s s

n u m

b e

"aturation in saliva

Physical properties

!aliva has theremar@able eBect o:increasin( sur:ace

hardness o: Fu


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!tudy by8

"cIntyre 1" et al, Ion e9chan(e bet&een $iva

!el: Cure 'IC and deminerali?ed dentine, Uni

#delaide, risbane I#D$ *++0

Proven ionice7chan*e



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#$oride re#ease



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Fluorie release )rom *lass+onomer

Fluoride Internal to cavity &all acteriostatic $eminerali?ation

>9ternal to the oralenvironment $eleased into tooth

tissues and saliva 'I restorations and

sealants ta@e upAuoride rechar(eE


#


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=#ass


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Ca/s$#ated *#ass ionomer

Prathip Phantumvanit !"#$T*+ ./.0 6/


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or@in( time

or@in( time

aitin( Time

be:ore )nishin(

aitin( Time

be:ore )nishin(

+ 0+ ,*+ ,4+DsecE

0 secfaster

X!"# %ast settin& ti'e

Final )nishin( can start a:ter


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$e(ular ; :ast settin(capsules

$e(ular settin(po&der.li=uid

Settin* times



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Re*$#ar set

"i9in( time8 0 secor@in( time8 min :0 sec

Initial settin( time8 : min 0

secFinal )nishin( time8 min

Ca/s$#e worBin* times

Prathip Phantumvanit !"#$T *+./.0 2*


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$iva !C8 0.5

mFu


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# -yr evaluation o: the success rate o: l I+ II e&t$ati$n& $> the ima% m$la&e&t$ed :ith hih-visosity *+ :a& 94? Silma? S et al *++0E

#:ter yr, the overall &uvival e&t$ati$n&$> 6I :a& 95? >$ l I and 82? >$ l IIe&t$ati$n& @ impli)e, Moi/e #T orM#T (Ph$n,han%udh ! et al 2012 $m

-ent Health)

=< in /rimary teethrestorations


C#inica# and Micro3io#o*ica#


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C#inica# and Micro3io#o*ica#eva#$ation of caries remova#methods



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reD$encies of MSE;ETFC for cariesremova# 3efore and after 2 months

"' (nG2) ART (nG2) ;+R (nG2)CFU "!.7.TVC "!.7.TVC "!.7.TVC

e:ore #:ter *mo

e:ore #:ter* mo

e:ore #:ter* mo

GD +.*.+ *.*.+ +.6.+ *.*.+ +.6.+ /.*.+

+-++ +..+ +.+.+ +.6.+ +.+.+ +..+ 6.+.2

+-+++ .+.+ +.+.+ +.+.+ +.+.+ +.*.+ +.+.*

++-++++ .+.+ +.+. +.*.+ +.+.+ +.6.+ +.+.2

+++-+++++ +.. +.+. ..+ +.+.* *.*.+ +.+.+

+++++ +.2. +.+.+ 5.6.* +.+.+ +..* +.+.*

P$n,han%uth !# *$n,ai&an = + Phantumvanit P#Prathip Phantumvanit !"#$T

*+ ./.0 20

C$m$#ative s$rviva# rates (%) for C#ass


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C$m$#ative s$rviva# rates (%) for C#ass< H


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Caries chan*es in cariesremova# methods8 after 2

monthsCariesremova#

% Caries/ro*ressio

n

% Cariesre*ression

%+nchan*ed

caries

>D1n45 *36 5302 4+3++

#$Tn/+

*326 53+5 4+324

U$n /0

*364 2350 /*34

P$n,han%uth !# *$n,ai&an = + Phantumvanit P# 2009


Radio*ra/hic chan*es after


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Radio*ra/hic chan*es after2 mo

Carious lesionbe:ore restoration

#:ter restoration

&ith >D1 cariesremoval sho&edcaries re(ression

Prathip Phantumvanit !"#$T *+./.0 2/


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!"#$T% Procedure – Ho& !"#$T%

#cceptability – ho bene)t%

Overview

SMART-Malaysia 0415 Part 1

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Transcript of SMART-Malaysia 0415 Part 1