Study material

Date: 2015-10-07; view: 447.

Topicality.

Treatment of caries of the temporary teeth in children. The peculiarities of preparation and filling of the carious cavities, choice of filling materials. Silvering as a method of treatment of the temporary teeth' caries.

Control questions

1. What are the peculiarities of clinical development of acute forms of caries of the temporary teeth?

2. What are the peculiarities of clinical development of chronic forms of caries of the temporary teeth?

3. What is the clinical picture of acute moderate caries?

4. Name the peculiarities of clinical development of caries in children in the temporary teeth with immature roots.

5. What is the clinical picture of a chronic moderate caries?

The treatment of caries in the temporary teeth is a difficult problem. The well performed caries treatment determines the further development of the temporary tooth- a possibility of its retention for the whole physiological period in the oral cavity.

Aims:To master the skills of treatment of caries of the temporary teeth according to the development, depth of affection, cavity localization and a period of development of a tooth.

The treatment of caries of the temporary teeth is performed without sealing (non-operative methods) or by the way of preparation of the carious cavity and its sealing (operative method).

The choice of treatment method, medications and sealing material depend on the child's age, the period of her/his development and group of the temporary tooth, depth of affection, localization of a carious cavity, development of the pathological process ( acute or chronic) as well as intensity of caries affection.

The non-operative methods of caries treatment include a method of deep fluoridation and method of impregnation ( silver covering). They are applied at treatment of the primary caries forms in the temporary teeth in children.

The method of deep fluoridation was offered by A. Knappwost (Germany). Deep fluoridation is a chemical formation of a fine-grained calcium fluoride (the average diameter of particles is 50 A.U.) within the area of demineralized enamel. Deep fluoridation occurs as a result of the subsequent processing of the enamel with the solution №1( magnesium-fluoride silicate) and solution №2 (fine-grained suspension of calcium hydroxide). The substance formed is a fluoride-silicate complex which further spontaneously breaks down into the small crystals of calcium fluoride СаF2 and magnesium fluoride МgF2,as well as polymerized silicate acid which protects them from washout. The crystals of СаF2 and МgF2 during a continuous period of time ( for more than a year) excrete fluorine in the concentrations which cause remineralization of the affected areas.

Indications for deep fluoridation in the temporary teeth: acute initial and acute superficial caries in teeth on stages of maturation or stabilization, preventive processing of fissures and other caries- susceptible areas in the temporary teeth.

Method of deep fluoridation includes processing the teeth with an enamel-sealing medication ( Humanchemi, Germany). The enamel surface of the temporary tooth must be cleaned from the dental plaque and dried. Then we apply a liquid # 1 onto the prepared enamel. In 0,5-1 minutes we apply the liquid # 2 and keep it for a minute. The treatment course lasts for three visits.

The impregnation method of caries treatment is a non-operative method, aimed at stabilization of a carious process. The indications are: acute and chronic superficial caries of the temporary teeth on all development stages, circular caries of the temporary teeth, smooth caries of the temporary teeth, approximal caries of the frontal group of the temporary teeth on stages of stabilization and root resorption. Methods of treatment: We use a 4 % alcohol solution of silver nitrate with the subsequent restoration with a 4% solution of hydrochinon for precipitation of the non-soluble silver salts combined with a decalcified surface of the hard tissues. The silver nitrate in combination with organic compounds makes albuminates which form the protective film on the enamel or dentine' surface. Silver also has a bactericidal action stipulated for the denaturation of proteins of the bacterial cells. It penetrates through the dentine tubules into the depth up to 0.5mm, blocks them and favours the carious process stabilization.

Treatment of caries of the temporary teeth by preparation and sealing (operative method).

It is applied at the superficial, middle and deep caries of the temporary teeth, and it is expressed in the preparation and formation of a carious cavity and sealing it with appropriate sealing material. The preparation of a carious cavity may be implemented by using the high-speed and mechanic tips and burs of various sizes and configurations, chemical-mechanical way ( processing the carious dentine with a special gel and manual removal of softened dentine with special instruments or excavators), manual preparation with various kinds of excavators (ART-method).

The formation of a carious cavity is performed for the sealing material which it will be sealed with. At preparation of the carious cavity for sealing materials with low adhesive properties( amalgam, silico-phosphate cements) we must keep to the principles of preparation, developed by Black.

In case of sealing with the glass-ionomer cements, compomers and composites,- preparation and formation of a carious cavity is performed more carefully, removing only the dental tissues, which are affected with caries, till the unchanged dense dentine on the carious cavity walls.

Chemical-mechanical extraction of the carious dentine(Carisolv)

Chemical-mechanical removal of a carious dentine includes its chemical softening and the further careful excavation.

The Carisolv system includes a set of syringes with a special gel and special instruments for the manual extraction of the carious dentine from the cavity.

The pink gel is a mixture of amino-acids (glutamine acid, leicine, lisine), as well as sodium hypochlorite. The gel contains erythrosine. At application into the carious cavity of mixture of these substances there happens a reaction at which we observe formation of N- chlorinate- aminoacids. This substance combines with the collagen structures of the carious dentine and causes the collagen denaturation which provides for its easy extraction. The underlying healthy dentine isn't chemically ruined.

Method: The required amount of gel must be applied onto the object-plate just before the preparation. Then we put some gel into the carious cavity so as to fill it completely. In 30 seconds we should start extraction of a carious dentine from the walls of a carious cavity with the appropriate-shaped and -sized instrument( from the Carisolv set of special instruments). The gel is applied into the cavity a few times before all the carious dentine isn't removed. The dentine removal will be manifested by the retention of a rosy gel coloring in the carious cavity as well as its transparency. The preparation of a carious cavity with Carisolv system lasts usually for 5-15 min. and requires 0,2-1,0 ml of gel. In some cases the disclosure of a carious cavity is performed with the drilling engine . According to the results of investigation, application of Carisolv system in the temporary teeth is more effective than in the permanent ones because of lower degree of mineralization of the dentine.

The indications for chemical-mechanical removal of the carious dentine in the temporary teeth are: caries of the 1^st class by Black at presence of free access into a carious cavity, caries of the 5^th class by Black, secondary caries, deep caries, fear of stomatological intervention, especially in children after painful dental drilling, inadequate behavior of children who don't allow to perform traditional treatment, caries treatment in children with psycho-neurological disorders.

The formed dentine surface is heterogenous and well adhesively binds to the glass-ionomer cements and adhesive systems.

ART- method of treatment of caries of the temporary teeth.

ART- method (Atraumatic restorative treatment) stipulates for the manual preparation ( necroectomy) of a carious cavity with excavators of different size and the further sealing with glass-ionomer cement.

Sealing of carious cavities in the temporary teeth.

For sealing of carious cavities in the temporary teeth we use the modern sealing materials- glass-ionomer cements, compomers, composite materials, amalgam, in some cases- silicate-phosphate and zinc-phosphate cements. The choice of a sealing material depends on the child's age and her/his behavior during stomatological treatment, degree of the temporary tooth development, depth and localization of a carious lesion. To seal the temporary teeth we often use glass-ionomer cements, which is caused by their sufficient adhesion and ability to excrete fluorine for some time period.

Also with this aim we may use glass-ionomer cements with silver.

Treatment of acute deep caries in the temporary teeth.

The treatment of acute deep caries in the temporary teeth is possible on the stage of maturation and stabilization; it is performed in 1-2 dental visits. If during preparation there occurs pulp denudation, the further treatment must be performed by the scheme of pulpitis treatment. If after completion of preparation the floor of the carious cavity is relatively dense, it is necessary to perform the antiseptic processing of the carious cavity, dry it and apply the healing bandage onto its floor. Also for this we may use hardening calcium-hydroxide-containing pastes (cements) or zinc-oxide-eugenol cements. the treatment is terminated in the same visit by application of a permanent sealing from the glass-ionomer cement.

In case of considerable softening of the dentine on the walls and floor of a carious cavity after its preparation it is filled with zinc-oxide-eugenol paste (temporary sealing). During the second visit ( in 6- 8 weeks) the temporary sealing is completely removed, then we perform final preparation of the carious cavity and its permanent sealing.