Methods of remineralizing therapy.

Date: 2015-10-07; view: 394.

The enamel surface of the permanent tooth must be cleaned from the dental plaque and dried.

We apply a gauze band, soaked in the remineralizing solution, onto the changed enamel.

Every 5 minutes we change the bands with the new ones. The duration of the procedure is 15-20 minutes.

The course of remineralizing therapy consists of 15-20 visits, which are performed every day or every second day.

Remineralizing solutions don't have prolonged action on the enamel surface, this is why we should use the fluorine- containing varnishes, which are preserved on the tooth enamel surface for a long time, and cause continuous emission of fluorine from the varnish into the enamel. We may use such varnishes: Duraphat (Colgate), Bifluorid 12 (VOCO), Fluor Protector (Vivadent), Fluoridin (VOCO), Belak F (ВладМиВа, Russia), Ftorlak (Russia). The methods of application are processing well cleaned and dried dental surface with the fluorine- containing varnish ( with the subsequent recommendations not to eat and drink during the next 2 hours and not to clean teeth in the next 12 hours). To achieve enamel remineralization in acute initial forms of caries we may apply method of deep enamel fluoridation, which provides for two-phase impregnation of the enamel with fluorine medications which contain copper. This is why we use medication “ Enamel- sealing liquid” ( Germany).

Indications for deep fluoridation in the permanent teeth:

Acute initial and acute superficial caries in the permanent teeth on the stage of maturation or stabilization.

Preventive processing of the fissures and other caries-susceptible areas in the permanent teeth.

Methods.

The cleaned from the dental plaque and dried enamel is at first processed with the solution # 1 which contains salts of magnesium, copper-fluorine and silicate complexes. This provides for formation of the fluorine-silicate complex in the enamel interstices (SiF6)2. In a minute the surface is dried with air.

Then the enamel is processed with solution # 2 (alkaline suspension of fine-grained calcium hydroxide). As a result, the complex (SiF6)2 is broken down and forms crystals of CaF2 and MgF 2, hydrofluorine copper. their sizes are very little (50ang), this is why they may penetrate into the enamel interstices and excrete the fluorine ions for a long time, which provides for effective remineralization. The course of treatment is performed in three visits. The effectiveness of remineralizing therapy is determined by disappearing or decreasing in size demineralization focus.

Treatment of superficial and middle caries of the permanent teeth.

Treatment of superficial and middle caries of the permanent teeth in children depends on the period of tooth development, depth of affection and process localization. The areas of the superficial caries on the vestibular surfaces are prepared within the enamel and sealed with composites, compomers and glass-ionomer cements. At treatment of the fissure superficial and middle caries we should use the method of preventive sealing, offered in the 80-90^th years of the 20^th century. The method of preventive sealing stipulates for the minimum preparation of dental tissues only in the area of carious affection with the subsequent sealing. After this all the fissures of chewing surface are covered with a sealing material. So the preventive sealing combines operative treatment of caries, filling of the fissure, preventive sealing of fissures (invasive and non-invasive) and local fluoridation of dental enamel.

At localization of superficial caries on approximal surfaces of the permanent teeth we recommend processing the affected surface with fluorine-containing varnish or method of deep fluoridation. At progressing approximal caries we recommend preventive tunnel sealing of the cavity or classical preparation and formation of the carious cavity of the 2^nd class.

Treatment of acute middle and deep caries in permanent teeth.

For treatment we use the operative method which is presented with preparation with extraction of softened dentine from the walls and floor of the carious cavity with the subsequent formation and sealing it by appropriate sealing material. The treatment of acute middle and deep caries at the root maturation stage consists of the following stages: anesthesia, preparation of the carious cavity, antiseptic processing of the carious cavity, application of healing layer, application of isolating layer, permanent sealing.

For antiseptic processing we use the medications which are of wide spectrum of antibacterial action, but don't have cytotoxic action onto the pulp cells. these are ь 0,02%solution of furacillin, 0,5% solution of etonium, 0,2% solution of mephemin of sodium salt, 2% solution of gramicidin. After the antiseptic processing of the carious cavity we should put onto its floor the healing layer with odonthotropic actionusually we use medications with calcium hydroxide: Dycal, Life, Calcimol, Calcipulpe- chemically-cured and light- cured pastes: Cavalite LC, Calcimol, Prisma LC. the action of odonthotropic pastes is based on stimulation of dental pulp protective properties, which are manifested by the formation of reparative dentine. Also calcium hydroxide has anti-inflammatory action because of neutralization of acid medium. The high concentration of hydroxyl ions provides for bactericidal action. Zinc- eugenol paste also has odonthotropic actionIn case of considerable dentine softening on walls and floor of the carious cavity after preparation it must be filled with zinc-oxide-eugenol paste (temporary seling). It is changed in 3-6 months with the further permanent sealing.

Also it is worth using the glass-ionomer cements as an isolating layer, especially in the teeth with immature roots.

At sealing of large cavities (especially in the molars) we should use the sandwich- technique of sealing. It stipulates for application of various materials: g;ass-ionomer cements and photopolymer composite materials.

The layer from the glass-ionomer cement must be thick enough, but be located less than 1.5 mm from the cavity margin. Thos provides for tough combination of the composite sealing with the hard dental tissues, and this guarantees good polymerization of a photopolymer through all its depth. The excretion of fluorine by glass-ionomers reduces the risk of secondary caries development.

Sealing of carious cavities in the permanent teeth.

At sealing of the carious cavities in the permanent teeth we use modern sealing materials: glass-ionomer cements, composite materials which are chemically- and light-cured, amalgams. the choice of sealing material depends on the child's behavior in the stomatological chair, stage of tooth development, depth and localization of carious affection and group of the tooth.