cons sheet # 10 - Halah Obaidat

Bio medical approach in restorative dentistry modern dentistry practice

• Bio-mimetic: biology + mimics ,Simulate similar to nature
--Mexican in the 21 century shot his tooth off to get rid of the pain (not bio mimitic) so removal of teeth in the past was the solution
-- today if you have carries ,your tooth hurts you get a filling old dental techniques :small filling to larger to larger to endo to removal
Reasons for re-doing a filling : is either the return of carries ,deterioration of the filling, Remove the filling of another doctor ;Not good in your opinion.
• Factors (that affect the success of the restoration) which we can’t control:
1- moister
2- Thermal fluctuation the normal range from -4 to 55
3- Occlusal forces might affect the restoration
• If we are simulating nature we should : Restore harmonious purposeful functions
Functionality of teeth:
Central :incise food canine: sheer food Molars :chew, grind
The nature defined those functions and we want to restore it (mimic it)

• Amalgam is Not a bio-mimetic approach, if we want a bio-mimetic approach we use adhesive dentistry it restores the biomechanics, structures, esthetics of the tooth if the tooth is normal leave it as it is but if it needs to be restored we do it by composite or porcelain ‘’adhesive technology’’
Adhesive technology , minimal invasive is close to biomimitic approach (comparable to it)
(like in surgery laparoscopy for kidney stone minimal invasive procedure, in the past morbidity not form the stone itself but from the surgery because they opened the abdomen )if we want to mimic nature we should not play with it a lot, we restore not create things (play in the safe margin),

• Minimally invasive dentistry :
1- identify the risk
2- prevent destruction

• amalgam:
(Today we have what is called ‘’Bonded amalgam fissure sealant tooth)
-Biomaterial view of amalgam is fine, bio-mimetic approach it’s not good
-in minimally invasive approach we must identify the risks :
1- toxicity of the material :Amalgam is thought to be toxic, might cause autism , SLE
2- non conservative cavity which increase risks of pulp exposure :

cavity design for amalgam:
resistance : depth 1.5 if less there is no resistance Retention :by tilted walls
if I have Caries with depth less than 1.5 and I’m making an amalgam restoration I must reach a depth of 1.5 therefore I’m doing excessive cutting therefore I’m not mimicking nature
-if we have Secondary carries a 0.6mm increase in the cavity each time we remove the amalgam and replace it
-10-15 year is the life span of amalgam ,8-10 years amalgam life span for type 2 cavity preparation
So if it made an amalgam restoration for a 10 year old patient, at 20 then at 30 we must redo it again then at 40. we might need root canal or extra coronal restoration . cost amalgam 15, 20, 50 JD ,EXTRA coronal for crown 150, 350 JD
Cost is much more so try to minimally invade and prevent destruction
• Analysis for the teeth :
MOD : ‘’class II’’ the structure durability will decrease to half if we do an MOD cavity (chance of breakage increase by 2)
It not just the toot structure we lose by manipulation ,tooth loss by breakage also increases
 Minimally invasive dentistry :
1- early detection (very small lesion saving tooth structure) 2- minimal surgical invasion , 3- repairing defective restoration rather than replacing the defective restoration
Those are the levels/the platforms of biomemetic approach (minimum invasive dentistry )

-early detection of carries by radiographs ,the probe shouldn’t be used will destroy (incipient carries) subsurface carries and will cause a cavity ‘’not a minimal surgical invasion’’
-Minimal surgical invasion : carbide burs 0.8 is their diameter if a cavity is less than 0 .8 we are doing excessive cutting
-If a breakage in amalgam we must redo it they say(remove old amalgam and apply new amalgam) but that is not true (amalgam doesn’t bond to amalgam is debatable I use something else called Bonded porcelain bonding ) .
• yes the efficiency does increase if we remove the whole crown to do a full crown restoration or implantation but that is not minimally invasive
• Minimally invasive requires that we detect the carries before it reaches the x-ray phase if carries detected by probe we exceed the preventive phase (the re-mineralization phase)
-Method of early re mineralization :electroic phase monitor ?(not quite sure about the name sorry!)
-Conventional radiography is by BItwins digital enhancement and subtraction radiology
Digital enhancement : differentiates between Tooth structure that is affected by carries and the normal one (to know how much should we remove)
Subtraction radiology : Is there carries under the actual restoration, repair or replacement

-Modern dentistry : minimum procedures , minimum invasion
--GB black he’s the father of classical dentistry
--Bomafood ?? The father of Modern dentistry (founder of acid itch, composite)

-Picture: if we make a cavity for amalgam then a lot of dentinal tubules and enamel prisms are lost‘’ not minimally invasive‘’
-60% of all dental procedures are a failure, mostly from secondary carries
• Minimally invasive technique :
1- preventive phase: ** diet control ,diet analysis :mostly done for children (they eat lots of sweets) We ask about coffee It causes discoloration, Pepsi it causes acid itch ,demineralization, erosion Smoking it causes stains ,xerostomia ,periodontal disease ‘’smoking is a risk factor’’ ,total tooth mortality ,tumors are the end stage of smoking,
** fissure sealant to cover the fissures
2- Carries :
**preventive resin restoration: composite low filled like fissure sealant **Composite
**glass ionomer
**Amalgam
-If we are mimicking nature we should know our dimension,,
-a Medical approach also means minimally invasive dentistry
-Paradigm shift: if you follow the same road as the others you’ll have the same results but if you choose a different road its more risky but you might have more benefit(revolutionary science, a change in the basic assumptions within the science. It is in contrast to the idea of normal science. wikipedia)
-Extension for prevention BLACK’s concept ,but now we do prevention from extension not really that famous but we hope in the future it will be
In conservative dentistry there are burs which basically can be used for everything not anymore for each cavity there is a specific bur
• Class II (in normal bitewings x-rays ,inter proximally under the contact point) the marginal ridge not involved but in the classical procedure we need to break it not minimally invasive therefore we use :
1- a tunnel instead from the Occlusal surface into the box without breaking the ridge
2- spot preparation only Occlusal approach don’t reach the contact if contact is easy (not sure what the Dr. meant by that OO)
If you want to mimic nature, don’t not play around much whatever is normal keep it don’t remove it
• Most difficult tooth to restore is the canine ,,so we try to stay away from the canine ,nature gave it a large size and the largest root no way to lose it by carries or periodontal disease so I don’t mess with it

--Life span of composite is less than amalgam yes but that doesn’t justify using amalgam that need sacrificing tooth structure
• Ryge criteria: criteria for repairing or replacing restoration
Category : ALFA, BRAVO, CHARLIE, DELTA
Any restoration I don’t judge it according to what I see ,I use ryge’s criteria (a subjective way)
ALFA : restoration is protected and protecting the tooth structure
BRAVO: If little problems can be changed by little repair
Charlie: unacceptable restoration but can be repaired; composite discoloration only remove outer layer no involvement of the tooth
DELTA: remove the whole restoration

• Things to do instead of the cutting :
People mostly fear the anesthesia and the cutting(the sound as well)
If the dentist doesn’t give sufficient anesthesia everything is fine until the cutting starts the vibration causes the major pain to appear,
burs remove the tooth structure in a very invasive way so we use something else called air abrasion only removes the superficial layer of the tooth by using a machine that has aluminum Al2 or Al3 to remove staining or carries
or we use laser for cavities
dental adhesion: (Dr. showed us a picture that he has done a composite restoration on it) if I don’t want the restoration to have macro mechanical resistance and retention form ,I want it to have either micromechanically or chemo mechanical retention and resistance I use composite so we can just remove the carries without the need for a basic cavity shape ,might need replacement in 5 years but that’s fine because if I were to use an amalgam restoration I might of needed an endo treatment

heircamp ?? technology
for all teeth I do laminate veneers instead of the classical crowns which we remove 60 -70% of the crown (over destruction) while in laminate veneers we only remove 12% so it’s a minimally invasive procedure

--Dentine bonding agents, dentine adhesion


Halah Obeidat Dr. rabab3a ,before lama al sayed’s sheet GOOD LUCK with the finales :)