India is a colorful world of remarkable diversity and
extremes. Nowhere is this more apparent than in the distribution of wealth and
accessibility to health care.
I am so happy! Today, I treated the son and daughter of
the man who refuels my car at my local petrol pump station. When I saw him
recently, I asked him how his children were. “They complain of aches in their
teeth,” he said, and I asked him to bring them over to my clinic.
Mehak, age 9, and her brother Abdul, age 6, live with
their parents in a slum behind the petrol station. Children in this
socio-economic class receive little or no dental care in India, and over the
years I have provided free treatment to many underprivileged children living in
my town. I feel a noble quaking in my core after each treatment. Parents
see their happy children and shower me with gratitude, but I insist that I am
simply doing good work, and I like doing it.
Case 1 Mehak complained of pain when eating, and clinical evaluation revealed extensive decay on her lower left E (Fig. 1). After caries removal with a round bur and hand excavator, without pulpal exposure, the cavity was cleaned, and Etch-Rite 38% phosphoric acid etch gel was placed for 15 seconds and rinsed well (Figure 2). A thin layer of ACTIVA BioACTIVE-RESTORATIVE (Pulpdent USA) was placed as an insulating layer, massaged for 20 seconds, and light cured (Figure 3). The cavity was bulk filled with ACTIVA without the use of a bonding agent and allowed to self-cure for 40 seconds before light curing for 20 seconds. The self-cure time reduces polymerization stresses while the light provides a more complete cure of dual cure resin materials. The restoration was contoured, finished and polished (Figure 4), and Mehak was all smiles (Fig. 5). She was ready to come back for her next appointment when her abscessed lower right E would be treated.
Fig. 1. shows extensive decay of #75, lower left E, on 9-year-old patient. The pulp is not exposed.
Fig. 2. After caries removal on lower left E, the tooth was thoroughly cleaned, isolated, and etched for 15 seconds with Etch-Rite (Pulpdent USA).
Fig. 3. ACTIVA Restorative A3 shade was placed as a thin insulating layer, massaged 20 seconds and light cured. Restoration was then bulk filled with ACTIVA, allowing material to self-cure 40 seconds before light curing. No adhesive was used in this case.
Fig. 4. Checked occlusion, contoured, finished and polished.
Fig. 5. A happy nine-year old, eager to come back for her next appointment after a pain-free visit to the dentist.
Case 2 Six-year-old Abdul also suffers from discomfort and needs considerable dental work. On this visit, I restored his upper right D, #54, which was decayed but without pulpal involvement (Fig. 6). The decay was removed with a round bur and a tapered fissure bur, and a bevel was placed on the occlusal margin. The prepped tooth was cleaned and isolated. Etch-Rite was applied for 15 seconds and thoroughly rinsed, followed by hi-vacuum suction and blotting with cotton pellets. This leaves the tooth lightly dried but not desiccated. After placing a sectional matrix, Activa A2 shade was placed, allowed to self-cure for 40 seconds, and then light cured for 20 seconds. Occlusion was checked, and the restoration was contoured, finished and polished. Abdul will also need restorations on 51, 52, 61 and 62, and we have scheduled follow-up appointments for those treatments.
Fig. 6. Tooth #54, upper right D, is decayed, but there is no pulpal involvement.
Fig. 7. Decay was removed using a round bur and a tapered fissure bur. A fine bevel was placed on the occlusal margin. The tooth was etched, rinsed, and lightly dried wiht high-vacuum and cotton pellets, but not desiccated.
Fig. 8. Shows sectional matrix and placement of ACTIVA A2 shade. After 40-second self-cure, light cure for 20 seconds.
Fig. 9. The bite was checked, anatomy was contoured, and the restoration was finished and polished.
Fig. 10. A happy 6-year-old with his dentist.
Both Mehak and Abdul were given proper brushing instructions and taught how to best maintain their oral hygiene. Providing this education to both the children and their parents is imperative for their future oral health. I could see the glee on the children’s faces as they checked their teeth, felt no pain, and said “Thank you so much!” Their father was moving his hand to the wallet in his shirt pocket, but I stopped him. “There is no need,” I said, I am just happy to help you and your children. Ask them to take care, and may the Great One watch over you!”
About Dr. Rumpa Wig Dr. Rumpa Wig is a graduate from Govt. College of Dentistry, Indore. She has completed PG (Certification) in Aesthetic Dentistry from New York University, USA. She is the Vice-President on the Board of Indian Academy of Aesthetic and Cosmetic Dentistry (IAACD). As the Key Opinion Leader for some of the leading international companies, for India and ASEAN countries, she has delivered over 280 lectures, and workshops, internationally and nationally on topics in Aesthetic Dentistry. Her comprehensive hands-on courses are widely sought out and highly appreciated. She has many articles in various journals to her credit. She maintains a private practice in Bhopal, and focuses mainly on Aesthetic, Restorative, Adhesive and Minimally-invasive dentistry.
Poor oral health and limited access to care are the daily reality in the communities of El Rama, Muelle de los Bueyes, Bluefields and Kukra Hill in Nicaragua. California-based pediatrician Dr. Gina Johnson has participated in five mission trips to these communities under the auspices of International Ministries. On her most recent trip, Dr. Johnson brought 800 applications of Embrace Fluoride Varnish donated by Pulpdent.
The communities served by International Ministries suffer from severe dental caries, poor nutrition and a variety of other health concerns. Access to healthcare is extremely limited and community members travel for miles on foot and motorized bicycle to receive primary care, wellness exams, dental screenings and fluoride varnish treatments from Dr. Johnson and her team of clinicians. Community members were very receptive to receiving varnish treatment and expressed that Embrace had a much more pleasant taste than other varnishes they had used in the past.
The purpose of these mission trips is to educate community members about systemic health. Dr. Johnson addresses the root causes of disease and illness, and explains the connection between oral healthcare, good hygiene and overall health.
Carious lesions appear most frequently in the pits and fissures of molars and premolars. The dental plaque inside pits and fissures cannot be removed through conventional cleaning techniques used in dental offices or through home care. The morphology of the fissure makes it difficult to diagnose the initial lesion, and surface decay may only become evident when the carious lesion has profoundly progressed beyond the amelodentinal limit.
In the past, clinicians used the “extension for prevention” approach to treat caries in pits and fissures. Thanks to new restorative techniques and bioactive materials, dentists can use minimally invasive approaches for more conservative cavity preparations, such as Preventive Resin Restorations (PRR). PRRs were first described by Simonsen and Stallard in 1977. Now PRRs can be performed with ionic composite resins, which restore the lesions in pits and fissures and help prevent recurrent caries in the rest of the fissure system.
Diagnosis of PRR The clinical diagnosis for PRRs has three primary elements:
Assessment of the patient’s caries risk Document the patient’s medical history and perform testing as necessary to determine caries risk.
Diagnosis of lesion depth Diagnose enamel lesions and not only cavitated lesions. This is important as the progression of the enamel lesion can be arrested.
Diagnosis of lesion activity Both the activity of the lesion and the risk of caries are very important for diagnosis and treatment planning.
Indications for PRR PRR can be performed on the occlusal surfaces of molars and premolars, buccal fossa of lower molars, and palatal sulcus of upper molars. They are indicated in both temporary and permanent dentition. A PRR is indicated when the carious lesion in the pits and fissures is small and discrete and confined only to the enamel, or when the process has reached the dentin, but without pulpal involvement.
Technique
The methods described above have evolved simultaneously with dental materials
and dentin adhesives. The PRR technique involves removing a minimal amount of
dental tissue with an air abrasion system with a 29-micron aluminum dioxide
powder. Caries removal may not reach the amelodentinal limit and may remain
confined to the superficial dentin. In both cases, selective etching should be
performed only on the enamel, followed by the application of a bonding agent.
Subsequently, a dual-cure bioactive ionic resin
(Activa Restorative Pulpdent) is applied and, after completing an initial 20-30
second self-curing phase, is covered with an oxygen inhibitor and light-cured.
If the cavity is deeper, the clinician could use the sandwich technique, which
consists of placing a fluid bioactive liner on the floor of the cavity (Activa
Base/Liner Pulpdent) and then proceeding with the restorative material.
Case Study A 15-year-old male patient presented with occlusal lesions on teeth #3.6 and #3.7 (#18 and 19) as shown in Figures 1 and 2. He was anesthetized and a rubber dam was placed. Anesthesia and absolute isolation with rubber dam are optional, depending on patient comfort and acceptance. The occlusal surface was cleaned with soft sandblasting, and caries was selectively removed with a small polymeric round bur in a conservative manner without cavity design (Figures 3 and 4). The cavo-surface angle was polished with an abrasive point to eliminate unsupported prisms. Areas of exposed dentin were covered with Teflon tape before selective etching enamel with a 37% orthophosphoric acid gel for 30 seconds. The surface was rinsed with water for 10-20 seconds and dried until it became chalky in color before applying a bonding agent. This was followed by placement of the bioactive resin (ACTIVA BioACTIVE-RESTORATIVE). For best results, allow the resin to self-cure for 20-30 seconds, cover with an air-block gel, and then light cure for 20 seconds on the low intensity setting. After removing the rubber dam, excess material was removed and the occlusion was checked.
Figure 1. Shows occlusal lesions on teeth #3.6 and #3.7 (#18 and 19).
Figure 2. Shows occlusal lesions on teeth #3.6 and #3.7 (#18 and 19).
Figure 3. Caries was selectively removed with a small polymeric round bur in a conservative manner without cavity design.
Figure 4. Shows prepared teeth after selective caries removal.
Figure 5. Final restoration.
Figure 6. Final restoration.
About Dr. Corrado Caporossi
Dr. Corrado Caporossi received his degree in Dentistry and Dental Prosthetics at the European University of Madrid in Valencia, Spain where he completed a thesis on “Functional aesthetic rehabilitation in the anterior field with feldaspar ceramic veneers.” He is currently registered with the Order of Physicians and Dentists of Rome and is a member of AIO and ANDI. Dr. Caporossi is also an external professor at the Cardneal Herrera University of Valencia (Es.) and in the master courses of the University of Bari Aldo Moro. He carries out his professional activity in Labico (Rm) in his own dental microscopy center with a particular focus on partial aesthetic rehabilitions. Dr. Caparossi is a speaker at numerous national and international universities where he gives courses of advancement, and at national and international congresses where he discusses aesthetic reconstructive adhesive dentistry with the use of bioactive materials. He provides practical theoretical courses for training in and improvement of multidisciplinary restorative dentistry.
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Mooney J. Tratamiento de lesiones incipientes: operatoria dental mínimamente
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diagnosing, monitoring and logical treatment of occlusal caries in relation to
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234-232.
Crawford PJ . Sealant restorations
(preventive resin restorations). An addition to the NHS armamentarium. Br Dent
J 1988; 165:250-253.
Ekstrand KR, Ricketts DN, Kidd EA, Qvist V, SchouS. Detection,
diagnosing, monitoring and logical treatment of occlusal caries in relation to
lesion activity and severity: an in vivo examination with histological
validation. Caries Res 1998;32: 247-54
Llodra JC, Baca P, Bravo M. Selladores de fisuras. En: Bascones Martínez A.
Tratado de Odontología. Tomo II. Madrid. Smithkline Beecham S A; 1998: 2249-57
Nyvad B, Machiulskiene V, Baelum V. Reliability of a new caries
diagnostic system differentiating between active and inactive caries lesions.
Caries Res 1999; 33: 252-60
Paterson RC, Watts A, Saunders WP, Pitts NB. Modern concepts in the
diagnosis and treatment of fissure caries. Chicago: Quintessence Publishing Co;
1991
Ripa LW, Wolff MS. Preventive resin restorations: indications,
technique, and success. Quintessence Int 1992; 23:307-315. Swift EJJ.
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The private Facebook group is a forum for dental hygiene professionals from all over the world to share their experiences, learn about advances in dental materials, and provide feedback to Pulpdent Corporation.
Pulpdent has launched
a new continuing education (CE) podcast on bioactive and biomimetic dental
materials. Hosted by Viva Learning’s DentalTalk, the four-part series provides
1 CEU and is available on iTunes and Stitcher.
In the fourth and final podcast, host Dr. Phil Klein
interviews Larry Clark about the challenges and opportunities associated with
bioactive and biomimetic dental materials. The podcast covers clinical
techniques, relevant scientific research, and future developments in bioactive
and biomimetic materials.
Pulpdent has launched
a new continuing education (CE) podcast on bioactive and biomimetic dental
materials. Hosted by Viva Learning’s DentalTalk, the four-part series provides
1 CEU and is available on iTunes and Stitcher.
Patients are curious about the materials dentists use in
their mouths and want to learn more about different treatment options. In this
episode Larry Clark and Dr. Phil Klein discuss how the dental industry can
engage patients in conversations about bioactivity and biomimicry.
