Lecture 16 Resin Infiltration (copy)

primary goal in treatment

minimally invasive

aerosol producing procedures

COVID-19 Transmission: Aerosol

Droplets

what generates aerosol?

handpiece

• need H2O irrigation to not burn tooth

• can have harmful viruses

what factors come together to contribute to caries?

tooth, bacteria, diet, time

intrinsic factors of caries

Antibacterial agents

Dental Sealants

Fluoride

Chewing gum

Protein

Sugars

Ca2+ PO43-

Plaque pH

Microbial species

Saliva

extrinsic factors of caries

education

behavior

oral health literacy

attitudes

sociodemographic status

income

dental insurance coverage

knowledge

cariogenic challenge

The main metabolic pathway is conversion of sugar by glycolysis to pyruvic acid and then directly to lactic acid . Other acids, such as acetic acid or propionic acid are also produce

what acids are produced in sugar consumption?

lactic, acetic, propionic acid production, other acids demineralized of hydroxyapatite of enamel and dentin --> leads to drop in pH

cariogenic challenge: frequency and time

with 3 meals/day: long times of pH increasing to critical pH value, get remineralization

constant feeding; bacteria is not good; pH stays low for more time

lower recovery of salivary pH in healthy areas if constantly fed bacteria and keep pH low

non-cavitated lesions

non-invasive treatment

cavitated lesions

invasive treatment (resin infiltration, sealants, F-, flossing, brushing)

caries lesion: non-cavitated

• ICDAS 1-3 (maybe 4)

• inactive

- no plaque

- WS, shiny

--> no tx

• active

- sealant or SDF --> non-invasive tx

- daily flossing, fluoride --> non-invasive tx

- resin infiltration --> micro-invasive tx

SDF

silver diamine fluoride

turns tooth black; if pt is too anxious for tooth cleaning

used on broken lesions, ICDAS 5/6; can put on non-cavitated lesions to stop it

sealant

deep pits/fissures (makes deep fissure shallow so bacteria can't settle)

low viscosity resin, light cure

cavitated lesions

ICDAS 5/6, 4? --> depends on enamel breakdown

• SDF --> non invasive tx

- stops lesion when can't clean out teeth

• restorative tx --> invasive tx

what tx form is used with resin infiltration?

micro-invasive tx

radiolucent

permitting the passage of x-rays

i.e. caries, pulp

how do places with higher mineral content appear in an x-ray?

places with higher mineral content like enamel are more dense, more dark

radio-opaque

not transparent to X-rays or other forms of radiation

i.e. previous restorations

more dense areas due to previous restoration, metal

resin infiltration

caries' lactic acid demineralizes hydroxyapatite of tooth, weakens tooth

what can resin infiltration prevent?

prevents lactic acid from dissolving the caries, weakening the tooth

what is a disadvantage of MOD, Class II prep?

weakens tooth more than 70%

enamel demineralization

white even when wet

WS lesion

plaque accum. around contact point

WS can be ICDAS 2

areas of intact and pitted enamel

demineralization changes of hydroxyapatite content are happening underneath the surface

smooth surface becomes pitted in enamel

acid decalcified the enamel where pitted is rough instead of smooth, healthy

sealing of enamel demineralization

• sealing- resin composite material for tooth surface

• infiltration- goes into pores and fills whole lesion

enamel demineralization

•Sub-surface lesion under pseudo-intact surface layer

- need to remove pore access

- pitted but not cavitated surface of demineralized enamel

- see pitting, more mineral content bc salivary minerals are deposited here

•Increased pore volume (up 30%)

•Pores are diffusion path for microorganisms and substrate

•Light scattering causes white spot

where does the resin go into?

pores of lesion body

for enamel demineralization, where are more minerals found?

infact surface layer

lesion body

less minerals in lesion body, like a WS; light enters pores and remaining enamel, appears white

middle section, dark zone is the section on the right end

demineralized enamel

softer, only 10% of original enamel hardness

use probe (blunt) not sharp tools

resin infiltration of enamel demineralizations

•Removal of surface layer with acid --> access pores by removing surface layer, then fill/seal; questionable bc some think this causes the lesion to progress faster

•Pores are filled with resin

•Occlusion of diffusion paths

•Inhibition of lesion progression removing

•Stabilization of lesion

etching of caries lesions

thicker layer if older tooth

need to know thickness

use bur to remove minimal amount

can remove with bur but not always reliable; can damage adjacent tooth

etching of caries lesions - permanent enamel

HCl helps bc strong to remove tooth structure; etches away pseudo-layer completely

remove outer/pseudo-intact surface layer with phosphoric acid, 30s to etch tooth to corrode it before bonding composite

phosphoric acid is not strong enough to remove entire pseudo layer --> use with HCl

polyacrylic acid for 10s- remove smear tooth layer on enamel and dentin

HCl fcn in etching

removes pseudo-intact layer

etching of caries lesions - permanent enamel

2 min 37% H3PO4

2 min 15% HCl

phosphoric acid

use for 30s to etch tooth; corrodes it; not strong enough to remove entire pseudo layer; use with HCl; stronger than polyarcylic acid; demineralizes enamel, erosion, corrodes some tooth structure

polyacrylic acid

10 s; removes smear tooth layer on enamel and dentin

since phosphoric acid is not strong enough to remove entire pseudo layer, what should be used?

HCl

polyacrylic acid time

10 s

phosphoric acid time

30 s

HCl time

2 min 15% HCl

etching of caries lesions: primary enamel

thinner pseudo layer

30 s 37% H3PO4

30 s 15% HCl

2 min 37% H3PO4

2 min 15% HCl

infiltration of artificial lesions with adhesives

longer application, more it will penetrate material

longer application --> end up with lots of open area (30 s)

how long should HCl be used in etching

15% for 2 min

infiltration of natural lesions with adhesives

etch with HCl (15%, 2 min) to get resin into the lesion; does not fill completely

does 2 min H3PO4 penetrate the experimental teeth?

no penetration

what is the relationship between time and penetration of resin?

more time, more deep penetration

infiltration/penetration porous materials

time (more time, deeper penetration)

contact angle

surface tension

viscosity

radius (of pore; greater pore size, easier it goes in)

what is the relationship with CA, ST, and viscosity in runnier resins?

lower CA, lower ST, and lower viscosity

do higher or lower CA contribute more easy spread?

higher CA does not spread easily, lower CA spreads easily

improved resins for caries infiltration

want lower CA for material with lower ST, and lower viscosity

do high or low CA allow for optimal penetration into pores?

low CA

water

high ST, CA

flowable composite

high viscosity

high resin matrix

high CA

glycerin

high CA

thick

would using a high or low viscosity resin reach the bottom of the lesion?

low viscosity lesion

resin reached bottom of lesion, harden to make inhibition layer

inhibition of lesion progression

barrier made after light cure; hardens to get barrier

if have caries again on that surface, protons of acid will not be able to get through barrier, sealed off, pores closed, acid can't enter, lesion does not progress

caries inhibition with adhesives

if adhesive layer is thick/uniform enough, might prevent lesion formation

adhesive layer might stop lesion progression if thick enough

thin and porous layer causes lesion to progress

thin and porous layer causes lesion to progress

thin and porous layer causes lesion to progress

can stop lesion progression if penetrate pores with resin uniformly and deep enough

caries inhibition with improved resins

control- no resin lesion grows

adhesive- lesion grows

infiltrant- uniform filling of pores down to the bottom of lesion, no progression of lesion; infusing resin into pores can stop lesion

improved infiltration of natural caries lesion

↑ deep lesion, ↑ wider pores, ↑ deep resin can penetrate into it

application time- permanent teeth

penetration of resin into teeth needs 3-5 minutes

what is penetration of resin into teeth dependent of?

time and viscosity

how much time is needed for the resin to fill the teeth completely?

3-5 min

application frequency - effect on hardness: sound enamel

↑hardness ↓penetration, no indentation

application frequency - effect on hardness: demineralized

hardness is 10% of original value

indications for interproximal resin infiltration: preventive

fluoride therapy

indications for interproximal resin infiltration: micro-invasive

resin infiltation

E1- outer 1/2 of enamel

E2- inner 1/2 of enamel up to DEJ

D1- after DEJ into outer 1/3 of dentin

indications for interproximal resin infiltration: invasive

drilling, filling

D2

D3

cavitated on surface

resin infiltration of interproximal surface: DMG tips

low viscosity lesion

drying agent- desiccate lesion etching gel HCl

use interproximal tips

what two sources of absolute isolation is necessary for resin infiltration of interproximal surface?

RD and wedge (push teeth apart)

resin infiltration of interproximal surface applicator

applicator with pores on 1 side so only etch 1 side

tip, thin foil with perforations on 1 end

HCl and green dye so can see it

how long should HCl acid etching be for resin infiltration of interproximal surfaces?

120 s

how long should rinsing be after HCl acid etching for resin infiltration of interproximal surfaces?

≥30s to make sure all acid is gone between teeth

how long should drying be after HCl acid etching and rinsing for resin infiltration of interproximal surfaces?

30 s

what is used for drying in resin infiltration of interproximal surfaces?

100% ethanol

drying agent mix w/ water hydrophilic

has something

it will evap. take moisture from pores w/ it and dry it (dry the pores so resin can go into the pores instead of H2O)

how long should the resin be left for during resin infiltration of interproximal surfaces?

3-5 min

(will appear yellowish-runny)

TEGDMA infiltrant

monomer

has some ethanol and photoinitiators --> camphorquinone

(trigger polymerization rxn)

• accelerator 3º amine to make reaction faster

camphorquinone

activator when shine light on there that triggers polymerization rxn to start

accelerator 3º amine to make rxn faster

how long do you light cure the TEGDMA resin infiltrant?

40 s

what is vital to complete after curing the resin?

polish away the oxygen inhibited layer on resin surface

is resin infiltration successful in stopping lesion progression?

yes, lesions sealed with resin infiltrant do not progress; resin infiltration is effective in stopping lesion progression

resin infiltration of WS lesions

WS lesion due to braces

not cavitated lesion --> scarred after braces were removed

shiny --> inactive, lesion won't progress

masking WS lesions

clear resin to remove/mask lesion bc of change in optical properties

light goes into enamel --> hydroxyapatite crystals, rods

refractive index

optical properties of these materials

light bending from 1 medium to another

apatite RI

1.62

healthy enamel

these pores have light go through w/ minor deviation

Mircro-Porosities RI values for air and water

Air RI: 1.0

Water RI: 1.33

true or false

closer RI away from original material, means more bending, refraction, will happen

false

further RI away from original material, means more bending, refraction, will happen

what does demineralization do to pore size?

increases pore size bc of remineralziation; air and H2O inside

ICDAS 1

if you dry it, H2O from pores evaporate; more bending of light along lesions; light scatters at pore interface and is reflected back as white bc of difference in RI of what's in the pores compared to enamel

infiltrant RI

1.46

less bending bc higher RI than air or water, light can go through, WS lesion vanished

resin infiltration of WS lesions

Inhibition of WSL progression Reduction of WSL

Esthetic improvement

advantage of WS lesion

resin infiltration stops lesion progression and reduces size of WS

F- varnish

won't remove anything; remineralization alone won't remove WS

retraction cord function

pushes gum away from tooth/lesion

resin infiltration procedure

clean to remove plaque w/o anesthesia

cover gums with retraction cord, no RD because might cover cervical part of lesion

push retracted cord into gum

light cured barrier material protects gum tissue; runny composite

apply resin infiltrant for 2 min

etch whole tooth

spread acid on tooth with felt tip

rinse thoroughly to rinse away acid

drying agent

pores are open, lesion disappears a but, can repeat etching step if still there

might be used with microabrasion

polish composite, remove excess

remove gum barrier material

how long should the resin infiltrant be applied for?

2 min

DMG infiltrant

spreads out and goes into pores

low viscosity resin

WSL starts disappearing bc of match of RI between resin and enamel

how long should the resin infiltrant be light cured for?

40 s

home bleaching

works better than in-office bleaching bc at home is left for longer (6-8 hours at home vs. 20 min at a time in office which is not enough for the bleaching agent even though it is at higher concentration to go through resin and bleach teeth)

resin infiltration around brackets

pt needs ot have decent hygiene

do not do if poor hygiene

can do while braces are on