Recent Methodology in Management of Non-carious Lesions

Presented to Dr. Mohammad Atef Ibrahim Ali

Presented by: Reem Barbeer Andreas Dagher Serena Dakik Sara Doughan Alaa Dokmak

Outline Management of discoloration Management of abfraction Management of erosion Management of fracture Management of attrition Management of abrasion Veneers in management of non-carious

lesions

Discoloration It is defined as the

deviation from the normal color of the tooth.

It can be either intrinsic or extrinsic.

It also can affect the gingiva.

The mode of management depends of the type:

Management of Intrinsic Discoloration1. Micro-abrasion: It’s a technique by which small amount of surface enamel

is removed. It is done by hydrochloric pumice technique or

phosphoric acid pumice technique.

Management of Intrinsic Discoloration:2- Chair side bleaching:

3- Night guard bleaching:

Application of hydrogen peroxide to the external surface of the tooth

Applying heat to activate the applicant

Application of carbamide peroxide gel in a special tray

Management of Extrinsic Discoloration1- Ultrasonic and sonic scaling: Power driven scalers that depends on quick

vibration with the combination of water flow. Advantage: increase the efficiency in the

removal of calculus.

Management of Extrinsic Discoloration2- Toothpastes containing titanium oxides: Recent tooth pastes contain titanium oxides that cover

the extrinsic stain.  Titanium dioxide is an intensely white pigment. It has a

high refractive index, which means it scatters light to create a very white product.

Gingival Discoloration The color of the gingival depends on several factors the

most important one is the pigments (mainly melanin). Hyper-pigmentation cause discoloration of the gingiva and it

can be caused hormonal, chemical, or physical factors. It an esthetic problem especially if it occur on facial aspect

of gingiva.

Management of Gingival Discoloration1. Laser irradiations: Used to ablate cells

containing and producing the melanin pigmentation.

The remnants of the ablated cells are removed by sterile gauze damped with saline.

Different lasers have been used for gingival depigmentation including: carbon dioxide , argon, diode, and others.

Management of Gingival Discoloration Advantages: Easy handling, homeostasis, and

decontamination and sterilization effects and it doesn’t require periodontal dressing.

Disadvantages: Expensive, require specialized equipment that are not commonly available.

Management of Gingival Discoloration2. Surgical procedures: It is a surgical removal of undesired pigmentation using

scalpels. Gingival epithelium is removed surgically along with the

layer of underlying connective tissue. The denuded connective tissue then heals by secondary

intention.

Abfraction Wedge shaped defect in cervical region of the

teeth caused by excessive forces in this area.

Management of abfraction1. Advanced types of GIC used for restoration: Fuji VII-EP (extra protection):

o Advanced by addition of 3% CPP-ACP (recaldent) o Releases calcium, phosphate, and fluoride that

increases protection against demineralization. o It has antibacterial effects.

Management of abfraction Riva Protect (SDI):

o Advanced by incorporation of FCA ( amorphous calcium phosphate).

o FCA: Absorbed easily by the

tooth since it is derived from the same material.

Supercharge the remineralization effect of GIC.

It adds calcium and phosphate to aid in protection.

Management of abfraction2. Finite elemental analysis: Deformation and stresses are generated when

loads are applied to structure, if excessive stresses exceeds elastic limit, failure may occur.

These stresses cant be directly measured and it is not easy to understand why and when a failure process initiate.

So, it is useful to use the application of engineering knowledge in dentistry which is the FEA.

Finite element method is a series of computational procedure used to calculate the stress in each element which performs a model solution.

Management of abfraction This analysis allows us to determine the stress resulting from

external force pressure, thermal changes and other factors. When the stress are well known quantitatively and qualitatively

proper restoration and prevention of abfraction can occur.

Erosion Erosion is the loss of tooth hard structure as a

result of a non-bacterial chemical reaction. This reaction is caused by acids that can be

extrinsic and intrinsic.

Management of erosion1. CO2 laser irradiation: It is a method used to increase enamel resistance to

demineralization and thus prevent effect of erosive acids. The absorption of CO2 lasers by enamel is associated with the

absorption of the phosphate mineral bands of the structure.

Management of erosion2. Proton pump inhibitors (PPLs): They suppresses stomach acid and treat conditions such

as acid reflux thus preventing erosion. Studies shows that are associated with dangerous side

effects that may be sometimes fatal. Prilosec is the most common type of these inhibitors.

Fracture loss of tooth structure that can occur as a

result of injury or trauma. Fractures can be:

o crown fractureso Enamel infractiono Enamel and dentin w/o pulp involvemento Enamel and dentin with pulp involvement

o root fractureso crown-root fractures

Enamel Enamel and dentin without pulp

Enamel and dentin with pulp

Root fracture Crown-root

fracture

Management of fracture:1. Fiber optics trans-illumination: Fiber optics optical fiber refers to flexible thin cylindrical

fibers of high optical quality glass or plastic. Can be used to diagnose enamel fractures particularly

incomplete cusp fracture before they reach their end stage.

Management of fracture:® The trans-illuminated

teeth can be documented by intraoral photography, using a two-handed technique by holding a trans-illumination device and an intraoral camera simultaneously, with the resulting images shared with the patient.

Attrition Attrition is a physiological loss of hard tooth

structure as a result of tooth to tooth contact with possible presence of abrasive medium.

These lesion are mostly located on incisal or occlusal surface but can also occur in proximal surface.  

Management of attrition:1. Sleepright slim comfort

night guard: It is designed specifically

for sufferers of teeth bruxism who have sensitive gums and small mouth.

Like the traditional night guards, it keeps our upper and lower teeth apart and prevent premature tooth wear and noise from teeth grinding.

Management if attrition: Advantages

o Can be adjusted to fit all sizes

o Requires no boiling o Easy to fit within

secondso Not bulkyo TMJ protection

Abrasion Abrasion is loss of hard tooth structure due to

frictional forces between tooth and external object or between teeth in presence of abrasive medium.

Main cause is aggressive tooth brushing technique

Management of brushing abrasion:1. Oral B Bluetooth connected

toothbrush: It is the first available

interactive electric tooth brush . It records brushing activities as

data that you can chart on your own and share with dental professionals.

You can use your smart phones as a remote control to customize your brush to your needs, including setting you target session length and selecting you preferred modes.

Management of brushing abrasion Advantages:

o It can tell us if our brushing is too hardo If we are brushing long enougho If our brushing habits have improved.

Veneers Indications of veneers in non-carious lesions

1) Correct the discoloration of teeth (caused by hypocalcification and hypoplasia).

2) Repair of tooth fracture.3) Repair enamel alteration (attrition, abrasion).4) Treat teeth staining.

The Latest Advances in Teeth VeneersLumineers:

Thin veneers. High resilience. Can last for twenty years or more. Easily applied with little to no pain. Reach patient’s satisfaction. Can be completed in just two dental

visits.

References Prevention of enamel erosion through CO2 laser

irradiation: An in situ study/ Karen Müller Ramalho. Proton Pump Inhibitors: Dangerous and Habit-

Forming Heartburn Drugs/ Sidney m. Wolfe. Inhibition of enamel erosion by stannous and

fluoride containing rinsing solutions/ Dr. E. Rakhmatullina.

http://www.bruxism.org.uk/shop/sleepright/slim-comfort.php

Application of the finite element method in Dentistry/ Máyra Andressa R. V. Piccioni, Edson Alves Campos.

References: connected toothbrush.com Using Fiber Optic Transillumination as a

Diagnostic Aid in Dental Practice/ Dr H. Strassler.

Ceramic laminate veneers: materials advances and selection/ Nasrin R. Sadaqa.

Gingival depigmentation as an effective treatment modality for enhancing esthetics: A case report and literature review/ Sandeep A. Lawandee.

THANK YOU