Диференційований підхід до вибору техніки мінімально інвазивного препарування при лікуванні апроксимального карієсу

Abstract

Relevance. Due to introduction in developed countries highly efficient caries prevention programs, the appearance of materials which form chemical bonding with the tooth tissues and possess anticarious action possibility to reduce the volume of removing of hard tooth tissues are appeared . This approach in dentistry is called M.I.-therapy (from English Minimal Intervention Treatment – minimally invasive treatment) or Minimal Invasive Dentistry (minimally invasive dentistry) and involves using new savings methods and preparation techniques. In Ukraine, M.I-therapy techniques used recently, but until now no clear instructions for their using. In domestic literature only tunnel preparation technique describes in detail, but others such as bate-cave and slot preparation ignored, and their English translation is ambiguous. The aim of this study was to establish clear indications for application access features and performance minimally invasive techniques stages of preparation aproximal located cavities, determination the advantages and disadvantages and their comparison with traditional technique. Slot preparation – a method of minimally invasive intervention used in small decayed lesions of 2nd class by Black (class 2.1, 2.2 by Maunt) on the distal contact surfaces of molars, where the distance between the affected tissues and marginal roll is less than 2,5 mm. Access is through a marginal ridge, saving it, where it is possible, removing only fragile demineralized tissues. If there is an access from the proximal surface (adjacent cavities, the absence of nearby tooth) possible access directly from the proximal side. Occlusal fissure is kept intact after the restoration of cavity with composite material can be protected with a sealant. For cavities are characteristic arbitrary, often unique design with maximum preservation of hard tissues, especially the immune zones. Tunnel preparation – an operative access through the chewing surface (vertical tunnel) or vestibular (oral) surface (horizontal tunnel) into the caries cavity of 2nd class by Black on contact surface with saving marginal enamel. Indications: cavities of 2nd class by Black low and medium depth with minimal proximal enamel lesions located below and on- contact point (lower marginal ridge at 2.5 mm or more). Opening of caries cavity is carried out through inter-cusps fissure (triangular pit) on the chewing surfaces with moving towards defect of contact surface and shape of a tunnel. Necrectomy involves not only demineralized dentin, but the enamel in the "entrance gate". We must to keep a sufficient amount of dentin above a marginal enamel to resist a chewing pressure. Advantages of M.I.- therapy are: preserve intact marginal enamel and chewing cusps; reducing the time of restoration; more easily and accurately to restore contact point; reduce the risk of marginal layer multiplying of restoration; higher aesthetic restoration. Disadvantages of M.I.- therapy are: necessity of high education and qualification of doctors; limitation of cavity bottom survey during preparation; formation of cracks in the surrounding enamel; necessity a specific tools that allows to inserting and modeling of material in inaccessible areas. The difference between the minimal preparation of aproximal cavities and "traditional" method is basically in its final form of cavities: the presence of sharply narrowed inlet aperture and areas of enamel without supporting of underlying dentin, saving of aproximal contact point. During the filling removed carious dentin have to be replaced with glass-ionomer cement, composite material or compomer, that due to the elasticity take over support and amortization of enamel. Conclusion. Thus, today the concept of minimally invasive treatment of dental caries is becoming standard in modern dentistry, although it is a kind of highly skilled, author’s treatment and is now used in clinics focus on providing expensive, exclusive and costly types of dental care.