Спосіб відновлення жувальної поверхні молярів у лікуванні фісурного карієсу в дітей

Abstract

Ураження постійних зубів діагностують невдовзі після їх прорізування, а найвищий відсоток уражень виявляється в перших постійних молярах і в 100% випадків – це фісурний карієс. Через особливості його розвитку в дітей карієс певний час може мати непомітний перебіг і виявлятися тільки під час профілактичних оглядів, коли дефект визначається у фісурі чи ямці, а оклюзійна поверхня залишається не зруйнованою. Відновлення оклюзійної поверхні зуба після препарування каріозної порожнини вимагає від лікаря знання анатомічних особливостей молярів, певних навичок, досвіду в моделюванні горбів, схилів, фісур і ямок та, звісно, часу. У терапевтичній стоматології останніми роками використовують спосіб відновлення жувальної поверхні зубів за допомогою оклюзійного ключа. Метою дослідження стало застосування методики відновлення жувальної поверхні молярів за допомогою оклюзійного штампа в дітей. Технологія відновлення жувальної поверхні з використанням ключа дозволяє лікарю економити час, необхідний для моделювання реставрації й коригування міжоклюзійних контактів, що вкрай актуально саме в роботі з дітьми.

Lesions of permanent teeth are diagnosed shortly after their eruption and the largest percentage of lesions is found in the first permanent molars, and in 100% of cases it is a pit-and-fissure caries. Considering this progress, the features in children caries may be unnoticed for definite period and be revelaed only during preventive checkups, when the defect is identified in the fissure or pit while the occlusal surface remains intact. Occlusal surface restoration after preparation of the carious cavity requires the knowledge of anatomical features of molars, certain skills, experience in modeling cusps, slopes, fissures and pits and, of course, doctor’ attention. Lately, the restorative dentistry has used a method of the occlusal stamp restoration for restoration of occlusal surfaces. The purpose of our study is to use the occlusal stamp restorative technique for restoration of occlusal surfaces of molars in children. This technique was used in 10 children aged 8 from 12 years old, who visited the department of pediatric dentistry with the aim of prevention of dental diseases. Examination of children revealed carious cavities in the first permanent maxilary (3) and mandibular molars. In all cases the carious cavities were diagnosed in the pits or fissures of the occlusal surface. The carious cavities had narrow inlets and the enamel of the occlusal surface was preserved but discolorated. The mentioned restorative method was performed in all cases according to the following algorithm. Appropriate topical and infiltrative anesthesia was provided for patients, teeth were isolated with the rubberdam, the tooth surface was cleaned and the occlusal stamp was made with “Latelux Flow” flowable composite in the following way: a portion of liquid composite was applied on the dry occlusal surface of the tooth and spread with dental applicator (Latus, Ultrafine). Then, a small portion of flowable composite was added to the area of the the microapplicator`s head and the composite was photopolymerized. The occlusal stamp was removed with a dental probe after polymerization, its quality was assessed and the carious cavity was prepared according to biological feasibility principles, which included standard steps. After preparation the total etching of enamel (30 sec) and dentin (15 sec) with orthophosphoric acid ("Conditioner 36", "Dentsply") was performed. After washing and drying, Prime & Bond Universal adhesive was inseted additionally to the carious cavity, dried, and polymerized. Liquid SDR composite (Dentsply) was added to the cavity as an adaptation layer, polymerized, and the rest of carious cavity was restored with nanohybrid composite CeramX SphereTEC one. (Dentsply). The last layer of material which was placed in the cavity was formed with the occlusal stamp. Firstly, the material was adjusted with a modelling spatula then Teflon tape was applied on surface and the stamp was placed on it. After the using of light pressure, the stamp and Teflon tape were removed, exceeds of material were extracted with a modelling spatula, the composite was adjusted to the tooth tissues along the restoration margins with a microapplicator, and then all the composite was polymerized. Furtherly, the stage of checking of the occlusal contacts was performed. Usually, the restoration were made with the occlucal stamp technique demanded minial occlusal corrections. The final stage was the finishing and polishing of the restoration. The stamp technique for restoration of occlusal surface allows minimize the time needed for modelling and adjustment of interocclusal contacts, which is very actual during the work with children and therefore can be recommended for general usage in clinical practice of pediatric dentistry.