Prervation and restoration of tooth structure Combining the approaches of preventative and restorative dentistry, this is a revised and updated guide to the clinical techniques and procedures necessary for managing tooth disorders and disease. Introduces minimally invasive dentistry as a model to control dental disease and then restore the mouth to optimal form, function, and aesthetics Contains several studentfriendly features, including a new layout, line drawings and clinical photographs to illustrate key concepts Covers fundamental topics, including the evolutionary biology of the human oral environment; caries management and risk assessment; remineralization; principles of cavity design; lifestyle factors; choices between restorative materials and restoration management Includes a companion website with selfassessment exercises for students and a downloadable image bank for instructors
introduction to the preservation and restoration of tooth structure an prepared and edited by Dr Graham J Mount continue Preservation and restoration of tooth structure please choose a chapter Each chapter has a series of photographs that supplement the text and illustrations in this book By double clicking on the folder symbol (see the icon below) you will be able to read a caption or commentary for that picture 10 11 12 13 15 18 19 20 21 22 Tooth structure The nature and progression of dental caries Management and control of caries Non-carious changes to tooth crowns Disease dynamics of the dental pulp Cutting instruments used in tooth restoration Basic principles for restorative dentistry Glass ionomer materials Composite resins Dental amalgam Tooth preparation for restoration with plastic materials Rigid materials used in tooth restoration Tooth preparation for restoration with rigid materials Restoration of aesthetics in anterior teeth Vital pulp therapy Restoration of pulpless teeth Periodontal considerations in tooth restoration Occlusion as it relates to restoration of individual teeth Failures of individual restorations and their management Chapter : Tooth structure Authors : WR Hume, GC Townsend It is essential to have a good understanding of tooth structure in order to understand both the nature of the defects and the diseases that can occur and to then make rational decisions on their prevention, treatment and repair Teeth are composed of four different tissues : enamel, dentine, dental pulp and cementum Each of these is made up of structural elements found elsewhere in the body, but arranged in unique ways In the brief description that follows, a basic knowledge of the embryology and histology of the developing tooth is assumed Readers interested in further information are referred to the reading list at the end of this chapter Each chapter has a series of photographs that supplement the text and illustrations in this book By double clicking on the folder symbol (see the icon at right) you will be able to read a caption or commentary for that picture To go to the next image, click once on the red button At the end of a sequence this button will return you to the chapter menu Chapter : The nature and progression of dental caries Author : JW McIntyre This chapter emphasises the modern concept of dental caries For many years it was thought to be a one way, progressive demineralisation of the enamel crystallites followed by degeneration of dentine, leading to cavity formation Theories concerning the actual cause of the degradation have varied but it has always been regarded as primarily of bacterial origin In the present concept, the emphasis is on a demineralisation/remineralisation cycle of the chemical reaction that occur on tooth structure This model assists the dentist to guide the patient to independently maintain a high level of control over the disease This approach is not inconsistent with models which focus on the concept of caries as an infectious disease However, the demin/remin approach provides greater emphasis on the aspect of enhancement of the natural host protective factors rather than simply aiming to control bacterial plaque infection Each chapter has a series of photographs that supplement the text and illustrations in this book By double clicking on the folder symbol (see the icon at right) you will be able to read a caption or commentary for that picture To go to the next image, click once on the red button At the end of a sequence this button will return you to the chapter menu Chapter : Management and control of caries Author : JW McIntyre Using an understanding of the demin/remin cycle discussed in the previous chapter, patients can be advised on strategies to prevent or reverse the problem It is necessary to determine for each patient which is the dominant factor or factors causing the disease It could be a highly cariogenic diet, poor plaque control or a serious depletion of natural protective factors causing an otherwise acceptable diet to result in caries Irrespective of the cause, it will be necessary first to educate the patient and then to gain control by either : - reducing the demineralisation process - enhancing the protective factors Each chapter has a series of photographs that supplement the text and illustrations in this book By double clicking on the folder symbol (see the icon at right) you will be able to read a caption or commentary for that picture To go to the next image, click once on the red button At the end of a sequence this button will return you to the chapter menu Chapter : Non-carious changes to tooth crowns Authors : JA Kaidonis, LG Richards, GC Townsend Apart from dental caries and iatrogenic modification such as cavity preparation by a dentist, the main processes that can change the morphology of a tooth during its lifetime are abrasion, attrition, erosion and fracture Modern dentistry has evolved into an art and science aimed at restoring the broken down dentition to its newly-erupted morphology on the assumption that the unworn tooth has the ideal functional form A variety of geometric concepts of occlusion have evolved over the years and occlusal reconstruction has tended to follow formal guidelines regardless of the great variabiity that exists in the architecture of the stomatognathic system within, and between, populations as well as in the same individual over time Fossil records, anthropopological research and studies in comparative anatomy, show that the processes responsible for tooth reduction have acted on teeth since prehistoric times It is therefore reasonable to recognise and accept tooth wear as a normal physiological process, no different from aging Changes to masticatory structures as a consequence of wear often represent adaptation and not pathology Only when the adaptive capabilities of the individual are surpassed will pathology become evident This broader concept modifies to some degree, the philosophy of clinical dentistry By recognizing progressive change in tooth form as a physiologically dynamic process, premature and unnecessary dental intervention may be avoided Each chapter has a series of photographs that supplement the text and illustrations in this book By double clicking on the folder symbol (see the icon at right) you will be able to read a caption or commentary for that picture To go to the next image, click once on the red button At the end of a sequence this button will return you to the chapter menu Chapter : Disease dynamics of the dental pulp Authors : WR Hume, WLK Massey An understanding of the events which occur in the pulp following insults enables the dentist to both protect the tissue, and to provide appropriate treatment when it is damaged Interceptive therapy may make the difference between pulp survival through healing and pulp death Various therapies may also reduce or eliminate pulpal pain In very general terms, the pulp responds to damage in ways similar to the other connective tissues, i.e it can undergo various forms of inflammation, it can heal, or it can die However, the pulp is unique among connective tissues in that it is entirely enclosed in dentine and it has processes which extend throughout the dentine so that pulp and the dentine should be regarded as a single entity Any trauma or therapy applied to the dentine should be regarded as trauma or therapy applied to the pulp Insults, such as the caries process and tooth restoration, are unlike those found elsewhere in the body and will change the pulp It is not surprising therefore, that some aspects of the pulps response to insults are unique Some therapies used to treat the dental pulp are also unique Each chapter has a series of photographs that supplement the text and illustrations in this book By double clicking on the folder symbol (see the icon at right) you will be able to read a caption or commentary for that picture To go to the next image, click once on the red button At the end of a sequence this button will return you to the chapter menu Chapter : Cutting instruments used in tooth restoration Author : GJ Mount The stage may be reached in the progression of dental caries where preventative therapy and remineralisation techniques will no longer be successful In the presence of frank cavitation in both enamel and dentine, it will no longer be possible to eliminate plaque It then becomes necessary to surgically debride the lesion and restore the tooth to original anatomy to prevent further breakdown It is also necessary to shape and restore broken teeth and to remove defective restorations and replace them Each of these actions requires cutting the tooth tissues or hard restorative materials Enamel is the hardest material in the body Some restorative materials are of similar hardness and dentine is only a little softer Rotating cutting instruments travelling at various speeds are the most effective means of reducing both tooth tissue and restorative material However, refinement of cavity margins is not always possible with rotary instruments because of difficulties of access and final removal of softened carious dentine may be best carried out using a degree of tactile sense Under these circumstances hand instruments remain useful Each chapter has a series of photographs that supplement the text and illustrations in this book By double clicking on the folder symbol (see the icon at right) you will be able to read a caption or commentary for that picture To go to the next image, click once on the red button At the end of a sequence this button will return you to the chapter menu Chapter : Basic principles for restorative dentistry Author : GJ Mount When a carious lesion has progressed to the point where it is not possible to remineralise, it is necessary to remove that part which is broken down and place a restorative material This chapter discusses the basic principles which must be understood to ensure proper placement and retention of the various restorative materials available No material is universal, and correct selection is important to ensure longevity In the following chapters these materials will be discussed in sufficient detail to enable the clinician to make a logical choice as to which material to select for each restorative problem Each chapter has a series of photographs that supplement the text and illustrations in this book By double clicking on the folder symbol (see the icon at right) you will be able to read a caption or commentary for that picture To go to the next image, click once on the red button At the end of a sequence this button will return you to the chapter menu Chapter : Basic principles for restorative dentistry Author : GJ Mount Adhesion There are essentially two types of adhesion available in the oral cavity A micro-technical union can be readily developed between composite resin and enamel simply by etching the enamel and applying an unfilled resin A similar union has been attempted with dentine but there remains some doubt about the the longevity because of the presence of a positive dentine fluid flow A chemical union can be developed between the hard tooth tissues and glass ionomer materials because of the polyalkenoic acids which provide an ion exchange as well as a chemical union with collagen A similar adhesion with composite resin is being explored Retention In the absence of adhesion there needs to be some form of mechanical interlocking between the restoration and the tooth structure This is generally provided through the use of ditches and grooves but occasionally self-threading pins may be indicated Protection As the cavity enlarges the strength of the remaining tooth structure becomes compromised and it may be necessary to offer some degree of protection against the future development of cracks at the base of a cusp Each chapter has a series of photographs that supplement the text and illustrations in this book By double clicking on the folder symbol (see the icon at right) you will be able to read a caption or commentary for that picture To go to the next image, click once on the red button At the end of a sequence this button will return you to the chapter menu ... Rigid materials used in tooth restoration Tooth preparation for restoration with rigid materials Restoration of aesthetics in anterior teeth Vital pulp therapy Restoration of pulpless teeth Periodontal... Periodontal considerations in tooth restoration Occlusion as it relates to restoration of individual teeth Failures of individual restorations and their management Chapter : Tooth structure Authors... understanding of tooth structure in order to understand both the nature of the defects and the diseases that can occur and to then make rational decisions on their prevention, treatment and repair