INSIPIRED TO IMPROVE ORAL HEALTH®
Sa do te zgjasi zbardhimi ?
Rezultatet e zbardhimit jane shume te qendrueshme, por ndikohen nga ushqimi i pacientit dhe zakonet e te perditshmes , procedura mund te riperseritet periodikisht.
Do te shkaktoi zbardhimi ndjeshmeri ?
Ndjeshmeria e dhembit eshte nje efekt anesor qe jepet gjate zbardhimit por qe merr fund menjehere pas aplikimit te zbardhuesit. Sidoqofte,produktet e Opalescence jane te vlefshem edhe me produktet kundra ndjeshmerise PF per nje komformitet maksimal. Kerkimet kane treguar se “porsi peroksidet penetrojne lehtesisht drejt enamelit dhe dentines,keshtu vepron edhe nitrati i potasiumit ". Fluoridi ka funksion primar si blokues tubular,duke mbushur vrimat dhe duke ndadalesuar rrjedhen e fluiditqe shkakton ndjeshmeri. Nitrati i Potasiumit vepron me shume si analgjezik ose se anestetik duke izoluar nervin nga ripolarizimi pasi eshte depolarizuar ne ciklin e dhimbjes.
Do te shkaktoje zbardhimi dobesim te Enamelit ?
Kerkimet mbi linjen e produkteve te Opalescence PF prezantuar ne American Association of Dental Research konfirmon qe zbardhimi me Opalescence PF aktualisht do te uli ndjeshmerine,sherben edhe si anti-karies,shton mikrofuqine e enamelit,dhe permireson mbi te gjtha shendetin e enamelit.
E rendesishme : Kontrolli i pacientit nga dentistit ESHTE MENYRA ME E MIRE DREJT ZBARDHIMIT!
Trajtimit e zbardhimit te dhembeve dot jene te efektshme dhe te sigurte nese jane te perodorur korrektesisht dhe materialet e sakta. Kjo perfshin djagnozen fillestare,pastrimin profesional te dhembeve, monitorimi i pacientit gjate fazes se trajtimit. Vete trajtimi nga pacienti me produktet OTC mund te mos arrijne rezultatet e kerkuara.Praktikisht,te gjtha produktet e sistemit Opalescence jane produkte mjeksore,dhe shperndahen ose perdoren vetem nga praktikues dentale(dentistet).
CLINICAL POINTER
PROBLEM: STAIN UNDER HYDROPHOBIC PROVISIONAL CEMENT
SOLUTION: Use sealing provisional hydrophilic cements (i.e.: UltraTemp)
CHEMISTRIES (THE “WHY’S”):
1. Non-sealing cements allow saliva and bacteria to move between temporary and preparation.
2. Iron-containing coagulum within cut tissues is a source of iron, which reacts with hydrogen sulfide gas (rotten egg gas, H2S) produced by anaerobic bacteria in this septic environment. The reaction yields ferric sulfide, the harmless yet annoying dark surface stain shown below. This stain can occur to a lesser degree from the natural iron in blood. Additionally, non-sealing provisionals are problematic as saliva and/or bacteria removes smear layer within one week, opening tubules to bacteria.
HOW TO PREVENT:
Either use an antimicrobial temporary cement (like ZOE) which leaks, but at least prevents bacterial growth, hence no H2S, and no formation of ferric sulfide.
OR BETTER YET:
Use a quality sealing provisional cement like Ultradent’s, non-eugenol, hydrophilic, polycarboxylate, paste-to-paste UltraTemp Firm or Regular cement.
Similar staining can occur even under definitive direct or indirect restorations if contamination is on the preparation prior to bonding. Scour and/or etch as needed prior to DBA application. For scouring, we recommend Consepsis Scrub with ICB Brush.
Two weeks earlier upon preparation, ViscoStat with Dento-Infusor was used to arrest bleeding. Provisional crowns were cemented with a popular NON-sealing, hydrophobic, resin-based temporary cement. NOTE dark color migrating from gingival margin inward.
PRE-PREPARATION PACKING TECHNIQUE
To ensure cord retention during preparation, use a cord large enough to firmly compress into sulcus.
Prepack–
Open proximal contacts and place Ultrapak knitted cord soaked in hemostatic solution. Because Ultrapak compresses upon packing, use a cord size that appears too large. The thin Ultrapak Packer quickly slips cord into position. The knitted cord’s unique design (interlocking loops) facilitates easy packing and locks it into place.
Preparation –
Extend margin subgingivally by cutting partway into knitted cord which doesn’t entangle in the diamond bur. Remove remnant of cord with calcium hydroxide applicator (tiny ball end). Bleeding is minimal. A small portion of uncut tooth above the gingival attachment is preserved to record in the impression
Hemostasis emostasis & Impression –
Rub the Dento-Infusor tip against bleeding tissue as solution is slowly expressed. Rinse with a firm air/water spray to clean and check for complete hemostasis. If bleeding is noted, repeat these steps. If additional retraction is required, repack with appropriate size cord. Air dry and make impression
TISSUE MANAGEMENT FOR IMPRESSION MAKING
An “astringent” is a substance that eliminates permeability of epithelium to tissue fluid flow. The result is a dry field,
an important tissue management solution for 21st century adhesive technology.
1. Subgingival preparation with bleeding.
2. ViscoStat burnished firmly against the sulcus with Metal Dento-Infusor tip.
3. Firm air/water spray removes residual coagulum and tests tissue for quality profound hemostasis.
4. Ultrapak knitted cord is soaked in ViscoStat, packed and left for one to three minutes.
5. Remove cord, firm air/water spray and dry.
6. Predictable quality impressions.
TISSUE MANAGEMENT FOR DIRECT BONDING
1. Several Class V restorations were performed on these anterior teeth two months prior. Inadequate tissue management or inadequate removal of hemostatic and/or blood contaminants have resulted in microleakage on the maxillary right central incisor.
2. With microleakage, blood pigments move into the space between preparation and restoration, and stain the interface.
3. Isolate tissues with Ultrapak cord soaked in hemostatic solution. Firmly air/water spray/rinse excess hemostatic from the cord, tissues, and tooth surfaces to prevent contamination and resultant leakage.
4. Replaced Class V restoration three months post-op.
1. Deep Class V’s–ViscoStat and Ultrapak cord are ideal for controlling fluids (blood and sulcular). Use a firm air/water spray to remove excess hemostatic solution.
2. Successful bonded restoration.
Two weeks post-op.
INDIRECT VENEER
1. Packing Ultrapak quickly displaces tissues and improves access for indirect veneer luting. (Note tissue management for bonded luting on next page.)
TISSUE MANAGEMENT FOR INDIRECT BONDING (LUTING)
1. Well-healed tissue two weeks post-op.
2. Sulcular fluids contaminate bonding materials/preparation when not controlled.
3. Seal epithelium by gently rubbing with ViscoStat and Blue Mini Dento-Infusor tip.
4. Hemostatic agent and residual temporary cement are scoured off with Consepsis Scrub, preparing the site for application of any dentin bonding agent, including self-etching systems.
5. Wash, dry and tissue stays dry.
6. Preparation ready for final cementation.
EXPANDED APPLICATION FOR VITAL PULPOTOMY
1. Control Bleeding.
Use Dento-Infusor tip with ViscoStat or Astringedent
2. A Sustained Antimicrobial*. Apply a thin layer of ZOE mixed to a putty
3. Eugenol Barrier*.
Apply a thin layer of Ultra-Blend plus, since eugenol inhibits most resin polymerization
4. Etch.
Apply Ultra-Etch phosphoric acid or Peak SE.
*Apply ZOE and Ultra-Blend plus in minimal thickness to keep maximum dentin available for bonding.
5. Bond.
Apply PQ1 dentin bonding agent or Peak LC Bond Resin.
6. Restore.
Use flowable and/or paste composite as desired.
Remove all hemostatic and extraneous coagulum prior to placement of the thin layer of ZOE.
Clinical Pointers
PERMAFLO DC PRIMERS FOR SUBGINGIVAL DESENSITIZATION -
For root sensitivity apical to Class II fillings or crown margins:
NOTE: If sensitive roots
are supragingival, we
recommend light cure
adhesive PQ1 and thin
layer of bond or sealant
resins.
1. Disinfect root and sulcus by rubbing
with Consepsis for one minute.
Hydraulics of syringe delivery are
beneficial for reaching interproximally!
Air dry, do not rinse.
2. Using the Black Mini Brush tip, firmly rub with Primer A 10 seconds then
Primer B 10 seconds. Check sensitivity by gently blowing air on the area.
Repeat procedure until sensitivity is reduced or eliminated (usually less
than 5-7 applications.) If sensitivity recurs, anesthetize, place retraction
cord, reapply primers and seal with PermaQuick bonding resin. Air thin and
inspect for puddled resin before light curing.
CLINICAL TECHNIQUE
1. Fit EndoREZ Points to length. Verify radiographically. Ultradent’s Premium Stiff Gutta Percha may also be used.
2. Dry the canal space using the Ultradent Capillary Tip and Luer Vacuum Adapter followed by paper points
3. Using a NaviTip on a Skini Syringe filled with EndoREZ, insert the tip to 2mm short of the apex. Express the EndoREZ while withdrawing until EndoREZ is seen at the top of the canal. To avoid bubbles, keep end of tip buried in the EndoREZ while withdrawing.
4. Insert the master EndoREZ Point gutta percha cone to length. Accessory points are recommended. EndoREZ will set in the canal in about 20-30 minutes. Seer off extraneous gutta percha and restore coronal aspect. EndoREZ is conducive to lateral condensation or warm gutta percha techniques.
VIT-L-ESCENCE LAYERING TECHNIQUE
Vit-l-escence allows you to layer enamel shades over dentin shades, creating the most life-like restorations possible
1. For Class IV restorations, veneer or diastema closures, a silicon putty matrix fabricated from diagnostic wax-up is recommended.
2. Use matrix as a guide for the basic shape of the restoration, and to support the initial lingual placement of material.
3. A thin layer of Opaque Snow is used to establish lingual contour and prevent show-through. This is not necessary if tooth structure exists on lingual wall.
4. Inner dentin body layer includes the basic hue of the exposed dentin. If this is A2, an A5 would be applied at the cervical and an A4 towards the incisal. Cure and apply basic hue (A2). Create mamelons using a carver.
5. Cover body and extend enamel edge with appropriate translucent shade. To achieve a “halo” (white line at the incisal edge), place a thin roll of Pearl Frost or Opaque Snow
6. Final adjustments are accomplished with multi-fluted finishing burs. Jiffy cups, points and disks are used for smoothing. Polish with Jiffy HiShine.
MICRO RESTORATIVE
1. Small Class I preparation treated with dentin bonding agent. Restoration is filled with flowable PermaFlo through the Black Micro tip.
2. Unsurpassed adaptation of the flowable composite occurs as it fills from preparation floor up.
3. Finished, radiopaque, 0.7μm hybrid restoration. Ultimate restorative seal!
After the bonding agent, apply a thin layer of PermaFlo at the gingival margin, proximal box axial margins and internal line angles to assure quality adaptation of composite.
SUPER ADAPTIVE INTITIAL LAYER:
MASKER
Masking dark colors initially, facilitates gorgeous esthetics at the surface.
METAL MASKING:
Place a thin layer of PermaFlo Dentin Opaquer over the exposed metal and light cure for 20 seconds.
PEDIATRIC RESTORATIONS
1. Rampant caries in a three year old.
5. One year later.
2. Slow speed and large round bur to remove all caries. Stain with Sable Seek to assure all of prep is in firm mineral dentin. (Compromise where close to pulp.) Quality tissue management is an absolute here; a long #0 or #1 Ultrapak cord soaked in ViscoStat is packed first.
3. Preparations are etched and PQ1 is applied. A thin first layer of PermaFlo is applied intimately to the adhesive layer with the Black Micro 20 gauge tip and light cured.
4. One or two additional increments are applied and cured. Restorations are quickly finished with finishing burs and abrasive cups.
ZBARDHIMI-Pyetjet pas Zbardhimit te Dhembeve
Ka shume faktore qe ndikojne ne njollosjen e dhembit. Disa medikacione,trauma dhembi,mbushje kanales dhe ushqime e pije mund ta shkaktojne cngjyrosjen e dhembit ne cdo kohe. Disa cngjyrosje jane siperfaqesore dhe te te tjere te brendshem. Te dyja rastet mund te trajtohen efektivisht nga dentisti juaj; zbardhimi profesional eshte opsioni me i mire per ndricimin e sigurt te dhembit te cngjyrosur.
Si funksionon Zbardhimi?
Procesi i zbardhimit nuk eshte tjeter gje vec" aftesise se peroksidit te karbamitit dhe peroksidit te hidrogjenit per te kaluar lehtesist ndermjet dentines dhe enamelit per shperndarjen e tij ne te gjtha pjeset e dhembit.” Keto perokside perthyhen ne rrenje oksigjeni,te cilat migrojne ndermjet prizmave te enamelit,duke thyer cdo molekule te ngjyrosur qe rezultojne ne cngjyrosjene dhembit. Struktura e dhembit nuk alterohet por thjesht ngjyra e brendshme e dhembit behet me e ndritshme.
“Agjentet zbardhues kthehen ne molekula te vogla te cilat levizin ne te gjtha drejtimet keshtu qe edhe pse gjthe dhembi nuk mbulohet me solucion ,i gjithe dhembi zbardhet.”
Studimet te shumta provojne efektivitetin e peroksideve ne zbardhimin e dhembit. Enameli, dentina, mbushjet ekzistuese dhe materialet lidhese NUK do te ndikohen ose demtohen nga agjentet zbardhues.
Do te ndikohet fuqia e bondit ?
Edhe pse agjentet zbardhues clirojne nje sasi te madhe oksigjeni ne dhembe,mbushjet ekzistuese NUK do te dobesohen.
Neqoftese para mbushjes aplikohet zbardhimi,mbushja nuk duhet te behet per nje periudhe prej 7-10 ditesh pas zbardhimit. Perqendrimi i madh i oksigjenit mund te ndikoje seriozisht ne polimerizimin e rezines.
