Smart Powder for cavity preparation 2 – The key to success

Active Care - Direct posteriors - Products
2 Oct 2017

The dynamic development of industrial technologies has had an impact on the technological development of various professional fields. One of the most favoured and popular dental instruments, the ancestor of the sandblaster, was developed for industrial purposes in the USA in 1870. Benjamin Tilghman created a machine that was suitable for quick and efficient cleaning of different surfaces. From 1883 it was indispensable in the industry. However, the breakthrough in its development was achieved in 1904 and in 1939 when it was made more effective by combining compressed air and abrasive materials. After a while, other abrasive materials (aluminium oxide, quartz, glass scraps and even organic materials) were used as an alternative to sand. A bit later this technology gained ground in the field of arts as well.

Dr. J. Tim Rainey, a Texan dentist is referred as to be the father of the dental implementation of technology. In 1940, however, the device was made by Dr. Robert Black, and in 1945 his first publication titled “Technique for non-mechanical preparation of cavities and prophylaxis” was already published in the journal J Am Dent Assoc. In 1951, the S.S. White Company launched the first equipment for dentistry purpose under the name of called Air-Dent.

It is even more exciting that in 1951, the very famous “The New Yorker” magazine – which essentially deals with social life and cultural events in New York, publishing satires and cartoons – considers this dental technology to be quite interesting and revolutionary to post an article about it.

Sandblasting has been rapidly integrated into adhesive restorative technology since 1990.

 

General indication areas in conservative dentistry are:

– Old composite removal

– Tooth surface conditioning for bonding procedures

– Superficial stain and discoloration removal

 

Contraindications:

Not suitable to prepare cavities with well-defined walls and margins

 

 

Advantages:

– Generates no heat, pressure or vibration

– Sometimes reduces the need for anesthesia (shallow cavities)

– Preserve a bigger amount of healthy tissue

– Reduces the risk of fractured and chipped teeth

– Relatively simple to use

 

Disadvantages:

– Not necessarily pani-free (the air can cause sensitivity)

– Not recommended for deep cavities (pulp proximity) or for proximal cavities

– Hard enamel can’t be removed to access the decay

– Unsuitable for preparation for indirect restorations

 

Almost every large manufacturer has a sandblasting appliance. Some of these products are only suitable for prophylactic use and others for combined use, namely for preparation. I personally own 3 appliances from different manufacturers, but since I “made friends” with AquaCare, I do not use the other two at all.

AquaCare is unique in many ways. It is not connected to the dental unit, it acts as a stand-alone piece, only receives high pressure air from the dental unit. It has a unique powder set with its own presentation and the same applies to the liquid. There are 4 types of powder available, including:

1) A prophylactic powder (sodium bicarbonate)

2) Two powders suitable for preparation (aluminium oxide 29 micron and 53 micron particles)

3) And, my favourite, which can only be used in AquaCare system is the Sylc Novamin, the active bio glass used for dentin desensitization. I wrote in details about it in my previous article.

Restorative dentistry has the following indications for aluminium oxide powders:

– Cavity cleaning

– Cavity preparation

– Cavity preparation and cleaning

– Old filling material removal

We have been using this technology for a long time for cavity cleaning after preparation. According to some literature, it may substitute the etching process and increase the bond strength.

The powder cavity preparation can be used strictly within the range of indications! Do not want to remove intact enamel, do not use it to create a proximal cavity, or to prepare indirect restoration and deep cavities!

Continuous control during preparation is absolutely essential! Within short time intervals check how the preparation works to prevent the removal of too much intact dental tissue! This is especially important when using the 53 micron powder!

AquaCare’s unique multifunctional pedal provides a great help with this. The AquaCare Twin includes a triple-action foot control that enables cut, clean, wash, and dry operations to be carried out through the same handpiece, allowing continuous operation without interruption. An entire procedure can be performed without removing the tip from the oral cavity. One handpiece supplies air, water and/or treating medium.

For those dentists who have no experience or routine in preparation work with air abrasion, it is advised to start with the smaller (29 micron) particle size and with lower pressure, even if it is more time-consuming! Rubber dam isolation is mandatory for ai abrasion procedures, and we should not forget to offer protective glasses for patients.

The preparation of the following two cases was done with AquaCare.

Fig. 1

Case 1 – Initial situation. Small cl. 1 caries of a lower first molar.

Fig. 2

Isolation with Photodam. Never use air abrasion without rubberdam isolation!

Fig. 3

Close-up of the caries.

Fig. 4

Prepared cavity. Only the affected dental tissue was removed with Pro Cut powder (blue – 29 microns).

Fig. 5

Close-up of the prepared cavity.

Fig. 6

The finished restoration.

Fig. 7

Close-up of the restoration.

Fig. 8

Final outcome.

Fig. 9

Case 2 – Initial situation. Deep cl. 5 caries of a lower first premolar.

Fig. 10

Rubber dam isolation prior to preparation.

Fig. 11

Close-up of the affected area.

Fig. 12

Prepared cavity. All the affected dental tissues were removed with Pro Cut+ powder (red – 53 microns) and Pro Cut powder (blue – 29 microns) in the deeper areas.

Fig. 13

Close-up of the prepared cavity.

Fig. 14

Almost finished restoration.

Fig. 15

After characterization. Before finishing and polishing.

Fig. 16

After finishing.

Fig. 17

The final result, after polishing.

Fig. 18

Remarcable moments in the history of dental air abrasion.

Fig. 19

The difference between cavity surface appearance before and after using AquaCare.

Fig. 20

Continuous control is mandatory during the preparation to avoid the accidentally loss of healthy hard tissues (mind the unintentionally removed proximal enamel!).

Fig. 21

Being unexperienced in contactless dentistry always start with smaller particles and pressure!

Fig. 22

General recommendations, technical data

 

Conclusions

AquaCare system can provide us both professionals and patients a more comfortable process of preparation eliminating the fear from drills, the sensation of vibration, sometimes reducing the need for anesthesia. Beside these advantages, AquaCare gives all dentists the opportunity to be conservative with minimal invasiveness, preserving more intact dentine and enamel structure during the preparation and cleaning process.
Always take into consideration the indication areas and perform a strict case selection!

Bibliography

1. Manauta J. Back to Basics: bulk and body. http://www.styleitaliano.org/back-to-basics-bulk-and-body
2. Marchetti G. Single Shade Makeover. http://www.styleitaliano.org/single-shade-makeover
3. Manauta J, Salat A. Layers, An atlas of composite resin stratification. Quintessence 2012.
4. Akhundov M. Composite meets ceramics. http ://www.styleitaliano.org/composite-meets-ceramics
5. Rasulzade N, Afandizade N. Minimal Invasive Preparation with Sandblasting. http://www.styleitaliano.org/minimal-invasive-preparation-with-sandblasting
6. Akhundov M. Step by step:Minimal invasive posteriors. http://www.styleitaliano.org/step-by-step-minimal-invasive-posteriors
7. Fernando Rey Duro, Joana Souza Andrade, Sillas Duarte Jr. Fluorescence: Clinical Evaluation of New Composite Resins. QDT 2012;35: 145-156.