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Case report: Air abrasion cavity preparation for caries removal in paediatric dentistry.

Abstract

Background: Air abrasion is a technique for removing dental caries and it has been reintroduced into the clinical setting as a result of improvements in equipment in association with both adhesive material development and minimally invasive restorative philosophy. Case report: A 6-year-old girl attended the Paediatric Dental Clinic of University of Rio de Janeiro, presenting with high caries activity which had previously been treated with diet counselling, oral hygiene instructions and adhesive restorations with composite resins using conventional rotary handpiece cavity preparation. Treatment: An adhesive restoration using air abrasion system for cavity preparation was the treatment proposed for removing the carious lesion on the palatal surface of tooth 83. This was carried out and was deemed to be acceptable to the child. Follow-up: Two years after the restorative procedure the patient presented with her restored teeth in perfect condition.

Key words: Dental Air Abrasion, Dental Caries, Child, Paediatric Dentistry

Background

The modern restorative philosophy of so called 'Microdentistry' is based on both preservation of the healthy dental structure and removal of the carious tissue only, thus minimising the need for strengthening and retaining the dental restoration. For this reason, new techniques and equipment have been available on the market such as the air abrasion system, which has been subjected to further research and to a wider application [Rosenberg, 1995]. Recent advances in adhesive dentistry have called for changes to our concepts of cavity designing and preparation, and air abrasion is now being recommended [Banerjee and Watson, 2002].

The air abrasion system is indicated for all types of cavity preparation, repair of amalgam, and composite resin restorations [Rosenberg, 1995]. When combined with different adhesive restorative techniques, it can be used for preparing tooth surfaces, for orthodontic bands; bonding and removing brackets; removing dental stains and sealants; polishing tooth surfaces; and diagnosing fissure and pit lesions [Goldstein and Parkins, 1994, 1995; Rosenberg, 1995].

The objective of the present paper was to describe an alternative approach to caries removal using air abrasion system in a 6-year-old child. The technique's advantages and disadvantages are discussed based on the case report.

Case Report

Patient. A healthy female patient aged 6 years old attended the Paediatric Dental Clinic of Federal University of Rio de Janeiro. She presented high caries activity which had been controlled previously through diet counselling, oral hygiene instructions, and adhesive restorations with composite resin using a conventional rotary hand-piece. However, adhesive restoration using air abrasion system for cavity preparation was deemed to be the treatment proposed for removing the carious lesion on the palatal face of the tooth 83 (Fig. 1 a). Informed consent had been previously obtained.

[FIGURE 1 OMITTED]

Treatment. The device used for such a procedure was a KaVoO Rondoflex[R] 2013 Air Abrasion System. After selecting both tip and grade of the aluminium oxide particles, the carious tissue removal was initiated under rubber dam (Fig 1 b). The air abrasion unit was positioned in parallel to the target surface in order to avoid any inclination, thus taking maximum advantage of the tip's angulation (Fig 2). The distance between the tip and the tooth should be approximately 5mm, minimising the cutting variation and maximising the hand-piece control as tactility is absent. Suction tip and moistened gauze were used throughout the procedure for removing aluminium particles because they can make visibility difficult. Approximately 45 seconds were required for concluding the cavity preparation. After removing the carious tissue, the tooth was restored by means of direct adhesive technique (Fig 3a).

[FIGURES 2-3 OMITTED]

No complaints or pain or discomfort were reported by the patient during the cavity preparation. However, she was rather anxious because of the device's pistol shape and its greater size in comparison with a conventional handpiece. Therefore, the child had to be conditioned by using tell-show-do (TSD) so that she could accept the new system. It should also be noted that the patient complained about the noise produced by the device and felt a kind of "cold" sensibility during cavity preparation.

Follow-up. The tooth was found to be clinically and radiographically satisfactory two years after the treatment (Fig 3b).

[FIGURE 5 OMITTED]

Discussion

The ideal cutting device for tooth preparation should follow certain requirements to satisfy both practitioner and patient, such as comfort and ease of clinical use, capacity to remove only decayed tissues, absence of odour and noise, requirements of minimum pressure, absence of vibration or heat during procedure, lower cost, and easy maintenance [Banerjee, et al., 2000]. Some of these aspects could be observed in the present case report.

Patients usually dislike procedures involving noise, pain, and local analgesia [Goldestein and Parkins, 1994, 1995]. In the present case, the clinical use of air abrasion system did not arouse any report of pain. On the other hand, discomfort caused by the noise was reported by the patient, although this was thought to be related to her young age and consequent lack of behaviour control.

The air abrasion technique allows removal of decayed dental structures and preservation of the healthy ones even when more conservative cavity preparations are performed.

Furthermore, heat and pressure are entirely eliminated while vibration and odour are greatly reduced. In this system, the cutting process occurs by means of kinetic energy and consequently no odontoblastic extensions are eliminated as happens with high speed rotary handpieces, which may result in pain. Such a characteristic allows 80% of all deep cavities to be prepared without the need for local analgesia, a relevant fact for treatment adhesion among adults and, especially, children [Malmstrom et al., 2003].

Patient protection during the use of air abrasion has been emphasised by several authors in view of the dispersion of aluminium oxide powder [Wright et al., 1999], and both practitioner and staff involved in the procedure must follow them. Rubber dam must be placed and the patient's nose protected as well. In addition, powerful suction and ventilation in the clinical setting [Wright et al., 1999], improve the final performance of the air abrasion system. The use of a moistened gauze placed upon buccal and lingual areas to retain the aluminium oxide particles makes it easier to eliminate them and lessens any aerosol.

Visibility during the air abrasion procedure is often difficult because of the aerosol resulting from the dispersion of abrasive particles, and indirect visualisation is even more difficult as the particles also erode the mouth mirror. Therefore, disposable mouth mirrors are indicated for performing air abrasion procedures [Goldestein and Parkins, 1994]. In the present report, however, deflection of aluminium oxide particles occurred during the cavity preparation, perhaps as a result of the excessive distance of >5mm. According to Laurell et al. [1995], the distance between the tip and the tooth surface should be of 1 mm in order to reduce the dispersion angle and consequently increase the visibility and cutting performance [Wright et al., 1999].

Conclusion

An air abrasion system was found to be clinically suitable for removing carious tissues and can also be recommended for restorative treatment in child patients, however specific training and protocol improvement studies still need to be carried out in order to improve the technique.

References

Banerjee A, Watson TE Air abrasion: its uses and abuses. Dent update 2002 Sep;29(7):340-346.

Banerjee A, Watson TF, Kidd EAM. Dentine caries excavation: a review of current clinical techiniques. Br Dent J 2000 May; 188(9):476-82.

Goldestein RE, Parkins FM. Air- abrasive technology: its new role in restorative dentistry. J Am Dent Assoc 1994 May;125(5): 551-57.

Goldstein RE, Parkins FM. Using air abrasive technology to diagnose and restore pit and fissures caries. J Am Dent Assoc 1995 Jun; 126(6): 761-66.

Laurell KA, Carpenter W, Daugherty D, Beck M. Histopathologic effects of kinetic cavity preparation for the removal of enamel and dentin. Oral Sung Oral Med Oral Pathol Oral Radiol Endod 1995 Aug; 80(2): 214-25.

Malmstrom HS, Chaves Y, Moss ME. Patient preference: conventional rotary handpieces or air abrasion for cavity preparation. Oper Dent 2003 NovDec; 28(6):667-71

Rosenberg S. Air abrasive microdentistry: a new perspective on restorative dentistry. Dent Econ 1995 Sep; 85(9): 96-7.

Wright GZ, Hatibovic-Kofman S, Millenaar DW, Braverman I. The safety and efficacy of treatment with air abrasion technology. Int J Paediatr Dent 1999 Jun; 9 (2):133-140.

L.A. Anyunes, V. Pierro, L.C. Maia.

Dep. of Paediatric Dentistry and Orthodontics, School of Dentistry, Federal University of Rio de Janeiro, Brazil.

Postal address: Dr L. C. Maia . Rua Gastao Gonplves,

47 apto 501--Santa Rosa--Niteroi, Rio de Janeiro 24240-030.

Email: rorefa@terra.com.br
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Article Details
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Author:Anyunes, L.A.; Pierro, V.; Maia, L.C.
Publication:European Archives of Paediatric Dentistry
Article Type:Clinical report
Geographic Code:3BRAZ
Date:Jan 1, 2007
Words:1418
Previous Article:Review paper: dental treatment for patients with Papillon-Lefevre syndrome (PLS).
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