Transcript Implementing interim therapeutic restorations

Matt Fisher, DMD, MS
Albuquerque IHS Dental Clinic
June 5, 2013
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Caries stabilization utilizing similar techniques
to ART (Atraumatic Restorative Technique)
Unlike ART, ITRs are considered to be
provisional restorations
Recognized by the AAPD as a beneficial
provisional technique
Coded as a provisional restoration (2940)
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Used to restore or prevent further
decalcification and caries in young patients,
uncooperative patients, or patients with
special health care needs.
Used when circumstances do no permit
traditional cavity preparation and/or
placement of traditional dental restorations, or
when caries control is necessary prior to the
placement of traditional restorations
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Very young patients with small or large
single-surface or two-surface preparations that
may lack traditional retentive properties
Teeth should have no clinical or radiographic
signs of infection
Uncooperative children that can’t or won’t
tolerate injections or lengthy restorative
procedures
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Uncooperative older children that have caries
in primary molars that will be exfoliating in the
near future
Temporary restoration of hypocalcified
permanent molars that will require full
coverage in the future
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Cotton rolls and pellets
Microbrush applicators
Floss
Vaseline or other lubricant
Mirror, explorer, probe, cotton forceps, spoon
excavator
Slow-speed handpiece
Assortment of round burs and finishing burs
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Glass Ionomer Restorative Material
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Glass Ionomer capsule activator and applier
Glass Ionomer Cavity Conditioner
Glass Ionomer Sealer
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Traditional GI better than RMGI
High fluoride release better
Fuji IX GP Extra a good choice
Fuji Coat LC
Amalgamator
Curing Light
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A true Glass Ionomer Cement
Fast-setting
Can finish restoration in 2.5 minutes
Contains additional glass filler for improved
translucency and esthetics
6x more fluoride release than traditional GIs
Increased durability, wear resistance, and
compressive strength
Shade A1 or B1 in children
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Remove caries with a slow-speed handpiece
with a carbide round bur or hand instruments,
with caution not to expose the pulp
Maximum caries removal at the periphery of
the prep to minimize leakage
Some caries can be left in the apical part of the
prep to avoid pulp exposures
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After prep is completed, rinse and dry the
tooth with cotton roll isolation.
Apply cavity conditioner for 10 seconds to
remove the smear layer. Rinse with water
Dry tooth with cotton pellet or gentle blowing
being careful not to dessicate the tooth.
Surfaces should still appear moist
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Tap GI capsule on counter to loosen powder
and activate
Place in mixer (amalgamator) and mix for 10
seconds
Load capsule in capsule applier
Syringe GI into cavity prep and slightly overfill
Lubricate finger with Vaseline and wipe across
the GI in the prep forcing the GI into the prep
and surrounding grooves
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Use a probe, explorer or spoon excavator to
wipe off additional GI, paying particular
attention to the interproximal areas
Place cotton roll on the contra-lateral side and
have the patient bite on it for 2-2.5 minutes to
allow the GI to set
Contour filling and remove any additional GI
with a large round bur or finishing bur
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Floss interproximal areas to verify there is no
GI in this area
Isolate with cotton rolls, dry tooth, and apply
GI Sealer. Light cure sealer for 10 seconds.
Rinse mouth
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Always use Tell-Show-Do
Show patient brown spot on their tooth and tell
them you are going to brush it off and make it clean
again
 Show them slow-speed on their fingernail letting
them know it’s a toothbrush that spins and brushes
 Air syringe and suction
 Show patient finished result
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Start with a non-binding bur if possible
Use intermittant, light strokes with the
handpiece to prevent heat buildup
Clean periphery of prep before going deep
Leave decay at bottom of prep to avoid pulp
exposure
Work fast… Try to keep appointment under
15-20 minutes for young children
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Easy and fast first appointment if possible.
This appointment sets the tone for the
remaining appointments
Make difficult appointments or those requiring
local anesthetic last if patient is asymptomatic
Use the small high-speed surgical suction or
the saliva ejector