2004 년 대한 심미치과학회 춘계 학술 집담회를 다녀와서 ..

1. 2004년 대한 심미치과학회 춘계 학술 집담회를 다녀와서..

2. I. Scientific aspect of colored restoration

3. A. Tooth colored restoration에서 Scientific data와 그 임상적 의미 • Marginal adaption • Bond strength • Polymerization shrinkage • Cusp deflection

4. 중합수축이 가져오는 임상에서의 문제점 Marginal adaption Cusp deflection

5. Marginal adaption / Cusp deflection • 중합 수축량 Vs 중합 스트레스 • 중합 수축량: 중합 전후의 volume의 차이로 Cusp deflection과 관계가 깊다. • 실험실에서의 비교 Heliomolar, Surefil < Synergy compact, Z100 < Dyract AP < Pyramid , Compoglass F Aelites LS: 중합수축이 적은 레진으로 현재 개발단계에 있는레진

6. Marginal adaption / Cusp deflection • 중합 수축량 Vs 중합 스트레스 • 중합 스트레스: 레진 중합 시 발생되는 스트레스로써 marginal adaption과 관계가 깊다 • Heliomolar < Z100, Pyramid < Synergy compact

7. Marginal adaption / Cusp deflection • Cusp deflection • 레진 중합전후 교두간의 거리 변이 정도 • 중합 수축량과 관계가 깊다 • 실험실에서의 비교 • Heliomolar, Surefil , Synergy compact, Z100 < Compoglass F < Pyramid, Dyract

8. Selective Bonding Technique Fine한 bur로 다시 갈고 산 부식을 포함한 통상적인 bonding GI conditioner + LC GI

9. B. Tooth Curing Light • 국내 현황 • 잘못 알려지고 있는 사실들 • 올바른 사용법

10. 국내 현황 • 최근 LED분야에서의 급격한 발전에 힘입어 증가 추세 • 잘못 알려지고 있는 사실들 • PAC lights는 1초 혹은 3초로도 충분하다? : 실험결과 적어도 12초는 되야 충분하다

11. 올바른 사용 법 • 가능한 가까이, 수직으로 • 큰 팁으로 • 주기적인 광조사도 검사: 일 1회 • 사용하는 레진 종류별로 민감한 파장이 달라서 반드시 레진과 curing light간의 올바른 matching이 필요

12. II. Clinical aspact of posterior composite resine restoration

13. A. 접착제 및 수복제의 선택 • 최신 접착제들에 대한 분석과 임상적용시 유의 사항 • 술 후 지각과민을 최소화 할 수 있는 임상 기법 • 구치부 영역에서의 복합 레진은 과연 믿을 만 한가? • 구치부 수복을 위한 복합 레진 선택 시 Guide line

14. 최신 접착제들에 대한 분석과 임상적용시 유의 사항 • 접착제의 선택 • Wet bonding / Dry bonding? “DRY BONDING” eg) super bond-수분 대신 bonding agent에 포함된 ferric sulfate가 collagen fibrin을 살려서…

15. 최신 접착제들에 대한 분석과 임상적용시 유의 사항 • 접착제의 선택 • What Type of adhesive system? Type III • Eg) SE bond, Cleio fil…. CRA report에서의 Type of adhesive system Type I. E + P + B Type II. E + P + B Type III. E + P + B Type IV. E + P + B

16. 술 후 지각과민을 최소화 할 수 있는 임상 기법 • Hybrid ionomer linre • Flowable resine • Multiple layer-Type II, 여러 번 박박 문질러서 • Higher viscosity adhesive • 4-METE Pulpal쪽 debonding시 통증-씹었다가 땠을 때 아프다

17. 구치부 영역에서의 복합 레진은 과연 믿을 만 한가? Yes !! If “KEEP THE PROTOCOL STRICTLY”

18. 구치부 수복을 위한 복합 레진 선택 시 Guide line • 구치부 레진: Hybrid, Micro hybrid • 전치부, Cl V 레진:Micro fil

19. B. 심미수복 치료시 도움이 되는 아이디어들(Material Information) • Resine polishing & finishing • Hybride type-sharp carvid bur • Micro fil type-diamond bur • Bis cover: surface sealant로 oxygene inhebition layer가 생기지 않음, LED light로는 중합되지 않음

20. 어린이와 청소년의 치아 우식증과 그 예방

21. 치아 우식증의 발생과 진행

22. detail of a tooth (to the right = enamel).It is covered by plaque, which consists mainly of bacteria. Plaque is often found close to the gum, in between teeth, in fissures and at other "hidden" sites. Demineralization:When sugar and other fermentablecarbohydrates reaches the bacteria, they form acids which start to dissolve the enamel - an early caries lesion occurs due to loss of Calcium and Phosphates Remineralization:When sugar consumption has ceased, saliva can wash away sugars and buffer the acids. Calcium and Phosphates can again enter the tooth. The process is strongly facilitated by fluorides

26. 탈회화 재광화 • 법랑질: 무정형의 고체, 용적비 10-15%의수분, 단백질,지질로 수성된 유기물이 결정체를 둘러싸고 있어 광물질을 확산시킬수 있는 물질 • 표층하방의 광물질소실이 시작되면 타액내의 칼슘이나 인에의한 재광화도 함께 활발이 진행 • 이때 저농도의 불소가 존재시 재광화가 촉진되며 광물질 소실이 감소 • 표층이 손상되지 않는 한 우식부위 재광화는 항상 일어남 • 표층이 파괴된 경우 우식은 비가역적으로 진행되며 반드시 수복을 요함 • 방사선 사진에 잘 나타나지 않는 법랑질에 국한된 우식부에 불소를 이용한 치료 가능 • 유치보다 두꺼운 법랑질을 지닌 영구치가 재광화에 유리한 조건

27. 치아 우식 예방법 • 불소의 사용 • 상수도 불소화 • 불소 보조제 복용 • 국소적 불소 도포 • 불소치약 • 불소 양치 • 치면 열구전색 • 치솔질 교육 • 식이조절

28. Fluoride is vital for dental health Fluoride combines with your tooth enamel tostrengthen it and increase its sistance to attacks from harmful decay causing acids. Plus, if you already have some decay, flouride can work to repair damaged tooth structure, often slowing or even stopping the decay process.

29. FLOURIDE VARNISH • What is Fluoride Varnish? • Fluoride varnish is a protective coating that is painted on a child’s teeth to prevent cavities. • It can be painted on teeth that already have cavities. Fluoride can help stop cavities from getting bigger. • The fluoride coating may be painted on the teeth 1 to 4 times each year. The number of times depends if the teeth have cavities or not.

30. How Is Fluoride Varnish Put On? • The varnish is painted onto your child’s teeth using a small disposable brush. It takes only a few seconds and is easily accepted by children. • Your child’s teeth may look yellow or cloudy on the first day. This color will gradually go away. Also, it is normal for the fluoride varnish to make the teeth feel sticky. This only lasts a short time.

31. Is Fluoride Varnish Safe? • Yes, fluoride varnish has been used for several years in many countries. Along with being safe, fluoride is an inexpensive and practical way to reduce tooth decay.

32. What Else Do I Need To Know? • After the fluoride varnish is painted on: • Your child should not eat for one hour. • Your child should eat only soft foods at the next meal. • Your child should avoid sticky foods for the rest of the day (e.g. fruit rollups, toffee, gum). • Do not brush your child’s teeth for 24 hours.

33. Protect Your Child’s Smile • Baby teeth are important! Healthy baby teeth help your child chew properly, speak clearly and smile brightly. To keep your child’s teeth healthy: • Limit sweet snacks. If necessary, eat them with a meal. • Floss and brush your child’s teeth daily. • Visit the dentist once a year. • If you have questions about your child’s teeth visit your dental office or call the dental health coordinator in your health region.

34. Step-by-Step Fluoride Varnish Application Find areas that need fluoride varnish Dry teeth with a gauze. Paint fluoride varnish on teeth.

35. Remineralization Protocol for Incipient Carious Lesions

36. The following protocol is for remineralization of incipient (non-cavitated early) carious lesions. Ensure that all teeth targeted for remineralization are documented in the dental record. Inform the patient that you are attempting to remineralize rather than restore the lesions and that success will depend largely on their compliance with your instructions. They need to understand the need for follow-up at the appropriate time so that lesion progression can be monitored. Some lesions may require restoration if remineralization efforts are ineffective. Be sure to document all preventive instructions and treatment rendered.

37. Step 1. Eliminate the Nidus of Infection a. Restore any cavitated lesions b. Seal deep, retentive pits and fissures

38. Step 2. Implement Preventive Measures (Steps 1 and 2 may be completed simultaneously.) a. Diet survey / modification b. Oral hygiene instruction c. Evaluate salivary flow d. In-office fluoride e. Home fluoride (dentifrice, fluoride rinses (ACT, Fluoriguard) prefer at least 3 fluoride exposures per day) f. Xylitol chewing gum - chew 2 chiclets for 5 minutes, 3 times per day

39. In-office fluoride 1) gels - 1.23% APF, 2% neutral NaF (4 minute tray technique, 4 applications over 2 - 4 weeks or 2) varnishes - Duraphat (Colgate), Fluor Protector (Vivadent) (isolate each quadrant with cotton rolls, apply to teeth, repeat in 3 - 6 months)

40. Step 3. Antibacterial Mouthrinses • (Chlorhexidine regimen should not be started until all cavitated lesions have been restored!) • a. Chlorhexidine Gluconate (.12%) - rinse with 1/2 ounce for 30 seconds once per week (1 bottle will last about 6 months)

41. Step 4. 6 Month Recall a. BW x-rays (monitor lesion size) b. Reinforce preventive measures in step 2. c. Check sealant retention d. Bacterial testing (Vivadent CRT bacteria) 1) If bacteria scores are <105, continue home fluorides and recall in 6 months. 2) If bacteria scores are ³105, go back to step 1 and repeat program. a. Possible reasons for persistent high Mutans Streptococci levels 1) Patient still maintaining high refined carbohydrate diet 2)Carious lesions still present that should have been restored 3) Possible inoculation from another person (e.g., spouse)

42. 식이 상담 • What's the Best Nutrition Advice? • Eat a variety of foods to get the energy, protein, vitamins, minerals, and fiber you need for good health. • Balance the food you eat with physical activity - maintain or improve your weight to reduce you chances of having high blood pressure, heart disease, a stroke, certain cancers, and the most common kind of diabetes.

43. Choose a diet with plenty of grain products, vegetables, and fruits which provide needed vitamins, minerals, fiber, and complex carbohydrates, and can help you lower your intake of fat. • Choose a diet low in fat, saturated fat, and cholesterol to reduce your risk of heart attack and certain types of cancer and to help you maintain a healthy weight. • Choose a diet moderate in sugars. A diet with lots of sugars has too many calories and too few nutrients for most people and can contribute to tooth decay.

44. Choose a diet moderate in salt and sodium to help reduce your risk of high blood pressure. • If you drink alcoholic beverages, do so in moderation. Alcoholic beverages supply calories, but little or no nutrients. drinking alcohol is also the cause of many health problems and accidents and can lead to addiction.

46. What is the Food Guide Pyramid? • The Pyramid is an outline of what to eat each day. It's not a rigid prescription, but a general guide that lets you choose a healthful diet that's right for you.The Pyramid calls for eating a variety of foods to get the nutrients you need and at the same time the right amount of calories to maintain or improve your weight.The Pyramid also focuses on fat because most Americans diets are too high in fat, especially saturated fat.

47. Women who are pregnant or breastfeeding, teenagers, and young adults to age 24 need 3 servings. Meat group amounts are in total ounces.