Protocol for Occlusal Dentine Lesions
From: RW137@...
Date: Fri Nov 14, 2003 12:13 am
Subject: Re: [healozone] Treating lesions into dentine
hi all,
julian made me promise to write to the user group about sealing reductant under fuji dressings, so here goes.
i have been using healozone since may2002.
my early applications were very ambitious and i experienced some dissappointments
however recent results are very encouraging.
the early problems were due to poor evaluation of the extent and depth of the occlusal lesion and a failure to provide adequate access for the ozone.
i would like to share my current protocol for occlusal dentine lesions and would welcome your comments.
having cleaned (prophyjet) and dried the occlusal surface i take a diagnodent (dd) reading.
0-10 diet advice
10-25 diet advice, advise patient/parent lesion reversible but ozone will ensure healing in which case ozone 40 secs, review 6 months and monitor.
25-30 lesion irreversible, oxone application directly to the occlusal surface 40 secs, review 6 months and monitor.
30 -45 if the enamel surface is intact then we need access to the caries. this is achieved by opening the fissure in the location and direction of the over 30 dd score.
no local is needed even with the turbine. access is minimal. view the caries under magnification, generally it is confined to the immediate (1-2mm) of the fissure depths.
ozone 60 seconds. record texture of caries (hard leathery soft) usual reminkit and non acidic diet instructions review 2-3 months. do not place a dressing.
at review assess texture, excavate any very broken down dentine, you will reach a hard (but carious looking ) base very easily. reozone 60 seconds place fuji 7.
45+ greater access is needed, still without local, excavate gently the very soft tissue (if patient experiences discomfort then oxone for 30 secs, apply reductant and then continue - pain will stop). the extent of the access and excavation is determined by the lesion. access cavity allows ozone to reach caries and also removal of irretrievably broken down tissue. ozone for 60-120 secs apply reductant. then moisten a cotton pledget with reductant, place in cavity and seal with fuji 7. leave 3 months
at review remove fuji 7, cavity walls almost invariably hard but covered in a 'powdery' unattached substance which scrapes away, re ozone. if 100% happy with healing restore with composite. if in doubt use a gi (not resin modified) and leave for further 3months.
previous protocols advocated removing deep lesion dressings and re ozoning every 2 weeks. it strikes me that the benefit in this is not the ozone but the reapplication of reductant.
placement of fuji 7 without a pledget allows healing but very slowly. minerals appear to come through the dressing and from the tubular fluid. it would be interesting to see if rootfilled teeth heal as quickly as vital teeth.
is there any way of 'dissolving' the very soft caries to enable even smaller occlusal access - does anyone have any suggetions on this
hope to see some of you at nec
rob wain, newcastle
Join our mailing list and learn about ozone therapy in the dental practice:
http://groups.yahoo.com/group/healozone/