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Implementing interim therapeutic restorations

Implementing interim therapeutic restorations

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Implementing interim therapeutic restorations

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  1. Implementing interim therapeutic restorations Matt Fisher, DMD, MS Albuquerque IHS Dental Clinic June 5, 2013

  2. Interim Therapeutic Restorations (ITRs) • 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)

  3. ITRs • 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

  4. Clinical Indications for ITRs • 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

  5. Clinical Indications for ITRs • 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

  6. ITR Supply List • 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

  7. ITR Supply List • Glass Ionomer Restorative Material • Traditional GI better than RMGI • High fluoride release better • Fuji IX GP Extra a good choice • Glass Ionomer capsule activator and applier • Glass Ionomer Cavity Conditioner • Glass Ionomer Sealer • Fuji Coat LC • Amalgamator • Curing Light

  8. Fuji IX GC Extra • 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

  9. ITR Procedure • 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

  10. ITR Procedure • 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

  11. ITR Procedure • 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

  12. ITR Procedure • 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

  13. ITR Procedure • 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

  14. Tips for Successful ITRs • 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

  15. Tips for Successful ITRs • 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

  16. Tips for Successful ITRs • 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