There are a vast number on the market, both resin based and glass ionomer, with an equivalent number of bonding agents but we have some new materials that allow us to broaden treatment with minimal or no use of the drill or 3:1. If I may introduce you to 3 striking products that cross the border between non-invasive treatment and minimally invasive treatment. These are the newer biomimetic materials than can actually help “ heal “ the damaged tooth whilst providing restoration of the cavity. I feel that the guidelines for pulpitis is too rigid and that with some gentle encouragement the pulp can recover. Certainly in these times we should think very carefully before embarking down the “ filling/extraction” route. Biodentine from Septodont is proving an exciting product with many uses . This was the first all-inone biocompatible and bioactive material to be used wherever dentine has been damaged. It is of particular use in possibly preventing the progress to irreversible. Pulpdent's Activa BioACTIVE dental filling material that behaves much like natural teeth. The material is bioactive thus stimulating the formation of dental hydroxyapatite and chemically bonds to teeth, which helps seal them against decay. The Activa range has recently been increased. This material is available now ready to be used and can eliminate the need for drilling. Another new advance could well be RENEWAL MI that should shortly receive its CE mark. This is a light cured composite that uniquely bonds directly to hard carious dentine and ‘ seals in’ the decay. No AGP/enhanced PPE/invasive preps. Again the ART technique could be used with sharp hand instruments and/or the ceramic burs to remove softer dentine. This material was developed and extensively tested by the excellent team at the Eastman being manufactured under licence by Schottlander. A ‘slightly’ older material that one could consider is gold. I think that regaining occlusal harmony should be an important consideration. Having to reconstruct massive restorations or damaged teeth can be very time consuming followed by checking/adjusting the occlusion. I think that an indirect restoration should be considered and allow the technician to obtain the best contours and restore the anatomical features. If a light cured material is being used it might be possible to use a prepared sheet of cling film to place over the restoration and have the patient bite ( GENTLY!) and thus adapt it to their occlusion. One could then incremental cure it. This could avoid major occlusal discrepancies. But I have to say that in many cases the body/ occlusion can adapt to change. We only have to look at when orthodontists alter an occlusion with a large amount of composite being deposited on the posterior dentition. Whatever materials and techniques we employ, we have to advise our patients that just because they have had treatment carried out this does not mean that they should not return for frequent “Dental MOT’s” and that we do expect them to share their end of the bargain in carrying out our advice.
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