USING AIR ABRASIVE TECHNOLOGY TO DIAGNOSE
AND RESTORE PIT AND FISSURE CARIES.

RONALD E GOLDSTEIN, D.D.S.; FREDERICK M. PARKINS, D.D.S., M.S.D., PH.D.
JADA,Vol.126.June 1995 p.761-765
 
AIR-ABRASIVE TECHNOLOGY

(Figure-3) Air-abrasive technology offers new options in caries diagnosis and restoration. (Footnote: 20,21) The scouring action of the air-abrasive method can clean out both stains and organic debris in preparation for sealant application and can open areas of early caries for replacement with resin restorative materials. This article will present methods of both diagnosis and treatment of pit and fissure caries employing air-abrasive technology.

AIR-ABRASIVE METHODS
 
Air-abrasive technology provides a new approach to diagnosing pit and fissure caries. This method is of particular advantage in examining darkened areas in the bottom of pits and grooves. If a suspicious darkened area is detected on visual examination, the air-abrasive system can deliver one or more short bursts of alpha alumina powder into the pit or groove. If the darkened material is simply a stain or the organic plug, this abrasive action will quickly eliminate it while leaving all but a few microns of healthy tooth structure intact.

(Figure-4)
(Figure-5)

Frequently, short bursts from the air-abrasive instrument reveal underlying decay that had been masked by the stain. This previously undetected decay may even penetrate into the dentin. Further bursts of the abrasive powder stream may be used to completely eradicate these dark, carious veins until only lighter-colored healthy tooth structure remains.
 
Because the dentist controls the duration and range of these bursts, he or she is able to remove tiny amounts of material at a time, preserving a maximum amount of healthy tooth structure. The air-abrasive technique roughens the tooth surface, leaving it suitable for direct bonding techniques without acid etching. (Footnote: 22-25) Carious dentin can be removed by additional bursts.
 
An air-abrasive preparation can be restored immediately with either a filled or an unfilled composite resin. If the grooves are shallow and little or no tooth structure is eliminated, a sealant may be appropriate. If the anatomy is irregular or decay had been present and tooth structure had to be removed, the lost material should be replaced with a bonded, filled resin and the restored tooth recontoured. Smaller secondary grooves may then be covered with sealant, creating a preventive resin restoration. (Footnote: 26-31)
 
If the caries extends beyond the enamel into the dentin, a glass ionomer should be placed before the composite and sealant (Footnote: 19) Further, authors of one article recommended use of a laminate restoration consisting of a composite resin sandwiched between a glass ionomer liner as well as use of a covering sealant if the finished restoration will be subject to occlusal stress.(Footnote: 19) These restorations can be completed quickly and conveniently using air-abrasion because this technology does not require liquid cooling or acid rinses and, therefore, allows the dentist to work in an entirely dry field.

(Figure-6)
(Figure-7)

This device is not well-suited for removing all decay, however. Moist and resilient decayed dentin cannot be abraded effectively with the air-abrasion unit. The particles tend to bounce, and they do not cut efficiently. Hand or rotary instrumentation should be used in these cases. Air-abrasion devices also cut dentin more readily than enamel, which allows overhanging enamel to develop. To avoid overextension in dentin, clinicians may need to trim the enamel margins with a rotary instrument. Larger restorative preparations may require the use of a combination of techniques.

• pit and fissure caries • air-abrasive technoligy/methods •
• discussion • summary • bibliography • close window •