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
 
DISCUSSION
 
The air-abrasive technique provides an alternative to the traditional method of diagnosing and treating fissure caries that offers a number of advantages. For example, more accurate diagnosis with immediate cavity preparation is possible with the air-abrasion system. The process could start with the hygienist, who should carefully examine the teeth for darkened areas in the bottom of pits and grooves. If available, an air-slurry polisher can be used with a sodium-bicarbonate slurry to remove most stains if no decay is present. The dentist should do a follow-up examination of any darkened area that is not removed by the sodium-bicarbonate slurry.
 
The traditional means of diagnosing caries has included use of the explorer and radiography. However, researchers have questioned the validity of both these methods in recent years. A sticky fissure detected by the wedging of an explorer tip is no longer considered a reliable sign of caries (Footnote: 12-19) (Figure 2). Probing of pits and fissures also has been de-emphasized because of its potential for damaging enamel. (Footnote: 15-17) Likewise, reports indicate that radiographs often fail to detect caries in the early stages. (Footnote: 12,18) Instead, studies suggest that careful visual inspection of an air-dried tooth surface is most revealing. (Footnote: 19,32) Intraoral video cameras can facilitate the viewing of caries in grooves that are too narrow for the penetration of an explorer tip. Any defects that are detected can be opened up and cleaned out using the air-abrasive system, revealing the true carious nature of the area beneath the organic plug.
 
Studies also question the advisability of placing a sealant over decay, particularly when the decay extends into dentin. (Footnote: 33) When sealants are properly applied over caries and carefully monitored, they are effective in arresting the disease. (Footnote: 34-37) Unfortunately, shrinkage and marginal wear commonly lead to leakage. In "Modern Concepts in the Diagnosis and Treatment of Fissure Caries," Paterson and others noted, "If such leakage occurs over active dentinal caries, it may not be detected before pulpal involvement or extensive undermining of enamel and/or cuspal fracture occurs." (Footnote: 19) This same risk of leakage and the reactivation of decay also is a concern when sealing over decayed enamel. (Footnote: 33) By employing air abrasion to clean and reveal decay, this can be avoided.
 
From the patient's point of view air-abrasive technology offers advantages. Patients readily appreciate the concept of conserving healthy tooth structure by attacking decay at the earliest possible moment. Psychologically, they also may feel better about maintaining teeth that have been restored to a natural, healthy appearance, rather than restored teeth that retain unsightly stains around the restoration. Since the air-abrasive system usually allows the procedure to be performed without anesthesia, vibration and annoying sounds, patients view the service as extremely valuable.
 
Expense reductions can offset this investment by reducing the use of prophy paste, disposable prophy angles or rubber cups and brushes. The tubular handpiece of the air-abrasive unit can be sterilized by bagging and autoclaving, and it does not require the labor-intensive lubrication and processing needed for high-torque/low-speed and air-rotor handpieces. Fewer burs, anesthetic cartridges and topical preparations also are used when the air-abrasive system is employed, further reducing expenses. Faster working times mean more accomplished at each sitting, increasing patient satisfaction. Faster working times also translate into more patient visits per day
 
Researcher's interests have also been piqued by the re-entry of this technology into dentistry. Initial studies using the technology with bonded resin materials have been encouraging. (Footnote: 22-24) Further studies of microleakage and bond strength are needed. Studies evaluating dentin bonding after air-abrasive preparation vs. conventional acid etching have been favorable but also variable and require further research. (Footnote: 22-25,38-40) Technique variations may reveal even more effective and efficient procedures with this new technology. Future air-abrasive equipment may incorporate improvements.

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