The History of Air Abrasion Air abrasion was first introduced to dentistry in the early 1950's. It did not gain recognition or acceptance at that time for two reasons: 1. The equipment was rather bulky and the delivery system was not refined. 2. The high speed turbine was coming into prominence at the same time and was a more familiar treatment method to the dentist.
Factors That Re-established Air Abrasion as a Method of Treatment 1. The Introduction of Fluoride. Fluoride appeared in the mid-1950's as an anti-carious additive. It was introduced to the public in two ways, by being added to the public drinking water affecting the developing tooth, and by being added to tooth paste to provide a topical application. The effect of fluoride is most evident on the smooth surfaces of the teeth where interproximal decay has been greatly reduced. However, on the occlusal of the posterior teeth where the pits and fissures are located, the decay process occurs differently than it did prior to the introduction of fluoride. Prior to fluoride, as the decay progressed down the grooves, it destroyed the surrounding tooth structure, forming a funnel shaped lesion. This enabled the dentist to visually see the decay process soon after it began. If the explorer would "stick" or if the decay was evident on a radiograph, the dentist would treat it. Until the time of treatment, the lesion was monitored. This is how and why "watch" areas became part of the standard treatment regimen. However, with fluoride, the decay process does not break down the surrounding enamel as it progresses down the grooves because the enamel is so hard. Instead the decay moves down the grooves, penetrates the enamel and undermines it. There is little or no visual changes on the surface of the tooth and the explorer does not "stick". 2. The Change in Radiographic Film X-ray units sold previous to the early 1960's were 65KV machines. The film speed used was slow and as a result the radiation necessary to expose this slow film required the patient to be radiated for a period of two to three seconds for the typical periapical or bite-wing. In the 1960's and 1970's, radiation exposure became an important issue to the general public. Dentists and other health care practitioners were instructed to reduce their diagnostic radiation. As a result, faster film was developed that required less time for the patient to be exposed to the X-rays. The use of faster film also reduced the clarity or definition of the radiographs. This results in occlusal decay not being seen until the areas are very large.
The Results of the Combination of Fluoride and Faster Film The introduction of fluoride has produced an entire generation who, for the most part, only have restorations on the occlusal of posterior teeth. This is an advancement over the previous generations' dental condition. However, most of these occlusal restorations are the typical G.V. Black "extension for prevention" amalgams. This means waiting until areas of decay are evident on a radiograph or until an explorer "sticks", results in a much larger restoration than is necessary in the light of today's expertise. Haven't we all decided to treat an occlusal pit or fissure of a molar we first saw as a "watch" area one, two, perhaps three years earlier, only to now discover a large area of decay not visible on the bite-wing radiograph? Sound familiar? CONCLUSION: Using only radiographs and the explorer to diagnose occlusal decay will result in unwarranted removal of good tooth structure because caries detection is delayed!
How Occlusal Decay Should be Diagnosed and Treated Today 1. Caries Detecting Solution Other methods of detecting occlusal decay have to be performed. The caries detection solutions that have recently been developed will now show the pits and fissures that need treatment long before they can be detected with the older method of radiographs and an explorer. The diagnostic procedures adequate in the 1950's through the 1980's are no longer proper treatment. Caries detecting solutions must be applied to help dentists diagnose decay before it progresses too far. 2. Micro Air Abrasion The technique of Micro Air Abrasion allows a dentist to remove areas of a tooth as narrow as 1/50th of an inch. Once the air abrasion technique is mastered, these pits and fissures can be treated much earlier than before, resulting in a minimal amount of tooth structure being removed. This can be accomplished about 90% of the time without the use of a local anesthetic, without the sound so many patients object to, and without the vibration of a rotary instrument. When minimal tooth structure is removed, bonded composite resins can be placed which restore the tooth to 90-95% of its original strength and 100% of its original appearance. Patients are enthusiastic when they realize decay removal can be accomplished as a pleasant experience long before complications occur.
A Simple Test To Perform Collect a number of extracted teeth. Determine which teeth appear to have "watch areas" and which have no visible decay on the occlusal surface. Separate them into two groups and take radiographs of each tooth. Discard any teeth on which you are able to see occlusal decay. Mark the remaining teeth so as to be able to identify the corresponding radiographs. Next, apply caries detecting solution to the occlusal surfaces of all the teeth. After 10 to 15 seconds wash off the excess solution. (I suggest using a green color solution rather than red because of its higher visibility.) The teeth you determined had "watch" areas will retain the stain. You will also discover that 75-85% of the teeth you determined had no decay, will show pits and fissures that are stained by the caries detecting solution. Remove the teeth that did not retain any stain from the test. Now you will have a collection of teeth that will exhibit stain in occlusal pits and fissures which can be checked with the radiographs, and prove that the radiographs show no enamel penetration of decay into the dentin. Using your high-speed hand-piece, remove the stain from these grooves. When all the stain is gone, re-stain the teeth. (The solution does not fully penetrate the whole of the decayed area at one time.) Keep removing the stained tooth structure and re-stain until the tooth no longer retains the stain. It will help to use some form of magnification because the tortuous path carious lesions can take can be difficult to follow. You will find virtually 100% of your "watch" areas and 85% of those in the group you felt had no decay (but retained stain in the pits and fissures) will have caries that extend into the dentin. Serially section the teeth to exactly check the dentinal penetration. Now check the radiographs. WOW! Was the width of the preparation you made in these teeth wider than 1mm? If the tooth had been diagnosed earlier with caries detection solution and treated with air abrasion, the preparations would have been only 1mm wide. If these were your teeth, or those of your family, how would you want them treated? THE EARLY DETECTION AND TREATMENT OF OCCLUSAL DECAY IS ESSENTIAL. HOWEVER, YOU MUST USE CARIES DETECTION SOLUTION AND MICRO AIR ABRASION TO ACCOMPLISH THIS!
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Air Abrasion is a gentle spray of an air and powder mix that removes tooth decay. By controlling the speed and the intensity of both the powder and the air,we can make the procedure virtually painless. Since a shot is not necessary in most cases, you will not have numb or drooping lips after your dental procedure.
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