a little “bit” of gc uk history · pdf filesite 2 - the ant/post areas between any...

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Birmingham Uni MSc 28th November 2012 1 Birmingham Uni MSc 28th November 2012 2 2

I hope to engage your interest!!

Birmingham Uni MSc 28th November 2012 3 3

A Little “bit” of GC UK History

Birmingham Uni MSc 28th November 2012 4

RESTORE



Some Dentists love their “Fillings”

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1896

We will be engaged in practicing preventive rather than reparative dentistry. When we will so understand the etiology and pathology of dental caries that we will be able to combat its destructive effects by systemic medication


Dr Mount’s New Cavity Classification

Site 1 - The pits & fissures on smooth surfaces.

Site 2 - The ant/post areas between any 2 teeth.

Site 3 - The gingival or cervical margin around the full circumference of a tooth.

Cavity sizes

Size 1 – Minimal

Size 2 – Moderate

Size 3 – Enlarged

Size 4 - Extensive


RESTORE


Primary Dentition


Permanent Dentition


GIC’s were developed in the UK by Dr Alan Wilson at LGC

Multiple applications with better physical properties

GIC’s could do the job and do it better!

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Dr John McLean - Cermet


What is a glass-ionomer?

All glass-ionomers need

two essential components to achieve a true

acid/base reaction.

Powder: Alumino-fluoro-silicate glass

Liquid: Polyalkenoic acid & water


Setting Reaction


GIC - Unique Qualities

CHEMICAL ADHESION

FLUORIDE RELEASE

GC Fuji II

Smear

plug Dentine

Dentinal

Tubule

Seal


Glass Ionomers

Advantages • Self adhesive properties

• No bonding agent needed

• Not affected by moisture • No rubber dam needed

• Fluoride release • Protection against secondary caries

• Anti-bacterial effect?


Glass Ionomers

Advantages cont; • Thermal expansion same as

from tooth structure • No stress on the margins/bonding agent

• Perfect seal is paramount for longevity

• No shrinkage stress during polymerisation • No gap formation

• Compensation mechanism for polymerisation shrinkage not needed

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Disadvantages • Limited aesthetic result

• Lower resistance to abrasion • Less strong and durable

Indication • Restorations where aesthetics are not most

important factor

Glass Ionomers


GC Fuji II LC 1992 FIRST DUAL CURED RESTORATIVE GIC


“ Quality of the SEAL ? “

How technique sensitive ?

How long does it last ?


Prof. Hien Ngo Hien Ngo qualified in dentistry at the University of Adelaide in 1982 and completed a MDS in fixed prosthodontics in 1990. He was appointed Principal Consultant to the Colgate Australian Clinical Dental Research Centre, Adelaide University in 1998 and Research Director of the Centre since 1999. At present, Dr Ngo’s main focus in research revolves around the interactions between the glass-ionomers and the dental tissues as well as the application of various microscopy and microanalysis techniques in cariology research. He has lectured extensively in Australia and internationally on these topics as well as the introduction and application of the Minimal Intervention concept.


Hien slides 1

Composite restoration “patchy” filling.


Hien slide 2

Steps 9x9x9x9x9 = 0.48

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Hien slide 3-6

Flat tubelles impossible to etch toward labial & palatal surface.


Shrinkage of VLC Composites Can be compensated by different

techniques


Chemically Fused SEAL





Hypermineralized & Acid Resistant Birmingham Uni MSc 28th November 2012 30


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Which is more important?

The bond strength achieved

or the seal maintained? Birmingham Uni MSc 28th November 2012 32

The repeat restoration cycle – GIC.

Minimal occlusal glass ionomer

Restoration maintenance

Further glass ionomer added

Composite laminate on GIC base


GC Fuji IX GP - History Millions of people world-wide can not obtain posterior restorative treatments due to lack of electricity

Problem Solution Preparation with burs not possible Work with hand instruments

Restorations with VLC materials Search for alternative materials


GC Fuji IX GP - ART Technique

Atraumatic Hand instruments

Restorative Treatment New material to be developed self adhesive

self curing

condensable

high physical properties

high wear resistance

protection against sec. caries


GC Fuji IX GP – Main composition

Powder w/w

Alumino-silicate glass 95%

Polyacrylic acid 5%

Pigment trace

Liquid

Polyacrylic acid 40%

Polybasic carboxylic acid 10%

Distilled water 50%


History of GC Fuji IX series

1994

1995

1995

1999

GC Fuji IX

GC Fuji IXGP

GC Fuji IXGP FAST

More aesthetic

More Convenient

Faster

GC Fuji IXGP CAPSULE

EXTRA improvement

2006 Fuji IX GP EXTRA

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Glass-Ionomer Cements


GIC

chemistry

Protection

during

setting


The Effect of Early Water Exposure on GIC Restorations

9 years 11 years


Achieving optimum clinical outcomes

Protect conventional glass ionomer cements during their initial setting reaction

Apply protection early

All glass ionomers are sensitive to dehydration for periods up to 6 months

Fast setting glass ionomers have minimal moisture sensitivity.


GIC

chemistry

Protection

during

setting

Speed of

set

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Birmingham Uni MSc 28th November 2012 43 Birmingham Uni MSc 28th November 2012 44

Working t im e

Working t im e

Wait ing Tim e

before finishing

Wait ing Tim e

before finishing

0 60 120 180(sec)

30 sec faster

Final finishing can be started after just 2 and 1/2 minutes after mixing.

Physical properties

EXTRA fast setting time


Class I cavity in resin teeth

1 hour after mixing

Shade A2

Ketac Molar

Aplicap

Fuji IX GP

EXTRA

RIVA

self cure

FAST

Best shade matching

Fuji IX GP

FAST

Physical properties

EXTRA good shade matching


GIC

chemistry

Protection

during

setting

Speed of

set

Finishing and

polishing


Pic of occlusal

matrix and

gingival matrix



The best surface finish is achieved with a matrix

Finishing and polishing cannot begin until a certain level of physical strength has been reached within the glass ionomer

It is important to maintain the water balance during finishing and polishing – do not dehydrate

Use a lubricant when polishing with abrasive discs

AND NOW WE HAVE A NEW TECHNOLOGY

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Revolutionary Surface Treatment

EQUIA COAT from GC Nano-filled self-adhesive Light-Cured Protective Coating


Fuji IX GP Extra - Aesthetic

EXtra gloss with coating

• Nice-looking restoration

• Smoothness equivalent to

natural tooth structure

Coated and non-coated (polished with #600 paper) restorations


Dispense EQUIA-Coat into dispensing dish

Application

Within 1 minute

EQUIA-Coat PLUS should be immediately applied within 1 minute dispensing.

EQUIA-Coat - Procedure

Time from dispensing to application


Clinical case – Lassocinski

GC Fuji IX GP EXTRA and EQUIA-Coat on Tooth 46


EQUIA


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GIC

chemistry

Protection

during

setting

Speed of

set

Finishing and

polishing

Optimum

adhesion



Conditioning the tooth removes the smear layer and

increases the surface energy for better wetting of the glass ionomer

For successful adhesion a glass ionomer must have free polyacrylic acid when applied, ie. it needs to look “wet” and be “sticky”

Do not dehydrate the tooth prior to glass ionomer placement


GC Cavity Conditioner Composition

w/wPolyacrylic acid 20 %

Aluminium chloride 3 %

Distilled water 77 %

Blue pigment trace


GC Cavity Conditioner Instructions for use

I. Prepare tooth

II. a. Apply GC Cavity Conditioner to dentine and

enamel

b. Leave for 10 sec.

III. a. Spray

b. Air dry. Do not desiccate

IV. Apply GC glass ionomer cement


GIC

chemistry

Protection

during

setting

Speed of

set

Finishing and

polishing

Optimum

adhesion

Delivery

systems



Capsules

• optimal flow and wetting properties

• optimum physical properties

• consistency and convenience of mix

Capsule activation techniques are important

Powder/liquid mixing

• work fast

• lowering powder/liquid ratios creates problems

Paste/paste is offered as an alternative to powder/liquid for RMGIC

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GC FujiCEM - Composition

Paste A Paste B

Fluoroaluminosilicate glass Polyacrylic Acid

HEMA Distilled Water

Dimethacrylate Silica

Birmingham Uni MSc 28th November 2012 63 Wright Cottrells 7th May 2011 63

November. 2009

GC CORPORATION

R＆D DEPT.

Fuji TEMP Temporary Luting Cement

(CODE NAME：IMC-200)

launched in Japan last July


Optimum

adhesion

GIC

chemistry

Interaction with the

oral environment

Protection

during

setting

Speed of

set

Finishing and

polishing

Delivery

systems


GI cements are dynamic structures

They can release and uptake fluoride

They increase in hardness when exposed to saliva exhibiting an uptake of Calcium and Phosphate

They can release apatite forming ions which can contribute to the internal remineralisation process



In severely acid-challenged mouths, eg.

head/neck radiation patients, the use of glass ionomer is desirable

Resin modified glass ionomers are more acid resistant than conventional glass ionomers

• RMGIC restorative/base (Fuji II LC)

• RMGIC adhesive + composite (Fuji BOND LC)


Moving away from the surgical approach to caries management

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RESTORE


IDENTIFY


Surgical control of caries

Restorations per se will not prevent or eliminate disease. Caries is a bacterial infection and until the

micro flora is controlled, all restorations are at risk of further

demineralisation.


Demineralisation Remineralisation

Testing Saliva tells us about “oral balance”

ACID SALIVA

acid from bacterial breakdown of

fermentable carbohydrates

= CARIES

acid which is ingested (eg Coke) or

acid from internal source (eg Reflux)

= EROSION, ATTRITION

Saliva, combined with

- Fluoride exposure,

- Good oral hygiene


Net loss of calcium and

phosphate ions below

critical pH

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The first question to consider:

“Why is this patient’s oral balance now

favouring demineralization?”

•Why has this mouth become more acidic?

•Why is their saliva not protecting their teeth?

How do we monitor?

•3 Tests available

•Risk assessment

•Saliva buffer check kit


Tri Plaque ID Gel


Saliva-Check BUFFER

Step 1: Test

the degree

of hydration

Step 2:

Assess the

resting

viscosity

Step 3:

Test the

resting pH of

un-stimulated

saliva

LJ Walsh LJ Walsh

H Ngo

Test un-stimulated saliva

Step 4:

Measure quantity

stimulated saliva

Step 5:

Measure

Buffering

Capacity

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Saliva Flow

Why would saliva flow be low/very low?

• Time of Day

• Nature of stimulus

• Olfaction (sense of smell)

• Smoking

• Unilateral stimulation

• Gland size

• Food intake

• Gland dysfunction

• Medication


Test stimulated saliva

Step 4: Test

quantity of

stimulated saliva

(5 mins)

Volume of Saliva

Value

<3.5 mL

very low

3.5-5.0 mL low

>5.0 mL normal

NB. Use the “traffic light” as your patient communication tool


Research

Buffer Strip developed in 1989 by Bratthall/Ericson.

University Lund Malmo Sweden

Study carried out using 62 samples of stimulated saliva and compared with two commonly used methods: an electronic method and dentobuff strips. Both methods correlated well.


Test stimulated saliva Step:5

Test buffering

capacity of

stimulated

saliva (quality)

Green =

4 points

Blue =

2 points

Red =

0 points

Combined total

Buffering ability

0-5

very low

6-9 low

10-12 Normal/high

NB. Use the “traffic light” as your patient communication tool


How to Record Results


Saliva-Check BUFFER In Vitro

Test for pH and Saliva Buffering Capacity

In which clinical situations is it important to test a

patients saliva?

-For those patients presenting with new oral health

problems (as a diagnostic tool to help identify potential causes of the

problem)

-Prior to extensive restorative treatment (what caused the loss

of tooth structure in the first instance – will the same problem

compromise the success of any new restorative treatment?)

-As part of Risk Assessment for any patient within a

dental practice (understanding where the Oral Balance rests before

irreversible loss of tooth structure takes place)

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RESTORE


Caries prevention strategies

Increasing fluoride exposure

Decreasing level of Mutans Streptococci

Increasing saliva flow

, pH, buffering capacity

Increasing availability of Calcium & Phosphate ions

Topical fluoride – gel, paste, varnish, rinse etc

Chlorhexidine rinse, varnish etc (F, Xylitol)

Sugar-free chewing gum

Casein Phosphopeptide- Amorphous Calcium Phosphate CPP-ACP


Prevent


Casein Phosphopeptides (CPP)

Milk protein

Developed by Prof Eric Reynolds at University of Melbourne

CPP is an excellent delivery vehicle to co-localise Calcium and Phosphate at the tooth surface in a slow release amorphous form; CPP-ACP


CPP-ACP (Recaldent )

Safe

Helps to maintain a state of super-saturation of Calcium and Phosphate ions on the tooth surface

Depressing enamel demineralisation

Enhancing remineralisation

Buffers plaque pH

TM


Dentinal Hypersensitivity

Before

After

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CPP-ACP in plaque

CPP-ACP


Cadbury Launches “Trident” gum in the UK


Research

Over 100 studies testing

all aspects of Recaldent in various preparations and concentrates. Laboratory based trials

Cadburys Schweppes have completed and published a significant clinical trial which appeared in April 2009 “Caries Research”


Who might benefit from Tooth Mousse?


Gingival recession


Xerostomia

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Erosion


Fixed orthodontic appliance

Birmingham Uni MSc 28th November 2012 100 Wright Cottrells 7th May 2011 100 Birmingham Uni MSc 28th November 2012 101 101 101

Active Care: Remineralisation: Recaldent™

Tooth Mousse™ Application • Daily tray application with GC Tooth Mousse™

for 5 min./day

Reynolds, 1987; Reynolds et al., 1995; Schupbach et al., 1996; Holt et al., 1996; Reynolds, 1997; Reynolds, 1998; Ardu S et al., 2007; Cai F et al., 2003; Iijima Y et al., 2004.


MI Paste Plus-CPP-ACFP

Birmingham Uni MSc 28th November 2012 103 103 103

Remineralisation by Tooth Mousse™ & MI Paste Plus™

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When to use toothmousse?

Application of CPP-ACP immediately following brushing with a fluoridated tooth paste will have a synergistic effect on remineralisation

Application of CPP-ACP immediately after acid challenges will help desensitise and localise bioavailable Calcium and

Phosphate for remineralisation and will stick to plaque.


How to use Toothmousse

Apply with clean finger

Apply interdentally with brush

Custom made/bleaching tray

NB. Tray application more effective for multiple area


PREVENT

Fuji Triage (formally Fuji VII)


Glass Ionomer & Resin based fissure sealants A clinical study 1990 - Mejare and Mjör

61% of GIC sealants were lost in 6-12 months macroscopically. 84% were lost over 30-36 months.

48% & 37% Delton/Concise were fully maintained after 36 months.

Resins were adapted better than GIC’s and remained smoother.

KEY FINDINGS

Caries was recorded in 5% of the resin sealants but was not found in the gic group even with the extensive loss.

Although 84% were clinically lost, the replicas revealed traces of gic in virtually all of them


An Atlas of Glass-Ionomer Cements Third Edition - G J Mount

The earliest fissure sealants were unfilled or lightly filled resins; but recent research has shown

that there are some doubts about the integrity of the acid-etch union between resin and enamel

in these regions. It has also been shown that a glass-ionomer will also successfully occlude

such a fissure and this is now being termed ‘fissure protection’ to differentiate it from a resin seal.

A scanning electron micrograph of a glass-ionomer

fissure seal demonstrating the usual ion-exchange

adhesion to the walls of a fissure some little distance

down from the occlusal surface. The glass-ionomer

appears to be well attached, regardless of the nature of

the enamel rods. Magnification X1600

Other surveys have recovered acceptable longevity for similar restorations

using stronger materials and in these cases the GIC appears to remain in

place very satisfactorily.

A very high magnification of the amorphous layer of

enamel. Note that whatever enamel rods there are

appear to be running parallel to the surface rather than at

right angles to it. This suggests that it will not be possible

to develop the usual etch pattern of the enamel surface

for micromechanical attachment of a resin fissure seal.

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Re-accumulation of plaque (shaded) at 48 hours in partially and fully

erupted molars, Carvalho JC, Ekstrand KR, Thylstrup A.

Dental plaque and caries on occlusal surfaces of first permanent molar in relation to stage of eruption.

J Dent Res 1989; 68: 773-779


What can I use Fuji Triage for?

Fissure Protection

Root Surface Protection

Caries Stabilisation

Intermediate Restorations

Endodontic Sealing

Hypersensitivity

Lining

Cementation of Molar Bands

Ozone Treatment, PAD


Fuji Triage

Pink, for identification

Command set

Minimal water sensitivity

Flowable consistency

High fluoride release

Protection for “at-risk” surfaces

Intermediate restorations

NOW AVAILABLE IN WHITE & POWDER/LIQUID


First Patent 1969

First Generation 1975 • Ketac Cem Fuji 1

Second Generation 1980 • Ketac Fil, Fuji 2, Fuji 3

Cermet 1985

Resin Modified 1990 • Vitrebond, Photac Bond, F2 LC

High Strength 1995 • Ketac Molar, Fuji 9

Fast setting High Strength 2000

• Ketac Molar Quick, Fuji 9 Fast

Command set 2002

Glass Ionomer Cements


BRINGING ABOUT CHANGE


Team Approach to Mi

RESTORE

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UK DENTISTRY ADVANCING INTO THE NEW MILLENIUM

JULY 2002 – EXTENDED DUTIES


NICE Document


Dental teams are Healthcare Professionals

• The MI practice must take a team approach

• Follow the process of extended duties

• MI works best when all members of the team play their part in the motivation and education of the patient

Hygienist

Therapist

DENTIST

Manager DSA/OHE


The Business of MI dentistry

Improve patient motivation and communication • Tri Plaque PH Test

• Saliva Buffer Test

Resulting in relevant oral health lifestyle advice and leading to a thorough understanding of the dental problem both by dental team and patient


The Business of MI Dentistry

Profit Centre 1 - Dentist

Restorative Dentistry

Endodontics

Implants

Rehabilitation

Cosmetic Dentistry

Profit Centre 2 - DCP

Restorative Dentistry

Periodontology

Patient Education

Treatment planning with Dentist

Profit Centre 3 - DSA/OHE

Patient Education

Patient Risk Assessment

Saliva Testing

Life style advice

Profit Centre 4 - Manager

Retail of dental sundries

Monitor use of sundries by patients

Dental product advice


Identify,

Plaque & Saliva Test

DSA/OHE

Restore Restore with self

Adhesive materials

Dentist/Therapist

Prevent Fissure protection

plaque control

Hygienist/Therapist

The Business of MI Dentistry

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Awareness – Financial Model

MI Advisory Board and the

MI Treatment Plan

Members & Protocol


The GCE MI Advisory Board,

a Pan-European group of Academics and General

Practitioners, has designed a Treatment Plan

for the implementation of the MI philosophy into

“Routine Clinical Practice”.

Birmingham Uni MSc 28th November 2012 125 125 125

Advisory Board

Chairman

Roussel, Frederic (GC Europe, Belgium)

Scientific Coordinator

Reich, Elmar (University of Cologne, Germany)

MI Advisory Board Members

Banerjee, Avijit (King’s College London, UK)

Basso, Matteo (University of Milan, Italy)

Blique, Michel (Luxemburg)

Doméjean-Orliaguet Sophie (University of Auvergne, France)

Gaucher, Céline (University of Paris V, France)

Khandelwal, Piyush (GC Europe, Belgium)

Lavoix, Laetitia (GC Europe, Belgium)

Milètic, Ivana (University of Zagreb, Croatia)

Zalba, José (Pamplona, Spain)


Treatment Plan – Flow Chart N°1 Identify

Diagnosis: Establish patient susceptibility

Aetiological factors for susceptibility

Visual caries lesions detection: Modified ICDAS

Anamnesis

Oral examination Investigatory X-rays: Bitewing

Recall Recall

Prevent Treatment Plan

No lesions Irreversible / Cavitated Lesions Reversible / non-Cavitated Lesions

Restore MI - Invasive treatments MI - Non Invasive treatment

Preventive Active Care Preventive Active Care Preventive Active Care or Maintenance

Susceptibility: High or Low


Mi Symposium – PEF and IADR Update

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Mi Treatment Plan “Roll Out” Update


MiTP Booklet


Pickards Manual by Prof Avi Banerjee - MSc

DENPLAN Conference 12 & 13th 09-2009


Denplan “Roll Out” 8 Venues in the UK 2011


Denplan 2012


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Mi and HSM/SOE


Mi articles – February 2012



FUTURE POLICY – Care pathways



Thank you for listening!

Any Questions?

a little “bit” of gc uk history · pdf filesite 2 - the ant/post areas between any...

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