air abrasion technology in conservative dentistry new technology in conservative that has got rebirth...

5. MINIMALLY INVASIVE
DENTISTRY is the need of the
hour as the conventional
‘extension for prevention’ is being
challenged and the more
conservative forms of operative
intervention are being
recommended.

6. Procedures that aid in the
removal of carious hard tissue,
causing little or no damage to the
adjacent sound tooth structures
are fast being researched.

7. Advance in diagnosis Advance in treatment
 CAT scans
 Digital X- ray
 RVG
 Intraoral Camera
 Digital Photography
 Botox therapy
 Ozone therapy
 Stem cell therapy
 Laser treatment
 Sedation dentistry
 Painless anesthesia
 NTI-tss Device
 Air abrasion

8. INTRODUCTION
New dental technology offer better
solutions for traditional oral health
problems than ever before.

9. The trend in dentistry is
utilizing technology to make
dentistry more comfortable, durable,
efficient and natural-looking for the
patient as possible.

10. Patients and their dentists benefit
from newer techniques that are
less invasive and more
dependable than the years of
past.

11. Procedures that formerly took
multiple trips to the dentist or
required multiple health care providers
can often be performed in the comfort
of one office by one qualified provider.

14. Botox therapy
Ozone therapy
Stem cell
Laser treatment
Sedation dentistry
Painless anesthesia
NTI-tss Device
Air abrasion

15. AIR ABRASION

16. Air abrasion dentistry has evolved
over a period of time from a new
concept of an alternative means of
cavity preparation to an essential means
of providing a truly conservative
preparation for preservation of a
maximal sound tooth structure.

17.  The development of bonded
restorations in combination
with air abrasion dentistry
provides a truly minimal
intervention dentistry.

18. Air-abrasion is a great dental
advancement over the dental
drill as it allows precise removal
of decayed teeth without the use
of a local anesthetic.

19. DEVELOPMENT OF AIR ABRASIVE
TECHNOLOGY
 The father of concept is an American Dentist,
Dr. J. Tim Rainey, from Refugio, Texas, USA.
 He was a student and friend of late Dr. Robert
Black, who actually invented and unsuccessfully
introduced the first air abrasive machine in the
1950’s.

20. development….
 Dr. Rainey was able to improve
and combine this technology
with the use of modern adhesive
restorative material.

21. development….
The instrument was first developed in the
1940’s by Dr. Robert Black .
In 1951- S.S. White technology introduced
Air- Dent the first commercially
available unit for preparing cavities in
teeth with air abrasion.

22. development…
New technology for the 1990’s - Air
abrasion resurfaced as an exciting “new
technology” that acts in synergy with
rapid evolution of adhesive dentistry,
which has changed tooth preparation
requirements and eliminated the need for
mechanical retention.

23. It is a method of tooth structure
removal that is considered to be an
effective alternative to the standard
dental drill.
In 1943 Dr. Robert Black of Corpus
Christi Texas began his pioneering work
in this field.

24. In 1945 he published a series of articles
on the use of air abrasive technique for
cavity preparation and prophylaxis.
An air abrasive unit called AIRDENT
was introduced in 1951

25.  Air abrasive technology is the use of
compressed air to propel aluminium
oxide particles with such force as to be
able to cut tooth structure in simple
terms it is a precision sandblaster.

26. The air-abrasion system uses
blasts of pellets of air and
aluminum oxide to treat tooth
problems such as cavities.

27. In spite of showing promising
results, the concept did not gain
popularity due to three major
factors;

28.  Firstly,
 not able to prepare cavities with
well-defined walls and margins,
materials during that time (mostly
amalgam and direct or indirect gold)
demanded such preparations since the
concept of bonding had not been
introduced.

29. • Secondly,
the introduction of the air turbine
hand piece in the late 1950s made
conventional cavity preparations
less time consuming.

30. Thirdly,
 as high-velocity suction had
not been developed, evacuation
of the powder was difficult.

31. Principles of Air abrasion
1. Accurate diagnosis of unsound tooth
structure and decay.
2. Accurate removal of unsound tooth
structure with minimal destruction of
sound tooth structure.
3. Restorative treatment planning based on
the probability of longevity of the
restorative material.

32. Though the basic concept of the air
abrasion device has remained the same,
it has experienced a rebirth not due to
changes in the device per se, but due to
improvements in bonding, restorative
materials, isolation, and high volume
suction.

33. AIR ABRASION SYSTEMS AND FEATURES
Air abrasion devices include ;
1) Cart
2) table top
3) handheld models.

34. System and features….
Hand held devices are generally not
suitable for restoration
preparation but used to prepare
tooth, metal, composite or
porcelain surfaces for bonding.

35. System and features…
Some models have built in features and
accessories, such as
 additional compressor,
 evacuation system and
 high intensity curing light.

36. System and features…
Some systems (ex. AIR-FLOW Prep K1)
capture the aluminum oxide powder
stream in water spray to reduce the
pollution which increases comfort of
operation.

37. AIR ABRASION

38. Principle behind air abrasion is based
on the formula for;
KINETIC ENERGY
E = ½ mv2
M = mass V = Velocity
the cutting capability of air abrasive is
attributable to the energy of mass in motion unlike
conventional mechanical methods that depend on
friction .

39. When that rapidly moving mass
strikes its target, most of its energy
is transferred to that material,
 if that material is hard the result is
removal of small amount of
material.

40.  If, on the other hand the
material is soft,
- the energy is mostly absorbed
by the material and then the
mass rebounds.

41. That is why the modality is
sometimes referred to as KINETIC
CAVITY PREPARATION (KCP)

42. Air abrasion can be best described as a
pseudo-mechanical, non-rotary method
of cutting and removing dental hard
tissue.

43. The terms “micro air-abrasion”
and
“kinetic cavity preparation”
have been used synonymously to
describe air abrasion.

44. Studies have shown that the bonding of
enamel and dentin surfaces prepared with
air abrasion is much better than that with
conventional carbide burs or acid etching ;
 with the introduction of flowable and
nano-filled composites .

45. Another major concern regarding
the powder particles has also been
averted due to;
 the use of isolation in the form of
rubber dam and
 high volume evacuation devices.

46. PARAMETERS…….

47. A number of parameters such as
the
 amount of air pressure,
 particle size,
 quantity of particles passing through the
nozzle,
 nozzle diameter of the hand
piece,

48. parameters…
 angulations of nozzle of the hand
piece,
distance from object
 time of exposure to the object vary the
quantity of tooth removal and
 depth of penetration.

49. PROCEDURE OF AIR
ABRASION

50. Take preoperative radiograph to determine if interproximal
caries is present
Isolate preferably with rubber dam
Use caries detecting dye to know the carious lesions

51. Using air abrasive unit with high volume evacuation placed in
the proximity of the tooth prepare cavity
After a few seconds of initial preparation examine the
preparation for decay
Re-apply caries detecting dye
Complete the preparation using the caries detecting dye until
all caries is removed

52. Apply the etchant for 20 seconds rinse with water
spray
Disinfect the cavity preparation with chlorhexidine
or other materials
Within 10 seconds apply the dentin-bonding agent

53. Immediately place the correct shade of composite
and photo-polymerize the material for 40 seconds
Use a carbide bur for initial shaping
A flexible polishing cup point or disc will provide the
final polish for the restoration
Remove the rubber dam and check occlusion

58. Advantages
It is painless
Local anesthesia is rarely needed
It works quickly and the tooth with a
small lesion is ready to restore in seconds

59. advantages….
It work quietly without the whine of the
all too familiar dental handpiece
There is no vibration or pressure
There is no production of heat
to damage the dental pulp and
lesser sound tooth structure is
removed.

60. CLINICAL USES
 Class I, II, III, IV, V
cavity preparations
 Sealants and preventive
restorations
 Repair of composite and
porcelain especially
margin of veneers
 Removal of composite
and amalgam.

61. clinical uses…

62. clinical uses…

63. HOW DOES IT WORK?
Air abrasion for restoration preparation
removes tooth structure using a stream of
aluminium oxide particles generated from
compressed air or bottled carbon dioxide or
nitrogen gas.

64.  The abrasive particles strike the tooth with high
velocity and remove small amounts of tooth
structure.
 Efficiency of removal is relative to the hardness of
the tissue or material being removed and the
operating parameters of the air abrasion device.

65. Generally, air pressures range from 40
to 160 psi.
The recommended levels are at 100 psi
for cutting and 80 psi for surface
etching.

66. The most common particle sizes are either
27 or 50 μm in diameter.
 The larger particles allow the clinician to
work faster but will result in comparatively
larger-sized cavity preparations than those
with the 27 μm particles.

67. • Higher particle flow rate will
allow more particles to abrade
the working surface faster.

68. The speed of the abrasive particles
when they hit the tooth depends
upon
 the gas pressure,
 nozzle diameter,
 particle size, and
 distance from the surface.

69. • Typical operating distances from the
tooth range from 0.5 to 2 mm.
• Further distances produce a more
diffuse stream that results in a
diminished cutting ability.

70. A number of variations in tip angulations
and nozzle diameters are available.
Smaller nozzle diameters can be used for
areas that are difficult to access.
The various tip angulations allow easy
placement and orientation of the handpiece
thus easing the strain off the operator's
hands.

71. PRECAUTIONS
1. Need to protect patient with glasses,
rubber dam if possible.
2. Dental team needs masks and glasses.
3. Stop frequently to check the progress.
4. Start with low pressure and low power
then increase as needed.
5. Hold tip 1-2 mm away from tooth at a 45
degree angle then activate.

72. precautions…
6. Always keep tip moving.
7. Requires external suction
and air evacuation for the
room.
8. Use disposable mirrors.
9. Like any air stream air
abrasion can cause
subcutaneous
emphysema.

73. USES/APPLICATIONS?
Specific indications for use of air
abrasion include ;
 caries removal;
 removal of small existing
restorations;

74. uses…..
 preparation of tooth structure for
cutting or etching for the placement
of composites, porcelain and
ceramics; and
 as an adjunct to the
conventional handpiece bur.

75. Some of the situations where
the air abrasion has particularly
proved a boon include:
 Removal of superficial enamel
defects

76.  Air abrasion is an excellent tool for
detection of pit and fissure caries –
Use of burs for this procedure would
remove far more sound enamel than
the few micrometers removed with
air abrasion.

77.  In the event of the operator not locating
any carious lesions, the area can easily be
sealed using a pit and fissure sealant.
 If caries is limited to enamel, then a
sealant or flowable resin-based
composite can be placed.

78.  If caries penetrates into dentin, then the
preventive restoration can be used with a
heavily filled resin in deep or wide areas
subjected to forces of mastication.
Sealant material may be used to cover
non-carious pits and fissures.

79.  Additionally, caries detector dyes
may also be used in conjunction
with air abrasives to detect
incipient lesion
 Air abrasion can also be used for
the removal of pit and fissure
surface stain on
enamel

80. Air abrasion used to remove & restore pit & fissure
caries using 27 micron-sized powder particles.
1) Fissure caries seen on occlusal surface of
mandibular 2nd molar.
2) Tip of air abrasion device placed on molar.
3) Removal of caries

81.  Teeth where the caries is restricted
only to a small section of the tooth
 Box-preparations for Class II cavities
can also be prepared.

82.  Surface preparation of abfractions and
abrasions –
- breaks the glaze of the highly
polished surface that is not suitable for
bonding and produces a highly textured
surface that is excellent for the wet dentin-
bonding technique.

83.  Removal of existing
restorations – the particles of
the air abrasives can be used at
higher pressures for removal of
old amalgam restorations

84. Air abrasion used to
remove old amalgam
restoration using 50
micron-sized powder
particles followed by
replacement with
composite resins.
1) Amalgam restoration
on maxillary molar.
2) Air abrasion device
used to remove amalgam
restoration.
3) & 4)Complete removed

85.  The use of local anesthesia while
working in dentin may be avoided
because of their cooling action through
high pressure air.

87. METHOD OF CLINICAL USE
A number of air abrasion systems are available today
such as the ;
 PrepMaster or EtchMaster (Groman Inc.),
 Airbrator (North Bay/Bioscience, LLC),
 PrepStart and PrepAir (Danville Engineering), or
 CrystalMark (CrystalMark Inc.) all of which work
on the same principle.

88. Some like the RONDOflex plus
(KaVo) work on the principle of air
abrasion technology with water
spray.

89. OPERATOR CONTROLS
MECHANICAL
DIGITAL

90. Mechanical control is
standard in most devices
their control of powder flow rate is
more tenuous than with digital
control
provides a consistent rate while
maintaining high efficiency.

91. Digital control
 In selected devices digital control also allows
for pulsed mode of operation, providing an
interrupted air abrasive stream at settings
from 0.5 to 2.0 seconds.

92. ANGULATIONS OF THE NOZZLE
TIP

93. Air abrasion handpieces and
nozzles are;
 removable to facilitate
sterilization and
have working angles
ranging from
0° to 120°.

94.  For precision cutting,
as might be required for a preventive
resin restoration,
the 80° tip is more appropriate than
the 45° tip.

95. When shallow preparations are
needed,
as in the case of cervical erosion,
the cutting patterns of the
45° tip are more appropriate

96. For facial and lingual
preparations,
a 60° angle produces a
shallower preparation and
allows for evacuation of
reflected spray.

97. Nozzle orifice diameters range from
200 to 800 μm.
 Larger nozzle orifices require
- higher powder flow rates and
- gas pressures to maintain
cutting efficiency.

98. OPTIONAL ACCESSORIES FOR THE AIR
ABRASION SYSTEM
In addition to the different grades of the
powder particles and the various tip
diameter sizes and tip angulations for the
air abrasion handpiece, there a few more
accessories which will provide the clinician
a better working environment:

99.  Air abrasion resistant intraoral
mirror:
Majority of air abrasion operative
dentistry procedures “eat up” an
average of two to three mirrors
per procedure, particularly when
indirect vision is used.

100. mirror…
In an effort to conserve mirrors, the
dentists will have a tendency to migrate
towards direct vision, which in turn
leads to obvious long-term deleterious
effects on one's back.

101. mirror…..
 This mirror designed by CrystalMark Dental
Systems, Inc. can
withstand the indirect blasts of abrasive
powder that are part and parcel of air
abrasion dentistry
come gold-plated for ease of identification by
the staff and
fit the standard no. 5 cone socket handle.

102. Sand trap:
 soft plastic spheres that slip onto
office suction
have a top opening through which
the air abrasive system tip is
introduced.

103. sand trap…
 traps the abrasive particles within the
sphere from where they can be evacuated
through the suction.
prevents the abrasive particles from
entering the patient's oral cavity

104. Power plus booster:
Available as an accessory to the Prep Start
(Danville Engineering)
 recompresses the compressed air up to 135
psi to increase the air pressure to allow for
faster cutting thus reducing the patient
chair-time.

105. Disposable air abrasion handpiece:
The Airbrator® (North Bay/Bioscience,
LLC) is a single-use air abrasion
handpiece that connects to your
existing air-line.

106. disposable….
It is a direct alternative to traditional, expensive,
self-contained air abrasion units. The Airbrator
comes in three grades:
1. High
2. Medium
3. Light

107. High Performance – For small incipient
lesions and cavity preparations.
Medium Performance – For sealants,
etching, bonding, and heavy stain
applications.
Light Performance – (Sodium Bicarbonate
Powder) For removing stains, cleaning, and
polishing.
.

108. Others like the EtchMaster and
PrepMaster® (Groman Inc.) are pre-filled
disposable air abrasion systems that can
adapt to your handpiece connection for
etching and intra-oral cavity preparations,
respectively

109. Super high volume evacuation systems:
Like the RapidVac or Union Medical
Evacuation System is the ideal companion
for all air abrasive systems.
 these devices completely eliminate the
chances of contamination of the dental
operatory with abrasive particles.

110. MicroVibe:
 Mechanical vibrations of the MicroVibe tip
helps resin penetrate narrow gaps
improves the flow of pit and fissure sealants
by increasing the contact between the
sealant and tooth structure for effective
restoration

111. DOES IT HAVE ANY LIMITATIONS?
There certainly are some limitations to
their use such as;
 Air abrasion is not an efficient means
of removing large amalgam restorations
especially, and there is concern for the
levels of mercury released when
amalgam is abraded.

112. limitations…
Air abrasion of amalgam for 1 min
releases mercury vapor four times in
excess of the OSHA standard.
 Same is true regarding removal of
full coverage restorations.

113. limitations….
Air abrasion is also not effective for
removal of gross caries because it does
not cut substances that are soft or
resilient.
 In such cases, however, hand
instruments like spoon excavators can
be used to scoop out the soft lesions
followed by air abrasives

114. limitations...
Also the depth of penetration during
cavity cannot be controlled, so it has
to be accompanied with visual
inspection in regular intervals

115. limitations…
 The splattering of the powder
particles within the oral cavity
and/or their accidental ingestion is
another area of concern for which
use of rubber dam isolation is a
must

116. limitations…
 Air abrasive systems also cannot
be used in conjunction with
magnification devices such as
loupes or dental operating
microscopes as the rebound
particles could cause damage to the
lenses

117. limitations…
 Care must be taken when
working near soft tissues due to
risk of laceration, air dissection,
and emboli.

118. disadvantages…
 An inadvertent spray to soft
tissues is not likely to cause
damage, but a prolonged direct
spray could potentially cause
injury.

119. limitations...
 It is also not suitable for
crown preparations for either
metal or porcelain coverage.

120. DISADVANTAGES
Not recommended for deep cavities that are
close to pulp
Only composite filling material can be used
coz it adheres to smooth surface created by
air abrasion

121. disadvantages….
 Ability to accomplish only some aspects of
dentistry.
Lack of tactile sensation when using the air
abrasion handpiece, because the nozzle of
air abrasion instrument does not come in
contact with the tooth.

122. disadvantages…
Air can cause sensitivity
Non contact based modality, leading
to significant risk of cavity over
preparation and inadequate carious
dentin removal.

123. disadvantages…
Mess and spread of aluminum oxide
around the dental operatory.
Danger of air embolism and
emphysema.

124. disadvantages…
Impaired indirect view because abrasive
particles collect on mirror rapidly
blocking the viewing surfaces.
Damage to dental mirrors, optical
devices like magnifying loupes,
intraoral camera lenses or
photographic equipment.

125. CONTRAINDICATIONS
Asthma patients.
Severe dust allergy.
Chronic pulmonary disease.
Recent extraction.
Open wounds in oral cavity.
Subgingival caries removal.

126. BEST CANDIDATES FOR PROCEDURE
Ideal for use in children and others
who are fearful and have minimal
decay.

127. OTHER PROCEDURES PERFORMED
WITH AIR ABRASION
 Remove some old composite restorations
 Prepare a tooth surface for bonding and
sealants
 Remove superficial stains and tooth
discolorations

128. CONCLUSION
As an adjunct to traditional
restorative techniques,
 air abrasion seems to be carving
out a place of itself in dental
armamentarium.

129.  Air abrasion tooth cutting has
been accepted relatively well by a
small segment of profession.
It is growing slowly and is expected
to continue to grow in popularity

130.  The ultimate goal is to extent life of
restored tooth with as less intervention
as possible.
When operative care is indicated it
should be aimed at
“PREVENTION OF EXTENSION”
rather than
“EXTENSION FOR PREVENTION”.