210. John Timothy Wright DDS, MS - Resin Infiltration and Sealants for Caries Management
Feb 6, 2024
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Dr. John Timothy Wright discusses caries management, demineralization, and remineralization in restorative dentistry. Topics include resin infiltration, sealants, and the importance of clean margins in dental procedures. The podcast debunks myths about anaerobic bacteria and emphasizes evidence-based practices in dental care.
Clean margins and seals are crucial for successful restorations, emphasizing the importance of enamel margins and sealants in preventing caries.
Maintaining a balance between demineralization and remineralization is vital for oral health, highlighting the role of fluoride in enhancing enamel resistance.
Deep dives
Importance of Clean Margins and Seals
One of the key points discussed in the podcast episode is the importance of having clean margins and seals in dental restorations. It is emphasized that a good seal is crucial for the success of any restoration, including protected restorations and atramatic restorative treatments. Without a proper seal, the restoration is likely to fail. The role of clean margins in ensuring a strong bond is highlighted and it is explained that enamel margins are preferred due to their strength and ability to resist bacterial infiltration. Additionally, the podcast emphasizes the relevance of sealants in preventing pit and fissure caries, with evidence supporting their effectiveness in preventing up to 70% of caries in these areas.
Understanding Demineralization and Remineralization
The podcast delves into the process of demineralization and remineralization and its significance in restorative dentistry. Demineralization, driven by microbial metabolism and acid production, leads to the breakdown of enamel. Conversely, remineralization occurs through the action of saliva, bringing in ions that help redeposit minerals and restore the enamel. The importance of maintaining a balance between these two processes for optimal oral health is stressed. The podcast mentions the work of John Featherstone, known for his studies on remineralization, and explains that fluoride can enhance the resistance of enamel to acid attacks. It is highlighted that while teeth become more resistant to caries over a person's lifetime, the susceptibility to caries can still change based on various factors such as environmental exposures and changing saliva levels.
Resin Infiltration and Arresting Caries
The podcast discusses resin infiltration as a treatment option for incipient caries lesions, particularly for E1, E2, and D1 lesions. Resin is flowed into the interproximal areas to arrest the lesions and prevent further demineralization. However, it is mentioned that resin infiltration does not entirely impede the remineralization process and does not guarantee complete cessation of demineralization. The speaker mentions the resin infiltration system called Icon, which has shown approximately 70% effectiveness in clinical trials over three years. Alternatives like silver diamine fluoride (SDF) are also discussed as potential treatment options, although the evidence for SDF in arresting approximal lesions is limited. The podcast suggests selective case selection for resin infiltration and alternative treatments like silver diamine fluoride or fluoride rinses in certain situations.
Evidence-based Guidelines for Pit and Fissure Sealants
The podcast refers to an article discussing the evidence-based clinical practice guidelines for the use of pit and fissure sealants. The guidelines, developed jointly by the American Dental Association and the American Academy of Pediatric Dentistry, highlight the high effectiveness of sealants in preventing pit and fissure caries. According to the guidelines, sealants can prevent up to 70% of caries in these areas. The importance of clean margins and proper moisture control for successful sealant placement is emphasized. The article also addresses the choice of materials for sealants, mentioning that there is currently no superior material established by clinical data. Resin-based sealants are preferred on well-isolatable teeth, while glass ionomer sealants are recommended for partially erupted teeth or situations with moisture contamination issues.
Tim Wright served as chair of the pediatric dentistry program. He has published over 200 peer reviewed manuscripts, edited two texts and authored 24 text chapters. Wright’s research interests include human genetics and craniofacial development and he has had over 25 years of NIH funding. He has chaired the Council for Scientific Affairs for the American Dental Association and American Academy of Pediatric Dentistry and is the current President of the American Association for Dental Research.
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