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Conservative

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Overview
Conservative dentistry involves procedures for eliminating caries and closing cavities after the elimination of the enamel and decayed dentine.

Caries may be either superficial or deep. With the former, it is necessary to remove only part of the dentine and enamel and fill the tooth with suitable materials (silver or compound amalgam). Silver amalgams have now been replaced with compound materials which, thanks to their adhesive qualities, make it possible to prepare smaller cavities than with the amalgams, which required special retentive features.

With deep caries the tooth pulp which also contains nerve endings may be involved, therefore suitable canal treatment must be carried out.

The term conservative indicates the goal of these treatments, that is the conservation of teeth which would otherwise be destroyed by caries.

 

How it works

Laser-assisted treatment of hard tissues

Caries are none other than infectious events provoked by certain bacteria causing the hard tissues to soften with a loss of normal tooth anatomy.
Traditional treatment demands accurate hygiene, using a rotating instrument (drill) to mechanically remove destroyed tissue and obtain a cavity that must then be filled with special compound resins to reconstruct and restore the tooth's anatomical appearance and function.
Despite its unquestionable efficacy, the drill causes discomfort and pain by generating heat and mechanical vibrations, consequently a local anaesthetic is often necessary.
The phobia surrounding this instrument is well known and often linked to traumatic encounters with the dentist, especially during childhood.
Laser is a valid alternative to the drill since it removes caries and old compounds without touching the teeth, thereby preventing the discomfort of vibrations. Moreover, it enables preparation of the cavity and relative bite, decontaminating the area at the same time. This reduces any post-op complications or relapses. Laser also produces less heat than the drill as the action is extremely superficial.
Erbium laser (Er:YAG) is used for treating hard tissues with a wavelength of 2940 nm, absorbed by both water and hydroxyapatite. The electromagnetic energy is absorbed by the water molecules and transformed into thermal energy, taking the temperature above boiling point. The increase in temperature rapidly turns the water into steam which causes an increase in pressure and a series of micro-explosions that induce a mechanical ablative effect and remove the tissue.
The Er:YAG laser beam cuts through the healthy and pathological enamel and dentine. Its efficacy depends on the percentage of water contained in the target tissue.
Decayed dentine is consequently removed far more rapidly since it has a higher water content (25%) than healthy dentine (8%), which in turn is cut less than the enamel for the same reason.
Erbium laser vaporises a surface area with a diameter of 0.5 mm whereas the drill removes a greater quantity of dental tissue three-dimensionally. The gauge of the laser beam is very small, ensuring excellent precision of cavity design. The visibility and control of vaporisation of decayed tissue are far superior, and the ablation targets only the decayed tissue without invading the surrounding or underlying healthy tissue. With appropriate control of the energy parameters, it is usually possible to work without anaesthetics or with very low doses (this is particularly suitable for Paedodontics), although this depends to a large degree on the operator's experience and skill.
Reconstruction of the lesion is carried out using traditional methods. Numerous studies have revealed how the use of laser favours the adherence of the compound resins to the tooth making it much stronger after laser treatment and guaranteeing a more stable filling.
 
Desensitisation of the teeth