The compression dome concept: the restorative implications.

Evidence now supports the concept that the enamel on a tooth acts like a compression dome, much like the dome of a cathedral. With an overlying enamel compression dome, the underlying dentin is protected from damaging tensile forces. Disruption of a compression system leads to significant shifts in load pathways. The clinical restorative implications are significant and far-reaching. Cutting the wrong areas of a tooth exposes the underlying dentin to tensile forces that exceed natural design parameters. These forces lead to crack propagation, causing flexural pain and eventual fracture and loss of tooth structure. Improved understanding of the microanatomy of tooth structure and where it is safe to cut teeth has led to a revolution in dentistry that is known by several names, including microdentistry, minimally invasive dentistry, biomimetic dentistry, and bioemulation dentistry. These treatment concepts have developed due to a coalescence of principles of tooth microanatomy, material science, adhesive dentistry, and reinforcing techniques that, when applied together, will allow dentists to repair a compromised compression dome so that it more closely replicates the structure of the healthy tooth.

Reconsidering remineralization strategies to include nanoparticle hydroxyapatite.

Dental caries is a transmissible biofilm-mediated disease of the teeth that is defined by prolonged periods of low pH resulting in net mineral loss from the teeth. Hydroxyapatite, fluorapatite, and the carbonated forms of calcium phosphate form the main mineral content of dental hard tissues: enamel, dentin, and cementum. Active dental caries results when the biofilm pH on the tooth surface drops below the dissolution threshold for hydroxyapatite and fluorapatite. The clinical evidence of this net mineral loss is porosity, whitespot lesions, caries lesions, and/or cavitation. The potential to reverse this mineral loss through remineralization has been well documented, although previous remineralization strategies for dental hard tissues have focused on the use of fluorides and forms of calcium phosphate. This in-vitro study documented the deposition of nanoparticle hydroxyapatite on demineralized enamel surfaces after treatment with an experimental remineralization gel. This finding supports consideration of an additional approach to remineralization that includes pH neutralization strategies and nanoparticle hydroxyapatite crystals.

Caries management in the dental practice.

Practical, cost-effective implementation of caries management in general practice has been limited by several factors. The single pathogen model of disease has not been effective in clinical caries management, and the advent of the ecologic plaque model and a better understanding of the management of imbalances in dental biofilms have led to the development of more effective treatment protocols based on the elevation of oral pH. Simplification of caries risk assessment, in combination with more effective treatment regimens, means effective caries management can be readily provided by general dentists. These gains in efficiency and efficacy, in combination with applicable current dental terminology (CDT) codes, means that caries management has become economically viable in private practice.

How to integrate CAMBRA into private practice.

The traditional dentistry approach treated the disease with a limited surgical strategy aimed at removing carious lesions on teeth. Today, the dental profession is refocusing its efforts to include risk assessment with evidence-based diagnosis while also treating the biofilm component of the disease. While there is compelling science to support CAMBRA, there are fewer articles with practical direction regarding how to integrate CAMBRA diagnostics and treatment into clinical practice, which this article addresses.