What is prr in dental?

Dental sealants are plastic coatings professionally placed on the occlusal or chewing surface of your permanent back teeth in order to prevent tooth decay. This treatment typically only takes a few minutes per tooth.

Since premolar and molar teeth have grooves in their surfaces called pits and fissures, they are especially vulnerable to decay. These fissures can be deep and narrow, making them very difficult to access and clean. Sometimes these fissures are smaller than even a single toothbrush bristle. Plaque then begins to gather in these areas, and the bacteria in the plaque attacks the tooth’s enamel. Over time, cavities can develop.

In fact, over 75% of tooth decay begins in these fissures. While fluoride helps prevent decay, dental sealants provide extra protection for these areas by creating a smooth surface over the fissured area.

It is important to understand that sealants are not meant to last forever, they will eventually fail. Over time, gradually, and virtually undetected, the sealants start to wear down. During this process, little pockets or holes appear which is the perfect hiding place for bacteria. While sealants can protect teeth for many years, they need to be checked for wear and chipping.

Dr. Brusky suggests that you get your sealants checked with regular dental examinations. “If a sealant has partially come out, it can create a pathway for bacteria to collect and rot the tooth from beneath the material coating.”

By using special magnification at our dental facility, Dr. Brusky is able to identify the dark shadow that appears under deteriorating sealants that normally goes unnoticed. If left untreated, the tooth is at risk for the decay getting even larger, eventually creating a pulp exposure and the need for otherwise preventable but more extensive dental treatment.

Sealants are usually applied on children’s teeth in order to protect their molars against the development of decay. In some kids, it is prudent to even put them on baby teeth if they don’t have good oral hygiene, there is a history of decay/fillings on the primary teeth, or the baby teeth have deep grooves.

If the tooth has already experienced decay, a filling may be necessary to repair the damage and to provide strength for the tooth. Fillings help restore damaged teeth to their normal function, appearance, and shape by filling in cavities caused by tooth decay, erosion, and/or fracture.

PRR uses the same tooth-colored composite material as fillings, but there is one very big distinction between the two. While a filling often extends into the dentin of the tooth, PRR does not. Like sealants, PRR is a preventive measure to protect teeth from decay. The difference between sealants and PRR is that sealants may only last 6 to 8 years, while PRR can last indefinitely, just like a filling. Another distinction is that hygienists can place sealants while only a dentist can place PRR or fillings, as a drill is used in both procedures to remove decay. In the PRR, the decay is only in the enamel and therefore anesthetic is not needed to remove it.

Dr. Brusky Only Uses White Fillings

Dr. Brusky only uses composite resins which are matched to your teeth to create a natural look. Because of this, tooth-colored fillings are often used on the patient’s front teeth. After applying adhesive, the ingredients are placed directly into the tooth’s cavity, where the mixture will harden. However, with very large fillings, composites may not be the optimum material since they could chip or wear over time.

Why We Don’t Use Silver Fillings (Dental Amalgam)

Dental amalgam, or silver filling, is an inexpensive and unyielding material commonly used for filling cavities. The metal alloy is comprised of mercury, silver, and tin, with small amounts of copper and zinc.

Dr. Brusky does not use this material due to concerns about toxicity, inferior physical properties, as well as the substance’s inability to bond adequately to the remaining tooth structure. Therefore, amalgam does not enhance the strength of a tooth a great deal, and stress cracks tend to be very common in metal-filled teeth. These cracks ultimately lead to more fractures of entire sections of the tooth, weakening it even further and allowing bacteria to enter en masse.

The other concern is that metal filling expands and contracts at a rate greater than the natural tooth when exposed to extreme temperatures, thus causing cracks in the tooth structure over time.

• Clean. Mechanical removal of decalcified and diseased tooth structure in the grooves.
• Condition. Chemically disinfecting and conditioning the tooth with a fluoride releasing bonding agent.
• Fill. Placement of flowable composite filling material to coat the grooves.

A Preventive Resin Restoration (PRR) is a thin, resin coating applied to the chewing surface of molars, premolars and any deep grooves (called pits and fissures) of teeth. More than 75% of dental decay begins in these deep grooves.

Carious lesions appear most frequently in the pits and fissures of molars and premolars. The dental plaque inside pits and fissures cannot be removed through conventional cleaning techniques used in dental offices or through home care. The morphology of the fissure makes it difficult to diagnose the initial lesion, and surface decay may only become evident when the carious lesion has profoundly progressed beyond the amelodentinal limit.

In the past, clinicians used the “extension for prevention” approach to treat caries in pits and fissures. Thanks to new restorative techniques and bioactive materials, dentists can use minimally invasive approaches for more conservative cavity preparations, such as Preventive Resin Restorations (PRR). PRRs were first described by Simonsen and Stallard in 1977. Now PRRs can be performed with ionic composite resins, which restore the lesions in pits and fissures and help prevent recurrent caries in the rest of the fissure system.

Diagnosis of PRRThe clinical diagnosis for PRRs has three primary elements:

Indications for PRRPRR can be performed on the occlusal surfaces of molars and premolars, buccal fossa of lower molars, and palatal sulcus of upper molars. They are indicated in both temporary and permanent dentition. A PRR is indicated when the carious lesion in the pits and fissures is small and discrete and confined only to the enamel, or when the process has reached the dentin, but without pulpal involvement.

Technique The methods described above have evolved simultaneously with dental materials and dentin adhesives. The PRR technique involves removing a minimal amount of dental tissue with an air abrasion system with a 29-micron aluminum dioxide powder. Caries removal may not reach the amelodentinal limit and may remain confined to the superficial dentin. In both cases, selective etching should be performed only on the enamel, followed by the application of a bonding agent.

Subsequently, a dual-cure bioactive ionic resin (Activa Restorative Pulpdent) is applied and, after completing an initial 20-30 second self-curing phase, is covered with an oxygen inhibitor and light-cured. If the cavity is deeper, the clinician could use the sandwich technique, which consists of placing a fluid bioactive liner on the floor of the cavity (Activa Base/Liner Pulpdent) and then proceeding with the restorative material.

Case Study A 15-year-old male patient presented with occlusal lesions on teeth #3.6 and #3.7 (#18 and 19) as shown in Figures 1 and 2. He was anesthetized and a rubber dam was placed. Anesthesia and absolute isolation with rubber dam are optional, depending on patient comfort and acceptance. The occlusal surface was cleaned with soft sandblasting, and caries was selectively removed with a small polymeric round bur in a conservative manner without cavity design (Figures 3 and 4). The cavo-surface angle was polished with an abrasive point to eliminate unsupported prisms. Areas of exposed dentin were covered with Teflon tape before selective etching enamel with a 37% orthophosphoric acid gel for 30 seconds. The surface was rinsed with water for 10-20 seconds and dried until it became chalky in color before applying a bonding agent. This was followed by placement of the bioactive resin (ACTIVA BioACTIVE-RESTORATIVE). For best results, allow the resin to self-cure for 20-30 seconds, cover with an air-block gel, and then light cure for 20 seconds on the low intensity setting. After removing the rubber dam, excess material was removed and the occlusion was checked.

About Dr. Corrado Caporossi

Dr. Corrado Caporossi received his degree in Dentistry and Dental Prosthetics at the European University of Madrid in Valencia, Spain where he completed a thesis on “Functional aesthetic rehabilitation in the anterior field with feldaspar ceramic veneers.” He is currently registered with the Order of Physicians and Dentists of Rome and is a member of AIO and ANDI. Dr. Caporossi is also an external professor at the Cardneal Herrera University of Valencia (Es.) and in the master courses of the University of Bari Aldo Moro. He carries out his professional activity in Labico (Rm) in his own dental microscopy center with a particular focus on partial aesthetic rehabilitions. Dr. Caparossi is a speaker at numerous national and international universities where he gives courses of advancement, and at national and international congresses where he discusses aesthetic reconstructive adhesive dentistry with the use of bioactive materials. He provides practical theoretical courses for training in and improvement of multidisciplinary restorative dentistry.

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Restoration of the minimal carious lesion using composite resin. Dent Update 15 1988; 32: 234-232.

Crawford PJ . Sealant restorations (preventive resin restorations). An addition to the NHS armamentarium. Br Dent J 1988; 165:250-253.

Ekstrand KR, Ricketts DN, Kidd EA, Qvist V, SchouS. Detection, diagnosing, monitoring and logical treatment of occlusal caries in relation to lesion activity and severity: an in vivo examination with histological validation. Caries Res 1998;32: 247-54

Llodra JC, Baca P, Bravo M. Selladores de fisuras. En: Bascones Martínez A. Tratado de Odontología. Tomo II. Madrid. Smithkline Beecham S A; 1998: 2249-57

Nyvad B, Machiulskiene V, Baelum V. Reliability of a new caries diagnostic system differentiating between active and inactive caries lesions. Caries Res 1999; 33: 252-60

Paterson RC, Watts A, Saunders WP, Pitts NB. Modern concepts in the diagnosis and treatment of fissure caries. Chicago: Quintessence Publishing Co; 1991