Current preparation concepts in adhesive dentistry The SiSta concept
Introduction
The advent of adhesive systems has made it possible to replace the macro-retention used for amalgams in favor of micro-retention.
In addition, current knowledge on the pathogenesis of caries and the fundamental role of fluoride in the demineralization-remineralization cycle has made it possible to establish a new way of treating the carious lesion by preventive treatment.
- The SI/STA concept
The concept of preparation according to the SI/STA classification is based on:
- Classification of carious lesions by their site and progression;
- Early diagnosis of carious lesions;
- Least invasive surgical treatment of carious lesions;
- Remineralization of reversible lesions;
- Cavity preparation and restoration respecting biological tissues and the biomechanical behavior of the tooth, by creating mini cavities.
These are surgical techniques focused on the lesion itself, requiring reduced enamel access preparation;
- Prevention of carious disease.
- SISTA classification
Based on the MOUNT and HUME classification, retaining as the main characteristic the determination of carious lesions by cariosusceptibility site “SI” and stage of evolution “STA” but introducing for each of the three sites, an initial stage (stage 0), which corresponds to a diagnosed lesion requiring strictly non-invasive treatment.
Sites and stages of carious lesion development: 2.1 Sites
Areas of dental plaque retention on crowns.
There are 3 sites, seats of the carious lesion, these three sites are common to the anterior and posterior teeth
We distinguish:
- Sites 1 or occlusal : Carious lesions initiated at the level of pits and grooves, fossae, cingulum and other coronal defects of the occlusal surfaces.
- Sites 2 or proximal: Carious lesions initiated at the proximal contact areas between adjacent teeth.
- Sites 3 or cervical: Carious lesions initiated at the cervical areas, over the entire coronal and/or radicular perimeter.
Diagram of the three sites of cariosusceptibility at the level of the anterior and posterior teeth
2.2 Stage:
This is the extension of the caries in volume (the evolution of the lesions), and in relation to anatomo-clinical and radiological landmarks. Five stages are possible:
- Stage 0 or reversible stage: Active, superficial lesion, without cavitation, not requiring surgical intervention but non-invasive preventive treatment.
- Stage 1: Active lesion in its early stages, with surface alterations, having crossed the enamel-dentin junction but not extending beyond the outer third of the dentin, to the point of being just beyond the possibility of remineralization, and requiring at least restorative intervention in addition to preventive treatment.
- Stage 2 : Active lesion of moderate extent, cavitary having progressed into the middle third of the dentine without weakening the cusp structures, and requiring restorative intervention to at least fill the loss of substance.
- Stage 3 : Extensive cavitary lesion having progressed into the internal dentinal third to the point of weakening the cuspal structures, and requiring restorative intervention to fill and reinforce the residual structures.
- Stage 4 : Extensive cavitary and parapulpal lesion that has progressed to the point of destroying part of the cuspal structures, and requiring restorative intervention for partial or total coronal coverage.
A simple table allows each lesion to be numbered according to its site and extension, and to communicate through this system the relevant clinical characteristics of the lesion
More than a simple classification, the SI/STA concept is a true therapeutic guide for modern dentistry;
It allows the therapeutic approach to be selected based on the site and stage of development ( Lasfargues et al 2006) :
Non-invasive preventive care.
Minimal surgical care.
More conventional restorative care.
2.3 Defects and limits of this classification
– First of all, it excludes lesions for which non-invasive treatment can be undertaken (the remineralization process)
– It is a classification of cavities regardless of their origin
– The term used “size” refers to a loss of substance, i.e. a static parameter, the term “degree or stage” would have been more appropriate referring to a notion of dynamism.
– This classification does not take into consideration the state of pulp health and that for all stages, it is considered that the tooth can remain alive.
– Also, only takes into consideration losses of carious origin, all other possible origins: trauma, old restoration, wear phenomena (abrasion, attrition, erosion, etc.) are not taken into account.
Schematic representation of the radiographic diagnostic criteria for carious lesions of sites 1 and 2 for each of the stages of the SI/STA concept.
- Basic principles of the SI/STA concept
The SI/STA classification only makes sense if it is used in accordance with the modern principles of restorative dentistry, now in good agreement with the term conservative dentistry instead of operative dentistry; these are the principles of tissue economy, the principle of adhesion, and the principle of biointegration.
3.1 Principle of tissue economy
The concept of adhesive and prophylactic dentistry assumes the maximum conservation of healthy structures, since this is the very substrate of adhesion techniques, and the preservation of residual tissues is the best guarantee of longevity of the restored natural tooth.
The best way to obey this principle is through the correct choice of access. All preserved structures contribute to dental strength, but some have a much greater role in this function.
Preserve the marginal ridges of anterior and posterior teeth by their beam structure and the location of functional occlusal contacts.
A second concept is to protect as much as possible the peripheral enamel, including unsupported enamel, including demineralized enamel when it is not directly subjected to occlusal forces.
Preserve remineralizable demineralized dentin in the deep (parapulpal) part of a cavity, in order to protect the pulp from surgical aggression.
3.2 Principle of membership
The development of the adhesive system allows to obtain the results of the orders:
- Mechanical: reinforcement created by the effect of increasing the resistance of the tooth/restoration complex.
- Biological : Sealing provides biological protection of the dentinal pulp by preventing bacterial invasion of the tooth surface / waterproofing of the dentin.
- Bio-integration
Biointegration, which represents the final objective of the treatment , is based on the association of preventive agents and restorative materials as well as on the use of non-aggressive techniques meeting the requirements of biocompatibility, functionality, aesthetics, and prevention of recurrences.
Current preparation concepts in adhesive dentistry The SiSta concept
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