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Samenvatting casuïstiek preventie en zorg
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samenvatting van casuïstiek preventie en zorg
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By: riri2345678 • 1 year ago
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Casuïstiek preventie en zorg1. SUPRA- EN SUBGINGIVAAL DEBRIDEMENT............................................................................................. 3
1.1 DOEL ...................................................................................................................................................... 3
1.2 HANDINSTRUMENTEN IN DE KLINIEK .............................................................................................................. 4
1.2.1 Supragingivaal ................................................................................................................................. 4
1.2.2 Subgingivaal .................................................................................................................................... 5
1.2.2.1 Gracey curettes ............................................................................................................................................... 5
1.2.2.2 mini gracey curettes ....................................................................................................................................... 5
1.2.3 Tandsteen detecteren ...................................................................................................................... 6
1.2.3.1 ODU 11/12 Explorer .............................................................................................................................. 6
1.3 ULTRASOON IN DE KLINIEK........................................................................................................................... 6
1.4 SONDEREN EN REINIGEN VAN IMPLANTATEN EN RESTAURATIES ........................................................................... 7
1.5 POLIJSTEN ................................................................................................................................................ 7
1.5.1 Polijstcups en polijstpasta’s ............................................................................................................. 7
1.5.2 Stainbuster®..................................................................................................................................... 8
2. FOUR HANDED DENTISTRY ..................................................................................................................... 8
2.1 AFZUIGING ............................................................................................................................................... 9
2.1.1 Vloeistofafzuiging ............................................................................................................................ 9
2.1.2 Nevelafzuiging (zoals in prekliniek) ................................................................................................. 9
2.2 MEERFUNCTIESPUIT ................................................................................................................................... 9
3. TANDEN BLEKEN & DE RESTRICTIEVE RICHTLIJN 2011/84/EU ............................................................... 10
3.1 KLEUR ................................................................................................................................................... 10
3.1.1 3D KLEURENWIEL VAN MUNSELL ................................................................................................................ 11
3.1.2 Berekening van kleurverschillen voor en na behandeling .............................................................. 11
3.2 POLIJSTEN – MICROABRASIE – WHITENING – BLEACHING ................................................................................. 11
3.2.1 Fluorosis ......................................................................................................................................... 12
3.2.2 Tetracyclineverkleuring ................................................................................................................. 12
3.2.3 Whitening tandpasta ..................................................................................................................... 13
3.3 DENTAL BLEACHING ................................................................................................................................. 14
3.3.1 Chemie van het bleken................................................................................................................... 14
3.3.2 Invloed van daglicht op tanden met tetracyclineverkleuring ........................................................ 15
3.3.2.1 Fotobleaching ...................................................................................................................................... 15
3.4 CLASSIFICATIE VAN DE BLEEKTECHNIEKEN ..................................................................................................... 15
3.4.1 Twee types bleaching therapie ...................................................................................................... 16
3.4.2 Bleekmechanismen ........................................................................................................................ 16
3.4.2.1 1ste generatie bleken............................................................................................................................ 16
3.4.2.1.1 Assisted bleaching (vitaal bleken) .................................................................................................. 16
3.4.2.1.2 Thuis bleken met een bleekbeugel (vitaal bleken) ......................................................................... 16
3.4.2.1.3 Vitaal bleken ................................................................................................................................... 17
3.4.2.1.4 Negatieve effecten van @ home bleaching ................................................................................... 17
3.4.2.2 2de generatie bleken ............................................................................................................................ 18
3.4.2.2.1 Thermisch bleken (Zaragoza, 80’s) ................................................................................................. 18
3.4.2.2.2 Photo-thermisch bleken ................................................................................................................. 18
3.4.2.3 3de generatie bleken ............................................................................................................................ 20
3.4.2.3.1 KTP-laser bleaching .............................................................................................................................. 21
3.5 WETGEVING WATERSTOFPEROXIDE ............................................................................................................. 24
3.6 SOORTEN BLEACHING ............................................................................................................................... 24
3.6.1 Assisted bleaching ......................................................................................................................... 24
3.6.2 Thuis bleken met bleekstrips.......................................................................................................... 25
3.6.3 Thuis bleken met een bleekvernis .................................................................................................. 25
3.7 RISICOFACTOREN ..................................................................................................................................... 25
3.7.1 Tandgevoeligheid .......................................................................................................................... 25
1
, 3.7.1.1 Behandeling van de tandgevoeligheid................................................................................................. 25
3.7.2 Pulpaschade................................................................................................................................... 26
3.7.3 Veranderingen ter hoogte van de harde weefsels ......................................................................... 27
3.7.4 Schade aan de mucosa .................................................................................................................. 27
3.7.5 Schade aan restauraties ................................................................................................................ 28
3.7.6 Storingen in functie van de occlusie............................................................................................... 29
3.7.7 Systemische effecten ..................................................................................................................... 29
3.7.7.1 Alternatieven voor waterstofperoxide veilig? ..................................................................................... 29
3.8 CLASSIFICATIE VAN DE BLEEKTECHNIEKEN: AVITAAL BLEKEN .............................................................................. 31
3.8.1 Historiek......................................................................................................................................... 31
3.8.2 Avitale bleking: cervicale resorptie ................................................................................................ 33
3.8.3 Indicaties versus risico ................................................................................................................... 33
3.8.4 Pro’s & con’s .................................................................................................................................. 33
3.8.5 Wat bij obliteraties? ...................................................................................................................... 34
3.9 ALGEMEEN BESLUIT ................................................................................................................................. 35
3.10 Hoge gezondheidsraad .................................................................................................................. 35
4. SLIJPEN ................................................................................................................................................ 38
5. AIRFLOW® ........................................................................................................................................... 39
5.1 ORALE BIOFILM ............................................................................................................................................... 40
5.2 PERIOFLOW® MET NOZZLE® .............................................................................................................................. 42
5.3 AIRFLOW PROPHYLAXIS MASTER .......................................................................................................................... 42
5.4 GUIDED BIOFILM THERAPY ................................................................................................................................. 43
5.5 KAVO PROPHYFLEX ™ 4 ................................................................................................................................... 44
5.6 INDELING VERKLEURING ..................................................................................................................................... 44
5.6.1 cariës ................................................................................................................................................... 44
6.ALGINAATAFDRUKKEN ............................................................................................................................... 48
6.1 ANDERE AFDRUKMATERIALEN ..................................................................................................................... 48
6.2 BENODIGDHEDEN .................................................................................................................................... 49
6.2.1 soorten afdruklepels ...................................................................................................................... 49
6.3 VOORBEREIDING ...................................................................................................................................... 49
6.4 DE AFDRUKNAME ..................................................................................................................................... 50
6.5 TIPS TEGEN KOKHALSREFLEX ....................................................................................................................... 51
6.6 NA DE AFDRUK ........................................................................................................................................ 51
7.TOFFLEMIRE EN TIJDELIJKE RESTAURATIES ................................................................................................. 52
7.1 PRACTICUM TOFFLEMIRE ........................................................................................................................... 53
8.TOPISCHE ANESTHESIE – ORAQIX® ............................................................................................................. 54
8.1 LIDOCAÏNE ...................................................................................................................................................... 54
8.1.1 Xylonor ................................................................................................................................................ 54
8.1.2 Oraqix®................................................................................................................................................ 54
9.DENTALE TRAUMA ..................................................................................................................................... 55
9.1 PIJN ............................................................................................................................................................... 55
9.2VITALITEITSTESTEN ............................................................................................................................................ 59
9.3 PERCUSSIETEST ................................................................................................................................................ 59
9.4 BIJTTEST ......................................................................................................................................................... 60
9.5 TAND GEVOELIGHEID ......................................................................................................................................... 60
9.6 IRREVERSIBELE PULPITIS ..................................................................................................................................... 60
9.7 PIJNLIJKE OF NIET-PIJNLIJKE PARODONTITIS APICALIS ................................................................................................ 61
9.8 PARODONTAAL ABCES (VOLWASSENEN) ................................................................................................................ 62
9.9 DENTALE/ PARODONTALE PATHOLOGIE KINDERTANDHEELKUNDE ............................................................................... 62
9.10 TANDTRAUMA ............................................................................................................................................... 63
9.11 WANNEER ENDODONTIE? ................................................................................................................................ 64
9.12 OBJECTIEVE EN SUBJECTIEVE CRITERIA WAAROM JE VOOR ENDO ZOU GAAN ................................................................ 64
2
, 9.13 NADELEN EN BEPERKINGEN VAN EEN WORTELKANAALBEHANDELING ......................................................................... 65
9.14 PULPAKAPPING .............................................................................................................................................. 66
9.15 APEXIFICATIE – APEXOGENESE ........................................................................................................................... 66
9.16 PULPOTOMIE ................................................................................................................................................. 66
9.17 STALEN CONFECTIEKROONTJE – ION KROONTJE®................................................................................................... 67
10 WORKSHOP BLEEKLEPELS CAVEX® ............................................................................................................ 67
10.1 CAVEX VACUFORMER SYSTEM .......................................................................................................................... 67
10.1.2 werkwijze bij alginaat (zie hoofdstuk 6)............................................................................................ 68
10.1.3 Cavex instant stone ........................................................................................................................... 69
10.1.4 werkwijze bleeklepel maken ............................................................................................................. 69
10.2 DE SENSE EN NONSENS VAN TANDEN BLEKEN ....................................................................................................... 69
10.2.1 wetenschap en omgeving ................................................................................................................. 69
10.2.2 sense en nonsens van tanden bleken ................................................................................................ 70
10.2.3 Cavex bite and white en ABC masterkit ............................................................................................ 72
11. MONDFOTOGRAFIE ................................................................................................................................. 72
12. BLOEDAFNAME ....................................................................................................................................... 74
VACUUM SYSTEEM .............................................................................................................................................. 74
SARSTEDT SYSTEEM ............................................................................................................................................. 75
VLINDERNAALD ..................................................................................................................................................... 76
13. CASUSSEN ............................................................................................................................................... 77
CASUS 1 (ZIE BLAD) ................................................................................................................................................ 77
CASUS 2 BRAM...................................................................................................................................................... 78
CASUS 3 .............................................................................................................................................................. 79
CASUS 4 .............................................................................................................................................................. 80
1. Supra- en subgingivaal debridement
= Instrumentatie van de kroon- en worteloppervlakken van de tanden om tandplak en
tandsteen van deze oppervlakken te verwijderen
Ook ‘niet-chirurgische parodontale therapie’ genoemd. De behandeling is voor patiënten met
tandvleesaandoeningen en is therapeutisch.
1.1 Doel
De eerste stap in de therapie is gericht op het begeleiden van gedragsverandering door de
patiënt te motiveren tot succesvolle verwijdering van de supra gingivale tandheelkundige
biofilm en beheersing van de risicofactoren, en kan de volgende interventies omvatten:
• Supragingivale tandheelkundige biofilmcontrole
• Interventies om de doeltreffendheid van de mondhygiëne te verbeteren (motivatie,
instructies, ...)
• Professionele mechanische plakverwijdering (SRP), waaronder de professionele
interventies gericht op het verwijderen van supragingivale plaque en tandsteen, en
ook mogelijke plaque-retentieve factoren die de mondhygiëne belemmeren
• Risicofactorcontrole, waaronder alle interventies voor gedragsverandering op het
gebied van gezondheid die de erkende risicofactoren voor het ontstaan en de
voortgang van parodontitis elimineren/verminderen (stoppen met roken, betere
metabolische controle van diabetes, en eventueel lichaamsbeweging, dieetadvies en
gewichtsverlies)
3
,De tweede stap van de therapie (oorzaak gerelateerde therapie) is gericht op het controleren
(verminderen/elimineren) van de subgingivale biofilm en tandsteen (subgingivale
instrumentatie). Daarnaast kunnen de volgende interventies worden opgenomen:
• Gebruik van aanvullende fysische of chemische middelen
• Gebruik van aanvullende gastheer-modulerende middelen (lokaal of systemisch)
• Gebruik van aanvullende subgingivale lokaal toegediende antimicrobiële middelen
• Gebruik van aanvullende systemische antimicrobiële middelen
1.2 Handinstrumenten in de kliniek
1.2.1 Supragingivaal
Kenmerken en gebruik H6/H7:
• Supragingivaal en licht subgingivaal (tot max 3mm)
• Werkblad 90°
• Adaptatie: >90°
• Angulatie: 80-90° naar de tand toe
• Activatie: actieve en trekkende beweging. Enkel met het eerste derde van de punt
werken, niet met het volledige werkblad
Kenmerken en gebruik 204S:
• Supragingivaal en licht subgingivaal (tot max 3mm)
• Werkblad 90°
• Adaptatie
• Angulatie :80-90° naar de tand toe
• Activatie: actieve en trekkende beweging. Enkel met het eerste derde van de punt
werken, niet met het volledige werkblad
4
, 1.2.2 Subgingivaal
1.2.2.1 Gracey curettes
1.2.2.2 mini gracey curettes
Kenmerken en gebruik:
• Instrument specifiek bedoeld voor bepaalde oppervlakken van bepaalde
gebitselementen van het gebit
5
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