Giuseppe Chiodera

My name is Giuseppe Chiodera , i was born born in 1979 in Brescia . I graduated in 2004 at University Of Studies Brescia , the town where i live placed in between mountains and lakes . My activity is focused on diagnosis , detect and manage caries lesions in the very early stages. Thanks to the university of Bern and Ginevra i had the opportunity to follow that street meeting great reserchers . Today my passion is Aesthetic and Conservative Dentistry , especially find new tips and tricks . My professional hobbies are Diode Laser and Ozone . I have the pleasure and the opportunity to do lectures in different university masters and course, a great chance to share ideas and learn .
My name is Giuseppe Chiodera , i was born born in 1979 in Brescia . I graduated in 2004 at University Of Studies Brescia , the town where i live placed in between mountains and lakes . My activity is focused on diagnosis , detect and manage caries lesions in the very early stages. Thanks to the university of Bern and Ginevra i had the opportunity to follow that street meeting great reserchers . Today my passion is Aesthetic and Conservative Dentistry , especially find new tips and tricks . My professional hobbies are Diode Laser and Ozone . I have the pleasure and the opportunity to do lectures in different university masters and course, a great chance to share ideas and learn .

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Fifth class lesions are very common in the population, and they seem to become more and more frequent, thus becoming a relevant topic to clinitians and a problem for a lot of patients.

The number of patients who have experienced Cervical Tissue Loss (CTL) is, in fact, growing and the incidence has shown a continuous increase over the years.

The CTL can involve hard tissues and soft tissues: this situation requires a multidisciplinar approach using a combined restorative and periodontal treatment.

 

It is really important to start with a proper etiologic diagnosis. The main causes for CTL:

Acids:  this category embraces all forms of chemical, biochemical and electochemical degradation.

Abrasion: Toothbrush / toothpaste action  

Abfraction: microfracture of tooth substance in areas of stress concentration.

 

Because of the complex interaction of these various mechanisms, it is generally incorrect to designate all CTLs as being caused by only one mechanism. The clinician should consider all etiological and modifying factors before completing the diagnosis or initiating treatment if indicated. 

The restoration of CTL is a big challenge for clinicians and adhesive materials, due the biomechanical aspects, the type of substrate availabe for the adhesion and the isolation of the operative field.

One of the problems could be the isolation: the Lesion can be so cervical that the difference between the buccal/lingual and the vestibular level of the healthy tooth can make the placing of the rubber dam really difficult or almost impossible using a clamp. The situation is different if we manage the  isolation of  the operative field using a dedicated instrument capable of acting, at the same time, as a gentle rubber-dam and as a soft tissues retractor, useful to expose the working area.

In dentistry, research and development of new materials and technologies reach for better prevention and early treatment of dental diseases.

In this context, the concept of "minimally invasive dentistry" is gaining space, a discipline that has its main goal in the respect of the healthy tooth tissue and has the treatment of primary and secondary lesions at the very early stage as a priority.

Careful diagnostic investigation, correct assessment of the biological risks/benefits and – last but not least – the conservative and highly specific removal of decayed tissue, preliminary measures are very important for the achievement of these results.

It is essential that the diagnostic path start from a proper clinical and radiological investigation through conventional diagnostic tools complemented by innovative tools in order to make otherwise clinically hidden lesions visible.

The observation that the enamel, dentin or decayed tissue, exposed to a laser light, emit a specific spontaneous fluorescence made it possible to develop devices that, using laser technology, allow us to attribute a "grading" to the carious lesion severity, which is a prerequisite for subsequent operational choices, more or less favorable to the intervention, both to monitor the evolution in time of the carious pathology and/or the effectiveness of the treatment.

 

 

Several clinal procedures need rubber dam placements. It is not easy; especially in the situation where the Root canal treatment has been done on a tooth prepared with vertical perparation or feather edge. It is most difficult when the target is in good isolaltion without soft tissue damage. This tecnique suggests that flowable composite can be used to place temporary wings, (which is good to stabilise the rubber dam) and can be easily removed after treatment. The temporary wings are also helpful when fixing the Rubber dam in restorative dentistry. Technique step by step:
During the documentation of a clinical case including pictures it is essential for the rubber dam not to have any folds as this will allow us to demonstrate that appropriate isolation is achieved. In order to level the folds the dam needs to be stretched to the opposite side of the arch. Ideally the isolation needs to extend to include the contralateral premolars As this entails isolating a non anaesthetised area the patient might feel the discomfort whilst isolating the contralateral side. furthermore, in many situations such as the presence of anterior bridges or orthodontic retainers, it is not possible to extend the isolated area and the appropriate stretching of the dam cannot be guaranteed. An alternative technique would be extending the isolation area until the contralateral canine and using finger pressure to level the dam and remove any creases or folds. Once this in achieved floss could be passed twice to secure the dam and achieve good isolation as well as blocking any voids which will facilitate say removal of the dam following the light curing phase.

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