The Vector Method

Tips and tricks for minimal invasive cavity preparation with the Vector system

The Vector Method

Tips and tricks for minimal invasive cavity preparation with the Vector system
A characteristic of the Vector system is a resonant ring in the head of the handpiece. This allows the use of vibration-free instruments in various conventional and asymmetric shapes, each with aerosol eliminated. During the preparation, the smooth metal instruments are surrounded by a film of water containing the finest abrasive particles. Similar to polishing, the various hard dental tissues and nonmetallic restoration materials can thus be prepared without surface or subsurface damage. The pulp structures are conserved and the pain response is significantly reduced. However, the effectiveness of the Vector method arises from the high drive frequency and the ability to use hollow instruments. Preferable applications are the preparation of cavities into deciduous teeth, particularly in the case of fearful children, as well as access cavities to initial caries lesions, the excavation of microinvasive cavities for adhesive restoration or the preparation of tooth-colored materials. Furthermore conventionally prepared cavities or stumps could be finished or marginally recontoured advantageously. These short clinical instructions supplement the clinical manual (Vector: Clinical applications and scientific principles) and give valuable information on the clinical procedure during Vector preparation. It is advisable to practice handling the instruments before first use on the patient, e.g. on a suitable extracted tooth.

Check list Vector preparation

Silicon carbide slurry (Vector fluid abrasive) as abrasive medium Preparation in kick-down mode with maximum energy Instrument held continuously in position instead of a wiping preparation movement Light to moderate application pressure (heavy pressure reduces the abrasive performance); listen for typical erosion noise Suction of excess liquid in the dorsal oral cavity area; never directly at the preparation site The maximum erosion rates are achieved using hollow instruments. These also allow precise centering of the instrument at the beginning of a preparation The desired cavity design is prepared as far as possible by selecting a suitably shaped instrument (e.g. oval or asymmetric) High erosion rates are achieved by lengthwise sinking of the instruments. Depending on circumstances, the same or different instruments are sunk several times with parallel displacement and the resulting interfaces shaped under horizontal application of the instruments

Unilaterally flattened instruments are available for proximal cavity segments (half- ellipsoids or half- flame cones). Care must be taken to avoid damaging adjacent teeth (e.g. matrix band) Instruments showing signs of wear should be conditioned with the grindstone in the toolkit before the next application. Considerably shortened instruments or instruments whose shape is heavily changed by wear must be taken out of service The more brittle the material to be worked, the more effective the Vector preparation is. Preparations into enamel are more effective than those into dentin No subsequent finishing of the prepared cavity margins necessary With the exception of small amalgam volumes, metals cannot be prepared Vector is not suitable for removal of dentinal caries

Preparation principle/ handling/instrument conditioning The Vector preparation uses fine silicon carbide particles (Vector fluid abrasive) with an average grain size of approx. 50 m suspended in water and washing over the active instruments for material removal. By using light to moderate pressure of the activated instrument against the surfaces to be prepared, these particles are accelerated within the operating gap between the instrument and the preparation surface. As a result, the opposite surfaces of instrument and cavity are subjected to erosion. Thereby the tough metal surfaces of the instruments abrade only very slowly, whereas effective abrasions occur on enamel, dentine and tooth-colored restoration materials. A cavity is produced using lengthwise sinking of the instrument as the negative of the instrument shape selected as well as by its horizontal translation. In contrast to rotating preparation instruments, the Vector system produces the highest material removal rates when using longitudinal sinking of the instruments. When combined with horizontal preparation movements, the removal rate is reduced. A particularly high rate of material removal and accurate positioning can be achieved with the hollow instruments.

The abrasion process with loose granules is reminiscent of a polishing process, which explains the very precise, almost athermic and very surface-protecting mode of preparation. As a result of the largely eliminated heat induction of the Vector instruments, high cooling water flow rates are not necessary for the preparation. The application pressure of activated instruments corresponds approximately to that of the periodontal application of the Vector system. Normally, combined with a high erosion effectiveness, there is a typical erosive preparation noise with which the user soon becomes familiar. To achieve optimum removal rates, the preparation instruments should be applied continuously in place and only moved to follow the material removal. Heavy application pressures or constant wiping movements familiar from rotating diamonds as well as suction of the liquid surrounding the instrument prevent optimum energy coupling. For this reason, the very low amounts of excess liquid should preferably be removed by suction sporadically in the area of the dorsal oral cavity on the antagonistic side.

Left: Functional principle of Vector preparations (schematic)

Right: Instrument conditioning The burs or sharp edges resulting from instrument wear are removed before the next preparation. This is done by operating the instrument without water and recontouring it on the grindstone in the toolkit.

Vector preparation
Advantages Limitations

High patient acceptance, reduced pain response (sensitive children, anesthetic often not needed) Low risk of injury due to accidental slipping of the instrument (nervous children) Avoidance of structural damage to sensitive cavity margins (marginal seal) No additional finishing required (time advantage) Advantageous finishing of conventionally prepared cavity or stump margins (forming instruments) Protection of soft tissue bordering cavities (reduced tendency to bleeding at gingival shoulders) Tissue and pulp protection (caries profunda) High touch sensitivity (perceptible opening of an initial caries) Hollow and asymmetrical instruments pre-designed for frequently occurring cavity design (precision) Low cooling water flow, aerosol eliminated (infected patients) Beneficial finishing of tooth colored restorations

Reduced overview due to suspended particles (release foot switch several times during preparation clear flushing of the preparation site) Reduced removal rate compared with rotating diamonds (particularly with horizontal instrument guidance) Inefficient preparation of large volume cavities or stumps to be provided for prosthodontics Significant limitations in preparation of metal restorations or dentinal caries removal

Preparation principle/handling/ instrument conditioning

Minimal invasive cavities of Black classes II and III Hollow instruments in various cylindrical and oval shapes are suitable for the preparation of access cavities for primary caries lesions requiring restoration. The shape of the cavity outline is advisedly prepared by pre-selection and use of a forming tool whose own geometry covers the largest possible partial segment of the cavity to be created. Depending on circumstances, the same or different instruments are sunk lengthwise several times next to one another with horizontal displacement. The resulting

edges at the joins of these cavities can then be removed by lateral movement of the instrument. Unilaterally flattened instruments (e.g. semi-spherical, semi-ellipsoid, semi- flame cone) are available for proximal cavity segments, in which the risk of damage to adjacent teeth is minimized. Furthermore, these instruments often allow unusual proximal accesses, for example using a separating technique or via adjacent cavities. The shaping of tunnel preparations is also made easier.

Shaping of the access cavity by lengthwise sinking of a hollow cylinder Precise centering High material removal efficiency Perceptible breaking through into the carious region

Proximal caries (schematic)

Oval access cavity through horizontally displaced sinking of a round hollow cylinder (alternative: use of an oval hollow instrument) Protection of adjacent teeth High removal efficiency

Shaping the access cavity Mechanical breaking off of the undermined margin Overview of the caries extension

Preparation of the axial cavity walls using micro-semi-ellipse Caries removal Conventional manual instrument(e.g. with sensitive patients) or round drill Successive expansion of the access cavity up to the final cavity design with Vector instruments and complete display of the carious defect Protective processing without marginal fractures; no need for additional finishing Good overview Minimization of the risk of damage to adjacent teeth (depending on conditions, additional protection of the adjacent tooth with metal matrix band)

Preparation of the cervical cavity shoulder using micro-semi flame cone Adjacent soft tissue remains uninjured resulting in reduced tendency to bleeding Protection of the cervical enamel (where still present) Good touch sensitivity Minimization of the risk of damage to adjacent teeth (additional metal matrix band if needed)

Class II cavity (schematic) ready for adhesive filling Cavity design according to minimal invasive criteria

Adhesive restoration (separator technique) after acid etching and adhesive impregnation of the enamel and dentin interfaces using flowable (picture) and/or highly filled composite in a multilayer technique

Minimal invasive cavities of Black classes II and III

Minimal invasive cavities of Black classes I and V Spherical instruments in variable size gradations, small cylindrical instruments or an oval hollow instrument are particularly suitable for microinvasive preparation of Class I and Class V cavities. Particularly with flat, elongated cavities such as are typical, for example, for opening long fissure sections, horizontal instrument guidance leads to unavoidable wear of the fine instrument tip. It is advisable in this case to use a parallel displaced sinking of the instruments over the desired cavity length, followed by joining of the individual partial cavities together while creating the final

cavity design. This saves time and reduces instrument wear. The Vector system is of particular advantage in these indication categories for deciduous tooth caries (protective preparation particularly of the thin residual dentine layer with efficient enamel abrasion), for pitted caries lesions (adhesive preparation while conserving undermined caries-free enamel margins), paragingival or subgingival cervical defects (protection of soft tissue and reduced tendency to bleeding) as well as for root caries lesions (easy access and protection of soft tissue).

Occlusal caries (schematic)

Occlusal access cavity Spherical instruments in variable size gradations allow pinpoint accurate access to the center of the carious lesion

Horizontal extension in the fissure relief Parallel displaced sinking of circular cavity segments increases the effectiveness Short preparation pulses also increase patient tolerance

Shaping the definitive cavity design with horizontal translation of the active instrument Simultaneous beveling of the cavity margins without the need for finishing instruments Maximum hard substance protection Class I cavity (schematic) ready for adhesive filling Cavity shaping according to minimal invasive preparation criteria

Minimal invasive cavities of Black classes I and V

Additional applications Further applications of the Vector preparation device are the finishing of conventionally prepared cavities or stump margins, finishing tooth-colored restorations or ultrasound-supported cementing, e.g. using bonding materials on a composite base.

Protective recontouring, finishing and polishing of sensitive toothcolored restorations (schematic) The indirect energy coupling of the Vector system via the abrasive slurry minimizes the risk of marginal fractures, particularly in composite fillings and adhesively inserted ceramic restorations. After polymerization of the composite, these are directly subject to high volumeinherent residual stresses and are therefore particularly at risk from fractures during contouring, finishing and polishing with conventional rotating instruments

Marginal finishing of conventionally prepared cavities and stumps using tapered instruments in variable size gradations (schematic)

Ultrasound-activated adhesive cementing (schematic) Using an active Vector instrument without water or slurry on a ceramic or a gold restoration to be cemented, liquefaction of thixotropic bonding material occurs such as, for example, with highly filled composites. Precise repositioning of the restoration and residue-free removal of excess cement are thereby made considerably easier.

Additional applications

P007-332-02/St.5.000.01.03.01 Printed in Germany Technical Developments are reserved.

Drr Dental GmbH & Co. KG Hpfigheimer Strae 17 D-74321 Bietigheim-Bissingen Drr Dental Online: http:/ /www.duerr.de eMail: info@duerr.de Author: Dr. Rainer Hahn PhD Private Institute for Minimal Invasive Dentistry, Tuebingen http:/ /www.zahnerhaltung.com