Minimal Intervention Dentistry – The Challenge for Materials
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Minimal Intervention Dentistry – The Challenge for Materials

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Minimal Intervention Dentistry – The Challenge for Materials Minimal Intervention Dentistry – The Challenge for Materials Presentation Transcript

  • Minimal Intervention Dentistry – The Challenge for Materials John W. Nicholson University of Greenwich
  • Minimal Intervention Dentistry - Modern approach to the treatment of tooth decay - Based on “Medical Model” of caries management
  • Historical Development of Dentistry
    • Extraction;
    • Surgical approach (“ drilling and filling ”): after G.V. Black;
    • Medical approach – Minimal Intervention .
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  • G.V. Black
    • Developed in the 1890s;
    • Highly formalised cavity design;
    • “ Extension for prevention”.
  • Critique of G.V. Black’s approach
    • A surgical model;
    • Caries “cured” by excision, then filling;
    • Appropriate for weak, non-adhesive materials;
    • Still the prevailing paradigm in the profession.
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  • The Minimal Intervention approach
    • A medical model;
    • Caries treated as a biological infection;
    • Surgical techniques are minor and stress retention of tooth tissue.
  • Details of the MI approach
    • (1) Reduces cariogenic bacteria;
    • (2) Uses preventive measures;
    • (3) Early lesions remineralised;
    • (4) Minimal surgery on cavities;
    • (5) Repair of defective restorations.
  • (1) Cariogenic bacteria
    • Caries is a bacterial disease;
    • Depends on dietary sucrose;
    • Driven by frequency of eating;
    • Modified by saliva.
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  • (2) Preventive measures
    • Topical fluoride;
    • Fissure sealants;
    • Patient education on oral hygiene
  • (3) Remineralisation
    • Requires management by non-intervention;
    • Enhanced by fluoride ion in saliva.
  • (4) Minimal surgery
    • Requires adhesive materials (glass-ionomers, adhesive composite systems);
    • Innovative, bespoke cavity design:
      • Possibly without drilling (ART technique).
  • (5) Repair of materials
    • To prevent cavity extension;
    • Not “botch job”, but appropriate.
  • The challenge for materials
    • Adhesion
      • Occurs naturally for glass-ionomers; problematic for composites.
    • Fluoride-release;
    • Release of other mineralising ions (PO 4 , Ca 2+ );
    • Repairable.
  • Conclusions
    • Minimal Intervention dentistry is the future:
      • Advocated by FDI;
      • Cost effective;
      • Less trauma for the patient.
    • A biological approach, not a mechanical one.
    • Makes significant demands on materials.