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7/17/10 www.midentistry.com/academia.html --- (c) midentistry ...

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  • 1. Minimum Intervention Dentistry (MI) (Overview) Evidence based Compendium
  • 2. MI Definition Disease risk assessment Earliest disease detection Minimally invasive treatment … a philosophy of health care including: Evidence based Compendium
  • 3. Minimum Intervention (MI) Focus on disease Etiology! Prophylaxis Diagnostic Treatment Past Now Evidence based Compendium
  • 4. Caries = multifactoral disease ORAL BALANCE Demineralization = Remineralization Disturbance of oral balance Demineralization > Remineralization
    • Higher bacteria count (S.mutans, Lactobacilli)
    • Reduced saliva function (flow rate, buffer capacity)
    • Decreased plaque pH , Increased plaque rate
    • Hypomineralization / Lesions
    • Cavities
    Disease Etiology: Caries Evidence based Compendium
  • 5.
    • bacteria
    • saliva function
    • plaque pH
    • etc.
    Risk factors Identified Modified / Reduced
    • Stop of disease = regain of ORAL BALANCE
    • Repair of reversible damage = Lesions (Remineralisation)
    • Repair of irreversible damage = Cavities
    3.a) Classification 3.b) Restoration
  • 6. Classification, according to lesion: 1. Location (Site) 2. Progress (Size) 1 3 2 1. Pits/Fissures 2. Contact area 3. Cervical caries classification (Mount/Ngo, 1998) Evidence based Compendium
  • 7. caries classification (Mount/Ngo, 1998) Size 0 1 2 3 4 Site 1 1.0 1.1 1.2 1.3 1.4 2 2.0 2.1 2.2 2.3 2.4 3 3.0 3.1 3.2 3.3 3.4 1 2 3 Evidence based Compendium
  • 8. MI principles of cavity restoration
    • Minimal necessary cavity access
    • Selective caries removal (atraumatic, minimally invasive)
    Evidence based Compendium
  • 9. Removal of infected, denatured, demineralised, non-sensitive dentine = outer infected dentine Treatment of affected non-denatured, sensitive, remineralisable dentine = inner affected dentine Carious dentine Selective caries removal Infected Outer Layer Affected Inner Layer Evidence based Compendium
  • 10. DENTINE - STRUCTURE Odontoplast cell Odontoplast process Intertubular dentine Peritubular dentine Pulp Dentine tubule Dentine fibers Evidence based Compendium
  • 11. BACTERIAL INVASION Odontoplast cell Odontoplast process Pulp Dentine fibers Biomass on top of Tubuli: ~ 90% of Bacteria Tubuli invaded by ~ 10% of Bacteria Tubuli infiltrated by Bacteria Acid
  • 12. DENTINE - DEFENCE REACTION Remaining of some INTERTUBULAR CRYSTALS after Demineralization BLOCKING of Dentine tubuli = “ TUBULAR SCLEROSIS” = YELLOW / BROWNISH discoloration of Dentine NATURAL BARRIER AGAINST FURTHER BACTERIA INVASION
  • 13. Carious dentine Selective caries removal Infected Outer Layer Affected Inner Layer
  • 14. Infected Outer Layer
    • Most of bacteria located
    • Not sensitive, dead tooth tissue
    • Soft
    • Collagen fibers damaged
    • Can not remineralize
  • 15. Affected Inner Layer
    • Few bacteria located
    • Sensitive, vital tooth tissue
    • Hard
    • Collagen fibers intact
    • Can remineralize
  • 16. Remineralisation of Affected Dentine +
    • Internal Factors (from Dentine & Pulp):
        • Intact Collagen Fibers
        • Active Odontoblasts
        • Active Mineral supply (Calcium, Phosphate) from the Pulp to the Dentine
  • 17.
    • External Factors (from Cavity):
        • Reduced bacteria number
        • Reduced bacteria activity
        • Fluoride
    Remineralisation of Affected Dentine Selective caries removal
  • 18. Mechanical concept: Difference in physical resistance to sharp hand instrumentation Chemo-mechanical concept: Electrostatic splitting MI treatment concepts & procedures 2 ways of Selective caries removal: Evidence based Compendium
  • 19. MI treatment concepts & procedures
    • Chemical softening of denatured (infected) carious dentine
    • Mechanical removal with non-cutting hand instruments
    Chemo-mechanical concept: Electrostatic splitting Selective caries removal Evidence based Compendium
  • 20. MI principles of cavity restoration
    • Minimal necessary cavity access
    • Selective caries removal (atraumatic, minimally invasive)
    • Cavity design according to extend of caries
    • Use of therapeutic materials (adhesive, remineralizing)
  • 21. MI principles of cavity restoration
    • Minimal necessary cavity access
    • Selective caries removal (atraumatic, minimally invasive)
    • Cavity design according to extend of caries
    • Use of therapeutic materials (adhesive, remineralizing)
    • Biomimetic replacement of tooth hard substances
  • 22. MI principles of cavity restoration
    • Minimal necessary cavity access
    • Selective caries removal (atraumatic, minimally invasive)
    • Cavity design according to extend of caries
    • Use of therapeutic materials (adhesive, remineralizing)
    • Biomimetic replacement of tooth hard substances
    Ultra-conservative, smaller restorations + maximum tissue preservation
  • 23. … in practice:
      • Ensuring maximum tooth tissue preservation
      • Be generally perceived as non-threatening (from Patients’ point of view)
    Minimal Intervention Dentistry Evidence based Compendium
  • 24. Minimum Intervention (MI) Patient friendly Positive impact on health