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

    • Minimum Intervention Dentistry (MI) (Overview) Evidence based Compendium
    • MI Definition Disease risk assessment Earliest disease detection Minimally invasive treatment … a philosophy of health care including: Evidence based Compendium
    • Minimum Intervention (MI) Focus on disease Etiology! Prophylaxis Diagnostic Treatment Past Now Evidence based Compendium
    • 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
      • 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
    • 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
    • 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
    • MI principles of cavity restoration
      • Minimal necessary cavity access
      • Selective caries removal (atraumatic, minimally invasive)
      Evidence based Compendium
    • 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
    • DENTINE - STRUCTURE Odontoplast cell Odontoplast process Intertubular dentine Peritubular dentine Pulp Dentine tubule Dentine fibers Evidence based Compendium
    • 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
    • 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
    • Carious dentine Selective caries removal Infected Outer Layer Affected Inner Layer
    • Infected Outer Layer
      • Most of bacteria located
      • Not sensitive, dead tooth tissue
      • Soft
      • Collagen fibers damaged
      • Can not remineralize
    • Affected Inner Layer
      • Few bacteria located
      • Sensitive, vital tooth tissue
      • Hard
      • Collagen fibers intact
      • Can remineralize
    • 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
      • External Factors (from Cavity):
          • Reduced bacteria number
          • Reduced bacteria activity
          • Fluoride
      Remineralisation of Affected Dentine Selective caries removal
    • 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
    • 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
    • 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)
    • 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
    • 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
    • … in practice:
        • Ensuring maximum tooth tissue preservation
        • Be generally perceived as non-threatening (from Patients’ point of view)
      Minimal Intervention Dentistry Evidence based Compendium
    • Minimum Intervention (MI) Patient friendly Positive impact on health