Conservative appraoches 2 Fifth-year dental students Operative dentistry first semester

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Dr. Inas Ayoub Elalem
inas.alalem@gmail.com
00970599448344
1
Operative Dentistry V

2. CONSERVATIVE
APPROACHAND
MINIMAL
INTERVENTION -2-

3. To drill or not to drill? Or when
to prepare a cavity?

4. Certain data have to be collected prior to decision making
about the necessity of conservative procedure. These are:
◦Diet Assessment
◦Caries risk assessment
◦Clinical Examination

5. ◦The most commonly used software for caries risk
assessment is the “Cariogram”

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13. Documenting caries and restorative decisions:

14. Documenting caries and restorative decisions:

15. Documenting caries and restorative decisions:

16. Restorations can be avoided in the following
situations:
◦ Non cavitated white spot lesions, such as hidden proximal
lesions detected on a bitewing radiograph, if these are confined
to within the enamel or are just into dentin ( as they are unlikely
to be cavitated)
◦ Root surface lesions, both cavitated and non-cavitated, if
accessible for cleaning and application of topical reminerlizing
products.
◦ Recurrent lesions adjacent to restorations, if both small and
cleansable.
◦ Large cavitated lesions accessible plague cleansing ( no
overhanging enamel), where loss of function and esthetic is
acceptable.

17. Biological or medical model of treatment
◦ This model deals with caries as a disease that should be treated prior to any
restorative procedure. It included the following:
◦ Diet and habits modification if required
◦ Salivary flow and buffering capacity adjustments if required
◦ Mechanical preventive measures ( calculus and oral biofilms control) to fit into a
dental office preventive program
◦ Use of antimicrobial to fit into a home-care preventive program ( chlorhexidine)

18. Biological or medical model of treatment
◦ This model deals with caries as a disease that should be treated prior to any
restorative procedure. It included the following:
◦ Remineralization of initial lesions.
◦ Fissure sealants for susceptible sites
◦ Infiltration methods as ICON
◦ Close follow up to monitor the healing procedures
◦ Preform minimal intervention and preparation for diseased tissues that cannot be re-
minerlized and restore them conservatively.

19. Surgical Model of treatment
◦ In this model, the diseased tissues are beyond healing potentials and could not
be re-mineralized. Diseased tissues are dealt with by drilling and cutting away
without giving attention to the microorganism as causative factor. This gives a
chance for the cariogenic organisms to re-attack new restored surfaces and
hence restart the cariogenic process again and again.

20. Features of a conservative cavity should
provide the following:
◦ Include all defective enamel and dentin
◦ No extension beyond defective areas
◦ Convenient instrumentation and material placement
◦ Freeing of all margins with adjacent surfaces
◦ Necessary resistance and retention forms.

21. Removing of remaining carious dentin:
◦ Partial caries removable
◦ Cariosolve
◦ Smart prep using malleable polymer material
incorporated with small paddles that become
rounded when they come into contact with
hard, healthy dentin.
◦ Face ( florescence aided caries excavation)
caries removal utilizing a pulsed erbium laser
rather a rotary bur.
◦ Internal remineralization ( atraumatic
restorative technique with strontium based
GLC material).

24. The key principles of minimal invasive cavity design
for an adhesive permanent restoration can be
summarized as follows:
◦ Minimize tooth structure removal so that the preparation follows the shape of the lesion, and is
sufficient to achieve visual and instrument access to the caries.
◦ Achieve a predictable marginal seal and remove demineralized dentin around the full cavity perphiry
◦ No flat cavity floor is required
◦ Create rounded internal cavity angles; occlusal keys or dovetails are not required.
◦ Some internal cavity resistance form or small proximal retention slots can be placed to reduce
stresses on the bond to dentine.

25. Conservative cavity designs:
◦ Preventive resin
restoration

26. Conservative cavity designs:
◦ Simple Box ( limited to teeth with narrow interproximal
contact)

27. Conservative cavity designs:
◦Slot preparation ( wide embrasure)

28. Conservative cavity designs:
◦Tunnel preparation ( full/ partial tunnel preparation

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