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Minimal Intervention Dentistry – The Challenge for Materials

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Minimal Intervention Dentistry – The Challenge for Materials

  1. 1. Minimal Intervention Dentistry – The Challenge for Materials John W. Nicholson University of Greenwich
  2. 2. Minimal Intervention Dentistry - Modern approach to the treatment of tooth decay - Based on “Medical Model” of caries management
  3. 3. Historical Development of Dentistry <ul><li>Extraction; </li></ul><ul><li>Surgical approach (“ drilling and filling ”): after G.V. Black; </li></ul><ul><li>Medical approach – Minimal Intervention . </li></ul>
  4. 6. G.V. Black <ul><li>Developed in the 1890s; </li></ul><ul><li>Highly formalised cavity design; </li></ul><ul><li>“ Extension for prevention”. </li></ul>
  5. 7. Critique of G.V. Black’s approach <ul><li>A surgical model; </li></ul><ul><li>Caries “cured” by excision, then filling; </li></ul><ul><li>Appropriate for weak, non-adhesive materials; </li></ul><ul><li>Still the prevailing paradigm in the profession. </li></ul>
  6. 12. The Minimal Intervention approach <ul><li>A medical model; </li></ul><ul><li>Caries treated as a biological infection; </li></ul><ul><li>Surgical techniques are minor and stress retention of tooth tissue. </li></ul>
  7. 13. Details of the MI approach <ul><li>(1) Reduces cariogenic bacteria; </li></ul><ul><li>(2) Uses preventive measures; </li></ul><ul><li>(3) Early lesions remineralised; </li></ul><ul><li>(4) Minimal surgery on cavities; </li></ul><ul><li>(5) Repair of defective restorations. </li></ul>
  8. 14. (1) Cariogenic bacteria <ul><li>Caries is a bacterial disease; </li></ul><ul><li>Depends on dietary sucrose; </li></ul><ul><li>Driven by frequency of eating; </li></ul><ul><li>Modified by saliva. </li></ul>
  9. 16. (2) Preventive measures <ul><li>Topical fluoride; </li></ul><ul><li>Fissure sealants; </li></ul><ul><li>Patient education on oral hygiene </li></ul>
  10. 17. (3) Remineralisation <ul><li>Requires management by non-intervention; </li></ul><ul><li>Enhanced by fluoride ion in saliva. </li></ul>
  11. 18. (4) Minimal surgery <ul><li>Requires adhesive materials (glass-ionomers, adhesive composite systems); </li></ul><ul><li>Innovative, bespoke cavity design: </li></ul><ul><ul><li>Possibly without drilling (ART technique). </li></ul></ul>
  12. 19. (5) Repair of materials <ul><li>To prevent cavity extension; </li></ul><ul><li>Not “botch job”, but appropriate. </li></ul>
  13. 20. The challenge for materials <ul><li>Adhesion </li></ul><ul><ul><li>Occurs naturally for glass-ionomers; problematic for composites. </li></ul></ul><ul><li>Fluoride-release; </li></ul><ul><li>Release of other mineralising ions (PO 4 , Ca 2+ ); </li></ul><ul><li>Repairable. </li></ul>
  14. 21. Conclusions <ul><li>Minimal Intervention dentistry is the future: </li></ul><ul><ul><li>Advocated by FDI; </li></ul></ul><ul><ul><li>Cost effective; </li></ul></ul><ul><ul><li>Less trauma for the patient. </li></ul></ul><ul><li>A biological approach, not a mechanical one. </li></ul><ul><li>Makes significant demands on materials. </li></ul>

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