1) Minimum intervention dentistry aims to detect and treat dental caries early using minimally invasive techniques to promote remineralization and repair of teeth.
2) Remineralizing agents like CPP-ACP and titanium tetrafluoride enhance remineralization by increasing calcium and fluoride levels near enamel.
3) Chemical agents like silver diamine fluoride and papacarie, as well as chemicomechanical methods like Caridex and Carisolv, soften carious tooth structure for easy removal while promoting remineralization.
2. INTRODUCTION
• The ideal aim of preventive dentistry is to avoid disease altogether, but
this is not possible in all cases
Aim is to
1. Early diagnosis
2. Minimally invasive therapy
Detecting Diagnosis Intercepting
Treating
dental caries
Introduction
5. CPP-ACP (Casein phosphopeptide-amorphous calcium phosphate)
• New way of remineralizing tooth surfaces by keeping high levels of calcium and
phosphorus ions in the proximity of the enamel
Mechanism of action
1. Casein phosphopeptides bind the calcium and phosphate ions forming CPP-ACP
complexes
2. which release calcium and phosphorus ions at pH values below 7. 3 CPP-ACP binds
readily to the surface of the tooth under acidic conditions
3. This localized CPP-ACP buffers the free calcium and phosphate ions substantially
increases the level of calcium phosphate in plaque
4. Therefore maintains a state of supersaturation that inhibits enamel demineralisation
and enhances remineralisation
6. • CPP-ACP is available commercially as:
1. Tooth mousse
2. Tooth mousse plus (CPP-ACP+sodiumfluoride)
3. MI paste
4. MI paste plus (CPP-ACP + sodium fluoride)
5. GC MI varnish (CPP-ACP + sodium fluoride)
7. Titanium Tetrafluoride
• Mechanism for fluoride fixation in enamel in which the fluoride is bound to
a polyvalent metal ion in the form of a strong complex.
• Suggested by McCann
• He discovered that both fluoride uptake and retention could be enhanced
when the tooth is pre-treated with any polyvalent metal capable of forming
strong fluoride complexes while simultaneously binding to the apatite
crystals
• Titanium ion pre-treatment showed the maximum uptake and retention,
followed by aluminium (among various metals such as Al, Ti, Zr,La, Fe, Be,
Sn, Mg, Zn)
8. Advantages
When compared with other topically used fluorides, the use of TiF4 seems to
have great advantages.
1. Higher uptake
2. greater penetration of fluoride
3. lower acid solubility of the tissues has been seen with TiF4 when
compared to NaF
4. It was observed that in addition to increasing the fluoride content, topical
application of TiF4 may also change the surface morphology of enamel.
9. • The marked protective effect of TiF4 is attributed to the following:
1. Chemically decreasing enamel solubility by increasing the fluoride
content
2. Physically providing a protective glaze resistant to any acid penetration
10. Enamelon
• Enamelon consists of unstabilized calcium and phosphate salts with sodium
fluoride.
• The calcium salts are separated from the phosphate salts and sodium
fluoride by a plastic divider in the centre of the toothpaste tube.
• An inherent technical issue with Enamelon is that calcium and phosphate
are not stabilized, allowing the two ions to combine into insoluble
precipitates before they come into contact with saliva or enamel
11. Silver Diamine Fluoride (SDF)
• Topical application of silver diamine fluoride (SDF) has been receiving more and more
attention due to its
1. low cost
2. simplicity in treatment
• Advantages of caries treatment with SDF include
1. its attributes of pain and infection control
2. Ease of use
3. low material costs
4. non-invasive nature of the treatment procedure
5. minimal requirement for personnel time and training.
12. Mechanism of action (SDF)
• Yamaga and his co-workers 6 suggest that both fluoride ions and silver ions
contribute to its mechanism of action.
• They propose that fluoride ions act mainly on tooth structure while silver ions act
mainly on cariogenic bacteria
• SDF+Ca10 (PO4 )6 (OH)2 CaF2 +Ag3 PO4
• CaF2 provides sufficient fluoride for the formation of fluoroapatite [Ca10 (PO4 )6
F2 ], which is less soluble than hydroxyl apatite in an acidic environment.
14. • The principal on which this method for caries removal work are based on
studies by Goldman and Kronman working in New Jersey US in the early
1970s
• Involves the chemical softening of carious tissue followed by its removal by
gentle excavation.
15. Caridex
• It received FDA approval for use in the USA in 1984 and was marketed in the
1980s.
• It is developed from a formula made of N-monochloroglycine and amino
butyric acid
• The system was granted in the form of two bottles solution
I having sodium hypochlorite and solution II having glycine, aminobutyric acid,
sodium chloride and sodium hydroxide.
• The system involves the chlorination and disruption of the partially
degraded collagen fibres in carious dentine. The carious dentine then
becomes easier to remove by excavation using the modified needle tip
16. Carisolv
• Medi team in Sweden continued to work on the Caridex system and resulted
in the launch of chemico-mechanical caries removal reagent known as
Carisolv in January 1998
• The fundamental dissmilarity between Carisolv and other products already
in the market was the use of three amino acids— lysine, leucine and
glutamic acid—instead of the amino butyric acid.
• Two syringes: Syringe I—containing 0.5% sodium hypochlorite solution
Syringe II—gel consisting of three amino acids
17. Papacarie
• In 2003, a research project in Brazil
• Papacarie is intrinsically formed of papain gel, chloramines, toludine blue,
salts, thickening agent which altogether idiosyncranise to its antibacterial
and anti-inflammatory features
• t is commercially available as a gel syringes that have 3 ml of solution
18. Air Abrasion
• Air abrasion was originally developed by Robert Black in 1945 as an alternative
pseudomechanical method for dental tissue removal and the first air abrasion
unit marketed was called the Airdent by SS White
• . This technique involves bombarding the tooth surface with high velocity
aluminium oxide particles (Alumina) carried in a stream of air.
• Disadvantages
1. This method of cutting is relatively painless
2. The total loss of tactile sensation
3. ability of alumina particles to remove sound tooth structure rather than the
carious substrate
4. Potential risk of inhalation problem should also be considered at the time of
selection.
19. • The abrasive units currently being marketed are
1. The three KCP series (KCP 1000 Whisperjet, KCP 2000 and KCP 2000 Plus)
(American Dental Technologies),
2. The MicroPrep (Sunrise Technologies) and
3. The Kreativ (Kreative Inc.).
20. • Contraindications of Air abrasion
1. It should be avoided in cases involving severe dust allergy, asthma, chronic
obstructive lung disease,
2. recent extraction or other oral surgery, open wounds, advanced
periodontal disease,
3. recent placement of orthodontic appliances and oral abrasions
4. subgingival caries removal
21. Ozone
suggested based on the fact that the remineralised tooth tissues are known to be
more resistant to decay than sound tooth structure.
• Ozone therapy causes remineralisation of incipient caries lesion.
• Ozone readily penetrates through decayed tissue, eliminating the ecological
niche of cariogenic microorganisms as well as priming the carious tissue for
remineralisation.
• it would be expected that ‘clean’ lesion (done by ozone) would remineralise.
• The remineralisation process will then take place with the aid of a topically
applied remineralising solution and the recommended patient’s maintenance
kit.
22. Laser Irradiation
• One of the potentially effective preventive measures is the use of lasers. As
early as 1966, Stern and Sognnaes
• using an Nd:YAG (Neodymium-doped: Yttrium Aluminium Garnet) laser,
showed that irradiated enamel specimens were resistant to acid
demineralization
• Highly absorbed wavelengths can modify the tissue composition and
structure by thermal action, and promote an increased acid resistance
23. Conclusion
• These non-invasive and minimally invasive modalities point to a direction of
potential consistent benefit in prevention, slowing the progression or
reversing early carious lesions
