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

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

  1. 1. Minimum Intervention Dentistry (MI) (Overview) Evidence based Compendium
  2. 2. MI Definition Disease risk assessment Earliest disease detection Minimally invasive treatment … a philosophy of health care including: Evidence based Compendium
  3. 3. Minimum Intervention (MI) Focus on disease Etiology! Prophylaxis Diagnostic Treatment Past Now Evidence based Compendium
  4. 4. Caries = multifactoral disease ORAL BALANCE Demineralization = Remineralization Disturbance of oral balance Demineralization > Remineralization <ul><li>Higher bacteria count (S.mutans, Lactobacilli) </li></ul><ul><li>Reduced saliva function (flow rate, buffer capacity) </li></ul><ul><li>Decreased plaque pH , Increased plaque rate </li></ul><ul><li>Hypomineralization / Lesions </li></ul><ul><li>Cavities </li></ul>Disease Etiology: Caries Evidence based Compendium
  5. 5. <ul><li>bacteria </li></ul><ul><li>saliva function </li></ul><ul><li>plaque pH </li></ul><ul><li>etc. </li></ul>Risk factors Identified Modified / Reduced <ul><li>Stop of disease = regain of ORAL BALANCE </li></ul><ul><li>Repair of reversible damage = Lesions (Remineralisation) </li></ul><ul><li>Repair of irreversible damage = Cavities </li></ul>3.a) Classification 3.b) Restoration
  6. 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. 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. 8. MI principles of cavity restoration <ul><li>Minimal necessary cavity access </li></ul><ul><li>Selective caries removal (atraumatic, minimally invasive) </li></ul>Evidence based Compendium
  9. 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. 10. DENTINE - STRUCTURE Odontoplast cell Odontoplast process Intertubular dentine Peritubular dentine Pulp Dentine tubule Dentine fibers Evidence based Compendium
  11. 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. 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. 13. Carious dentine Selective caries removal Infected Outer Layer Affected Inner Layer
  14. 14. Infected Outer Layer <ul><li>Most of bacteria located </li></ul><ul><li>Not sensitive, dead tooth tissue </li></ul><ul><li>Soft </li></ul><ul><li>Collagen fibers damaged </li></ul><ul><li>Can not remineralize </li></ul>
  15. 15. Affected Inner Layer <ul><li>Few bacteria located </li></ul><ul><li>Sensitive, vital tooth tissue </li></ul><ul><li>Hard </li></ul><ul><li>Collagen fibers intact </li></ul><ul><li>Can remineralize </li></ul>
  16. 16. Remineralisation of Affected Dentine + <ul><li>Internal Factors (from Dentine & Pulp): </li></ul><ul><ul><ul><li>Intact Collagen Fibers </li></ul></ul></ul><ul><ul><ul><li>Active Odontoblasts </li></ul></ul></ul><ul><ul><ul><li>Active Mineral supply (Calcium, Phosphate) from the Pulp to the Dentine </li></ul></ul></ul>
  17. 17. <ul><li>External Factors (from Cavity): </li></ul><ul><ul><ul><li>Reduced bacteria number </li></ul></ul></ul><ul><ul><ul><li>Reduced bacteria activity </li></ul></ul></ul><ul><ul><ul><li>Fluoride </li></ul></ul></ul>Remineralisation of Affected Dentine Selective caries removal
  18. 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. 19. MI treatment concepts & procedures <ul><li>Chemical softening of denatured (infected) carious dentine </li></ul><ul><li>Mechanical removal with non-cutting hand instruments </li></ul>Chemo-mechanical concept: Electrostatic splitting Selective caries removal Evidence based Compendium
  20. 20. MI principles of cavity restoration <ul><li>Minimal necessary cavity access </li></ul><ul><li>Selective caries removal (atraumatic, minimally invasive) </li></ul><ul><li>Cavity design according to extend of caries </li></ul><ul><li>Use of therapeutic materials (adhesive, remineralizing) </li></ul>
  21. 21. MI principles of cavity restoration <ul><li>Minimal necessary cavity access </li></ul><ul><li>Selective caries removal (atraumatic, minimally invasive) </li></ul><ul><li>Cavity design according to extend of caries </li></ul><ul><li>Use of therapeutic materials (adhesive, remineralizing) </li></ul><ul><li>Biomimetic replacement of tooth hard substances </li></ul>
  22. 22. MI principles of cavity restoration <ul><li>Minimal necessary cavity access </li></ul><ul><li>Selective caries removal (atraumatic, minimally invasive) </li></ul><ul><li>Cavity design according to extend of caries </li></ul><ul><li>Use of therapeutic materials (adhesive, remineralizing) </li></ul><ul><li>Biomimetic replacement of tooth hard substances </li></ul>Ultra-conservative, smaller restorations + maximum tissue preservation
  23. 23. … in practice: <ul><ul><li>Ensuring maximum tooth tissue preservation </li></ul></ul><ul><ul><li>Be generally perceived as non-threatening (from Patients’ point of view) </li></ul></ul>Minimal Intervention Dentistry Evidence based Compendium
  24. 24. Minimum Intervention (MI) Patient friendly Positive impact on health

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