The document discusses conservative approaches to dental cavities and restorations. It recommends collecting data on a patient's diet, caries risk, and clinical examination before deciding if a restoration is needed. Non-cavitated lesions, root surface lesions, and large cavitated lesions that can be cleaned may not require restoration. The document discusses using remineralization and preventive treatments before performing restorations when possible. It provides examples of conservative cavity designs that minimize tooth structure removal, such as preventive resin restorations, simple boxes, slots, and tunnels. The goal is to take a minimal intervention approach and restore teeth only when necessary.

1. ALPINE SKI HOUSE
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”

6. 6

7. 7

8. 8

9. 9

10. 10

11. 11

12. 12

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

29. ALPINE SKI HOUSEALPINE SKI HOUSE 29

30. ALPINE SKI HOUSEALPINE SKI HOUSE 30