Conservative approach and minimal intervention 1 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
APPROACH AND
MINIMAL
INTERVENTION

3. What do you think about
conservative dentistry concept,
do you support it or not ?

4. For most of the twentieth
century, the profession has
followed re-taughtable
approach of Black’s
principles.
What were Black’s
principles of extension for
prevention ?
What were his reasons
behind this approach?

5. What were the consequences of
Black’s principles of extension
for prevention?

6. Conservative approach in
restoration of hard tooth structure
defects:
◦ It focuses on a minimally invasive dentistry or
preservative dentistry, which allows a shift from
the traditional surgical approach to a control of
defects without cutting or if cutting is to be
done, it has to be restricted as much as possible.

7. Conservative approach in restoration of hard
tooth structure defects:
◦ The adoption of the medical model of treatment would thus save money, effort
and time by:
◦ Preventing the development of defects or new cavities.
◦ Preventing periodontal problems.
◦ Stopping the progress of existing lesions and decay spots.
◦ Stopping the progress of existing lesions and decay spots.
◦ Maintaining existing old restorations.

8. This concept encompasses the following
principles:
◦ Control of causative factor or carcinogenicity to eliminate further
demineralization.
◦ Re-minerlization of early lesions.
◦ Minimal Surgical intervention for cavitated lesions.
◦ Repair rather than replace for defective restorations.

9. Essentials to allow conservation:
◦ To achieve this conservative equation, several contributing factors
are to be shared in order to allow the realization of this required
target.
◦ These could be dependent on the operator, the tool used, the
restorative materials employed, the oral environment conditions and
the socioeconomic conditions of the patient receiving the treatment.

10. The Operator
◦ Two main issues are to be focused upon:
◦ First is the elimination of microorganism
to suppress demineralization
◦ Second is the saturation of saliva with
fluorides, calcium and phosphate to drive
them inside the tooth thus enhancing
remineralization.

11. The tools used:
◦ Micro dentistry replaced macro dentistry to allow microscopic removal of
diseased tissue. Therefore, maintenance of as much healthy tissue and
structural integrity of the tooth as possible, while still allowing feasible
visualization and access, is becoming a main requirement.
◦ To practice minimal invasive and micro dentistry, it was found essential for this
ultraconservative approach to utilize magnification, precise diagnostic
equipment and non-invasive cutting tools.

12. Magnification:
◦ Visual acuity helped accuracy of incipient
caries diagnosis and minimization of
healthy tooth destruction cutting.
◦ 1. Loupes

13. 2. Microscopes ( video)

14. Advanced diagnostic tools to detect incipient
lesions:
◦ Up to date, no diagnostic tool could make caries detection full
proof. The earliest possible lesion detection will provide the facility
of condition reversal. It could also provide for a minimum tooth
structure removal and consequently a much conservative
restoration. This would provide a cliché to be maintained that
dictates “ smaller is better”.
◦ It thus allows dentistry to be diagnostically-oriented.

15. The traditional methods of
detection of dental caries
◦ The lesion is already unnecessary
large.
◦ Probing may disrupt the tooth surface
and predispose to cavitation or may
erroneously result in misdiagnosis
because stickiness may be due to
fissure morphology or probe
pressure.

16. ◦ This raises the question: “ which
tool to use best and what tools
combination could perform a better
job?
◦ Is there a single tool to use to
detect smooth surface or occlusal
carious lesions ?

17. This led to the development of several techniques
that help the operator to reach an accurate diagnosis.

18. Intra-Oral Camera

19. Dental Radiography

21. Laser based device (DIAGNOdent):

22. Quantitative light induced fluorescence (
fluorescence of visible light) :
◦ The high resolution transillumination: Digital Imaging Fiber Optic
Transillumination tool ( DIFOTI):

23. Electrical Caries Monitor (ECM):

24. Minimal or Non-invasive cutting tools (
video) :
◦Air-abrasion technology:

25. Chemico-mechanical removal of tooth
tissues:

26. Ultra-sonic cutting
Chemical vapor deposition (CVD bur)

27. Ultra-sonic cutting

28. Laser cutting

29. Enzymes
◦ Pronase does not attack
sound dentin but
solubilizes more than 90%
of the nitrogen present in
carious dentin.
◦ It has no ability to remove
sound or carious enamel.

30. Ozone treatment:

31. The restorative materials
◦Bondodntics

32. The oral environment conditions
◦Salivary flow and PH

33. The socioeconomic conditions of the patients

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