Minimal Intervention Dentistry (MID) is a response to the traditional, surgical manner of managing dental caries, that is based on the operative concepts of G.V. Black of more than a century ago. MID is a philosophy that attempts to ensure that teeth are kept functional for life

1. THE CONCEPT OF MINIMAL INTERVENTION DENTISRTY Vs
G.V BLACK
BY
MASEREKA TOM
Makerere Univeristy
BDS III, 2017

2. AIMS
1. GV Black concept
2. Principles for minimal intervention dentistry
3. Modern approach to the treatment of tooth decay
4. Medical model of caries management
5. Caries treated as a biological infection

3. G.V BLACK CONCEPT
Greene Vardiman Black (1836–1915) father of modern operative dentistry
 Extension for prevention (1891), was the hallmark of cavity design which
has been revised and refined over the years.
 Basic idea was to prevent the recurrence of dental decay by placing the
margins of restorations along the lines that would be cleansed by the
normal excursion of food(black, 1924).
 Black's Principles are still used as the basic steps in the process of
designing and preparing a cavity for restoration.
Consists of seven principles designed mainly for amalgam and Gold inlays

4. Extension for prevention

5. PRINCIPLES OF CAVITY PREPARATION BY G.V BLACK
1. Outline form
2. Resistance form
3. Retention form
4. Convenience form
5. Removal of remaining caries
6. Finish enamel walls
7. Clean cavity preparation

6. 1. Outline form
Based primarily on the location and extent of the caries. Final outline form is not established until
the carious dentin and usually, its overlying enamel has been removed.
2. Establish a resistance form
Resistance to both fracture of the tooth and filling material must be built in so both will be resistant
to fracture during normal function.
3. Establish a retention form
The tooth preparation must be shaped in such a way to retain the filling material, without
weakening the remaining tooth structure.
4. Establish a convenient form
Allows adequate observation, accessibility, and ease of operation during the preparation and
restoration of the tooth. Only the minimal amount of reduction that will provide the necessary
convenience should be done.
5. Removal of the remaining caries
Deeper caries not removed by the initial cavity preparation is now removed. Care must be exercised
as the pulp may be in close proximity to avoid injury to the pulp.
6. Finishing of enamel walls and margins
Remove unsupported enamel, make the margins smooth and continuous to facilitate finishing of the
restoration.
7. Clean and medicate the cavity preparation
Rinse away all debris and dry the cavity preparation.

7. ..

8. THE PRINCIPLES OF MINIMAL INTERVENTION DENTISTRY
MINIMAL INTERVENTION DENTISTRY
Defined as a philosophy of professional care concerned with the first occurrence, earliest detection
and possible cure of disease on micro(molecular) levels, followed by minimally invasive and
patient-friendly treatment to repair irreversible damage caused by such disease.
Minimal intervention dentistry is a modern dental practice designed around the principal aim of
preservation of as much of the natural tooth structure as possible.
1. Modification of the oral flora
Dental caries is an infectious disease, and the primary focus should therefore be on control of the
infection, plaque control and reduced carbohydrate intake.
2. Patient education
The etiology of dental caries should be explained to the patient, together with the means of
prevention through dietary and oral hygiene measures.
3. Remineralization of non-cavitated lesions of enamel and dentine
Saliva plays a critical role in the demineralization/remineralization cycle and its quantity and
quality should therefore be assessed. There is strong evidence that ‘white spot’ lesions of enamel
and non-cavitated lesions of dentine can be arrested or reversed. Such lesions should therefore
be managed initially by remineralization techniques. The extent of the lesion should be
objectively recorded such that any progression can be identified at recall.

9. ..
4. Minimal operative intervention of cavitated lesions
An operative (surgical) approach should only be used when specifically indicated,
e.g when cavitation is such that the lesion cannot be arrested, or when there are
aesthetic or functional requirements. Operative intervention should focus on the
preservation of natural tooth structure and be limited to the removal of friable
enamel and infected dentine. This can be done with hand, rotary, sonic, ultrasonic,
air abrasive or laser instruments, depending on the circumstances. Each prepared
cavity is therefore unique, and is primarily dependent on the extent of infected
dentine rather than on a predetermined cavity design.
5. Repair of defective restorations
Removal of restorations results in an inevitable increase in cavity size as a
consequence of removal of sound tooth structure. Depending on the clinical
judgment of the dentist, repair could be considered as an alternative to
replacement in some circumstances.

10. MODERN APPROACH TO THE TREATMENT OF TOOTH DECAY
It is based on the concept that dental caries is an infection mainly caused by a marked
elevation of Streptococcus mutans bacteria and that a decrease in the levels of these bacteria
must be achieved.
This includes ;
 Caries reduction by use of fluorides and reduction of bacteria, monitoring for re-
mineralization of suspicious areas.
 Early caries detection and diagnosis
 Caries risk assessment; dietary, salivary function, oral hygiene, destructive and protective influencers that
may or may not be present in the individual patient.
 Reduction of bacteria through use of rinses to decrease caries causing bacteria such as;
 Chlorhexidine gluconate used two times per day for two weeks. High risk people continue
this regimen for up to one year.
 Betadine may be used as an alternative rinse .This one minute rinse kills the caries bacteria
for 3 to 4 months.
 Preventive dentistry oriented and conservative approach to the treatment of dental caries
for all ages.

11. ….
 Promoting remineralization; Current re-mineralization products include;
 Fluoride varnishes, gels ,rinses and tooth paste.
 Amorphous calcium phosphate also slowly releases calcium and
phosphate ions.
 Novamin paste; is a bioactive glass.
 Arresting active caries
 Placing restorations with minimal cavity design
 Repairing rather than replacing existing restorations

12. cont’n
 Treatment of caries can be accomplished through different types of intervention,
depending on the progression of the disease, the patient's age, as well as the
social, behavioral, and medical history of the child.
 Patients at moderate risk may require restoration of progressing and cavitated
lesions, white spot and enamel proximal lesions should be treated by preventive
techniques and monitored for progression.
 The ART(Atraumatic restorative therapy) is a procedure based on removing
carious tooth tissues using hand instruments alone and restoring the cavity with
an adhesive restorative material like glass ionomer.
 Stainless steel (preformed) crowns are pre-fabricated crown forms which can be
adapted to individual primary molars and cemented in place to provide a
definitive restoration.
 New treatment is ,Electrically Accelerated and Enhanced
Remineralization(EAER),accelerates the natural movement of calcium and
phosphate minerals into the damaged tooth. The two stepwise process first
prepares the damaged area of enamel then uses a tiny electric current to push
minerals into the repair site.

13. MEDICAL MODEL OF CARIES MANAGEMENT
The medical model includes four steps adapted from Steinberg;
1. Removal of bacterially infected tooth tissue.
2. Reducing risk for the patient(decreased ingestion of sugars and
carbohydrates frequency)
3. Reversal of demineralization by specific therapy
4. Follow up at home and with office visits(Frequency is based upon risk)

14. CARIES TREATED AS A BIOLOGICAL INFECTION
 The on set involves microorganisms i.e. acid producing bacteria.
 The concept recognize that dental caries is a transmissible,
infectious disease (medical model) in which interventions can
be applied to prevent and control this infection.
 Dental caries is a chronic process having episodes of activity
and inactivity
 With early recognition of the disease process (before cavitation),
intervention will stop and even reverse the disease process
(remineralization of the non-cavitated lesion).

15. Reference
 Tyas M J, Anusavice K J, Frencken J E, Mount G J. Minimal Intervention
Dentistry -A Review. FDI Commission Project 1-97. Int Dent J 2000; 50:
1-12
 The Art and Science of Operative Dentistry; Sturdevant C M, Barton R E,
Sockwell C L, Strickland W D, 5th edition, Mosby Co. St. Louis.
 Pickard’s Manual of Operative Dentistry; Kidd E A M, Smith B G N and
Pickard H M, 6th edition, Oxford Medical Publications.

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