The document discusses interim therapeutic restorations (ITRs) and minimal intervention dentistry. ITRs are used to stabilize dental caries in young, uncooperative patients and involve sealing lesions with materials like resin or glass ionomer without extensive drilling. Factors for the success of ITRs include proper diagnosis, adequate restoration, and appropriate excavation. The document also discusses techniques like air abrasion, polymer burs, and glass ionomer sealants that are minimally invasive and important aspects of modern caries management.

2. TO OUR TEAM WORK
Acknowledgements

3. PEDIATRIC DENTISTRY UPDATE
By DR/Ali Abdel
Fattah pedodontist

4. THE DENTAL HOME
THE DENTAL HOME WAS
ESTABLISHED AS “AAPD POLICY IN
2003, AND IS BASED ON THE SAME
CONCEPT AS THE AMERICAN
ACADEMY OF PEDIATRICS POLICY
STATEMENT DEFINING THE MEDICAL
HOME IN 1992.

5. THE DENTAL HOME
 The dental home is the ‘ongoing relationship
between the dentist and the patient, inclusive
of all aspects of oral health care delivered in a
comprehensive, continuously accessible,
coordinated, and family-centered way.
Establishment of a dental home begins no
later than 12 months of age and includes
referral to dental specialists when
appropriate (AAPD def,)

7. The Dental Home Provides…
a. Comprehensive oral health care including
“acute care” and preventive services
in accordance with AAPD periodicity
schedules.
b. Comprehensive assessment for oral
diseases and conditions.

8. The Dental Home Provides…
c. “Individualized “ preventive
dental health program based upon
a caries-risk assessment and a
periodontal disease risk assessment.
d. Anticipatory guidance about growth
and development issues,
(ie, teething, digit or pacifier habits).

9. The Dental Home Provides…
e. Plan for acute dental trauma.
f. Information about proper care of the
child’s teeth and gingivae. This would
include prevention, diagnosis, and
treatment of disease of the supporting
and surrounding tissues and the
“maintenance of health, function,
and esthetics of those structures
and tissues.”

11. Why Brush Teeth in”{ Day Care Centers}” ?
• Develop good habits
• Children may not
brush at home
• Children learn basic
hygiene principals

16. H2O
X X
Tips for Preventing Decay
It’s not the bottle, it’s the beverage

22. MINIMALLY INVASIVE TECHNIQUES
Minimally invasive techniques
today utilize microscope ,
imaging systems , lasers,
air abrasion Prevention
protocols can keep the
patient disease free
indefinitely

23. Historical Development of Dentistry
- Extraction;
- Surgical approach (“drilling and filling”):
after G.V. Black;
- Medical approach – Minimal Intervention.

24. Minimal Intervention Dentistry
- Modern approach to the treatment of
tooth decay
- Based on “Medical Model” of caries
management

25. The Intervention approach Minimal
 A medical model;
 Caries treated as a biological
infection
 Surgical techniques are {minor}
and stress retention of tooth tissue.

26. Details of the MI approach
- (1) Reduces cariogenic bacteria;
- (2) Uses preventive measures;
- (3) Early lesions remineralised;
- (4) Minimal surgery on cavities;
- (5) Repair of defective restorations.

27. (1) Cariogenic bacteria
 Caries is a bacterial disease;
 Depends on dietary sucrose;
 Driven by frequency of eating;
 { Modified by saliva }

28. (2) Preventive measures
• Topical fluoride
• Fissure sealants
• Patient education on oral hygiene

29. (3) Remineralisation
• Requires management by non-intervention
{medical model}
• Enhanced by fluoride ion in saliva.

30. (4) Minimal surgery
 Requires adhesive materials (glass-ionomers,
adhesive composite systems);
 Possibly without drilling (ART technique).

31. (5) Repair of materials
• To prevent cavity extension;
• Not “botch job”, but appropriate.

32. The challenge for materials
 Adhesion
– Occurs naturally for glass-ionomers; problematic for
composites.
 Fluoride-release;
• Release of other mineralising ions
( PO4, Ca2+ )
 Repairable.

33. Conclusions
• Minimal Intervention dentistry is the future:
– Advocated by FDI;
– Cost effective;
– Less trauma for the patient.
• A biological approach, not a mechanical one.
• Makes significant demands on materials.

35. Caries Stabilization
 Interim therapeutic restorations (ITRs)
 Resin and glass ionomer sealants
 Regular recharging of ITRs and sealants
with fluoride
 Fluoride varnish applications
 Twice daily brushing with fluoride toothpaste

36. Why Caries Stabilization?
 Poor Dental Access for 0-5 year olds
 Only 10% of 0-2 year olds are seen
yearly in the dental clinic.
 Only 25% of 3-5 year olds are seen
yearly in the dental clinic.

37. Policy Statement
Download AAPD policy on ITRs.

38. Indications for ITRs
 No pulpal involvement
 1 or 2 surface lesions
 Reduce fear
 Defer treatment
 Provide care at schools

39. Contraindications for ITRs
 Necrotic pulp
 Irreversible pulpitis
 3 or more surfaces
affected by decay

40. Fluoride Varnish
“every- every”

41. Factors for Success
1. Proper diagnosis
2. Adequate restoration
3. Appropriate excavation
4. Margin quality

46. POLYMER BUR
Smart bur 2 is self – limiting
caries removal bur for use in
a slow –speed hand piece
operating at up to 4000 rpm
Research demonstrates that
the polymer bur is truly dentin
safe & will not cut sound
healthy dentine

51. NU SIMLE SIGNATURE ARE ST ST CROWNS
WITH TOOTH COLORED COATING
NU SMILE ZR OFFERS SUPERIOR DURABILITY
AND EASY PLACEMENT COMPERED TO
COMPOSITE RESTORATIONS & STRIP CROWNS
NU SMILE & NU SMILE ZR

52. AIR ABRASION
This technique uses a stream of
purified aluminium oxide
particles that are forced under
pressure through a fine –focused
nozzle onto the tooth surface

54. AIR ABRASION
This technique uses a stream of
purified aluminium oxide
particles that are forced under
pressure through a fine –focused
nozzle onto the tooth surface

59. 59

61. POLISY STATMENT
ITR may be used to restore & prevent
dental caries in young pat ,
uncooperative pat , pat with special
health care needs & situations in which
traditional cavity prep, &/or placement
of traditional dental restorations are

62.  Indications for interim therapeutic restorations
(ITRs), and glass ionomer sealants
 Appropriate technique for placing ITRs and GI
sealants
 Variables that influence the success of ITRs and GI
sealants
 Behavioral management when working with young
children
 Oral health messages for parents and caregivers of
young children
 Strategies for follow-up and coding
Objectives

63.  I R T UTILIZES SIMILAR TECHINQUES Like
A R T BUT HAS DIFFERENT THERAPEUTIC
GOALS
( ART: REMOVAL OF CARIES USING HAND OR
SLOW SPEED ROTARY INSTRUMENT & THEN
RESTORE THEM WITH AN ADHESIVE
RESTORATIVE MATERIAL e.g G I CEMENT )
THE USE OF ITR HAS BEEN SHOWN to