minimal intervention dentistry

2. DR. UDAI KIRAN
3 rd year post graduate

3. 1. Introduction
2. Timeline Of Minimal Invasive Dentistry.
3. Golden Triangle Of Minimal Invasive Dentistry
4. Plan Of Minimal Invasive Dentistry
5. Goals Of Minimal Invasive Dentistry
6. Concept Of Minimal Invasive Dentistry
I. Caries Diagnosis
Ii. Caries Removal Or Early Restoration
Iii. Caries Control.
7. Advantages Of Minimal Invasive Dentistry
8. Conclusion
9. References.
CONTENTS

4. Dental caries –
Microbial disease of the calcified tissues of
the teeth characterized by demineralization
of the inorganic portion and destruction of
organic substance of the teeth

5. BLACK’S TEACHINGS
highly formalized cavity designs
precise size and geometry
weak, non-adhesive materials
‘Extension for prevention’

6. -- Martin J Tyas

7. process of removing only minimal carious tooth structure and attempting to re-
mineralize and restore the remaining tooth structure

8. The ever-changing field of Operative Dentistry has modified its
concept from “Replacement Dentistry” in 1917 to “Minimal Intervention
Dentistry “over the past 30 years.
“Extension for Prevention” to “Prevention of Extension”
“Drilling and Filling” to “Filling without Drilling”
have become the two major goals of minimal intervention
dentistry.
TIMELINE

10. GOLDEN TRIANGLE
• Three critical factors required to achieve success clinically
when using a minimally invasive operative caries
management strategy (MI OCMS):
1. The histology of the dental substrate being treated
2. The chemistry/handling of the adhesive materials used
to restore the cavity
3. Consideration of operative techniques available to
excavate caries minimally

11. PLAN OF MID

12. ELEMENTS OF MID
The dentist as a physician (requires a knowledge of the
factors associated with the development of caries)
• Individualized assessment of caries risk
• Appropriate preventive strategies
• Remineralization/arrest of non-cavitated lesions
The dentist as a surgeon (requires a knowledge of the
caries lesion)
• Minimum surgical intervention of cavitated lesions
• Appropriate maintenance of existing restorations

13. CONCEPT OF MINIMAL
INTERVENTION

14. Early caries
Diagnosis
Remineralization
Minimum
surgical
intervention of
cavitated lesions
Disease
control
Repair –
replacement
Concepts Of MID

15. 1. CARIES DIAGNOSIS
i. Caries risk assessment
ii. Early detection of caries

16. Caries risk assessment
• Patient history
• Clinical examination
• Nutritional analysis
• Salivary analysis

17. Visual and tactile examination
• Mirror & probe
• Tooth separation
Radiographic method
• IOPA
• Bite wing
Conventional Method
Early detection of caries

18. •Fiber optic transillumination
•Digital fiber optic transillumination
•Quantitative light induced fluorescence
•Laser fluorescence - DIAGNODENT
•Electrical conductance measurement
•Ultrasonic imaging
•Endoscope
•Videoscope
Recent Advances

19. Fiber Optic Transillumination(FOTI)

20. DIFOTI

21. Carious lesion detection:
laserfluorescence/
Diagnodent.
Quantitative light-induced
fluorescence.

22. Caries Detecting Dyes
Calcein
Zyglo zl- 22
Fuschin
Acid red system
9- Amino acridine

23. ii. Early Restoration And Caries Removal
• Remineralization Of Existing Lesions
• Minimal Invasive Operative Care

24. Remineralization Of Existing Lesions
Chlorhexidine and topical fluoride
• Reduces Cariogenic Bacteria And Flouride In
Formation Of Flourapetite

25.  CPP + ACP Meta stable solution as
CPP-ACP nanocomplexes
CPP-ACP complex
 have been shown to localize at tooth surface and prevent
enamel demineralization
 Contains calcium and phosphate in bio-available forms
 Also shown to remineralize enamel subsurface lesions
CPP-ACP

26. • Triclacium Phosphate
• NOVAMIN
• ENAMELON
• Ion Exchange Resin

27. Mechanical
i) Hand instruments – ART
ii) Rotary
Slot Preparation
Tunnel Preparation
CHEMOMECHANICAL
AIR ABRASION
LASERS
OZONE
MINIMALLY INVASIVE OPERATIVE CARE

28. A New Caries Classification
In response to the importance of site and size of carious lesions for
treatment, G.J Mount and colleagues have proposed a new
classification, which classifies lesions by combining both their site
and size.

29. According to their location:
• Site 1: pits and fissures
(occlusal and other smooth
tooth surfaces);
• Site 2: contact area between
two teeth;
• Site 3: cervical area in contact
with gingival tissues.
According to various sizes:
Size 1: small cavitation, just beyond
healing through remineralization;
Size 2: moderate cavity not extended to
cusps;
Size 3: enlarged cavity, with at least
one cusp which is undermined
Size 4: extensive cavity, with at least
one lost cusp or incisal edge.

30. ART
• The Atraumatic restorative treatment is a procedure based on
removing carious tooth tissues using hand instruments alone and
restoring the cavity with an adhesive restorative material.
• Goals of ART are:
i. Preserving the tooth structure
ii. Reducing infection
iii. Avoiding discomfort

31. ART PROCEDURE

32. • Hall technique

33. Tunnel preparations

34. Slot preparations
Small box or slot design,
Limited in size to extent of the lesion.
Approached
Occlusal - Vertical slot Facial/lingual - Horizontal slot.

35. CHEMO MECHANICAL CARIES REMOVAL
Scraping - removal of softened dentin without removing
the affected dentin.
Gel applied - softened caries - removed with hand
instruments.

36. CARISOLV
• It is in the form of Pink gel which can be applied to the carious
lesion with specially designated hand instruments.
• Aminoacid and 0.5% Sodium Hypochlorite
36

37. Advantages of CMCR
Reduced need of local anesthesia
Conservation of sound tooth structure
Reduced risk of pulp exposure
Suited for Pediatric dentistry, Anxious patients, Medically compromised patients
Limitations of CMCR
Rotary and hand instruments still needed for removal of tissue or material other than
degraded collagen

38. OZONE TECHNOLOGY
• Ozone (O3) is an energized form of oxygen.
• It is now a proven fact that 10 seconds application of
ozone gas at a concentration of 2200ppm could
eliminate 99% of the carious micro flora.
• For the therapeutic purposes, ozone can be produced
in a controlled manner using electrical units.
38

39. First - Black – 1945
Use stream aluminum oxide particles generating from compressed air
Particle size 27 to 50 µm
Gas pressure 40-160 pounds per sq inch
Flow rate – device, speed, gas pressure, nozzle diameter
Operating distance range from 0.5-2mm
Strike with high velocity - remove small ammounts
AirAbrasion

40. Advantages-
Used for both diagnosis and treatment of early Occlusal surface
lesions
Reduced noise, vibration, heat and sensitivity
Produce more rounded internal contours
No need anaesthesia

41. LASERS
• Lasers are devices that produce beams of
Coherent and very high intensity light. Lasers
are used in the treatment of soft tissues and
modification of hard tooth structures.
41

44. III. CARIES CONTROL
MATERIALS FOR MINIMALLY INVASIVE OPERATIVE CARE

45. Glass Ionomer Cement
• Conventional GIC:
- release fluoride
- anticariogenic properties
- technique sensitive
• anterior restorations in patient
exhibiting high caries activity.

46. Resin Modified GIC
• Anterior restorations in patient exhibiting high caries
activity.
• Advantage- sustained fluoride release
• Indicated for:
• Class V restorations in adults who are at high risk of caries
and
• Class I and II restorations in primary teeth that will not
require long term service.

47. COMPOMERS
• polyacid modified resin composite with constituents derived
from composite and glass ionomer components.
• Wear resistance and mechanical properties of compomers are
less than composite resin but the fluoride release and uptake are
greater.
• Eg: - Dyract
- Compoglass
- F-2000
- Hytac

48. Repair rather than
Replacement

49. While the concept of minimally invasive dentistry has long
been considered a rational, viable approach to restorative
care, preparation design, material science, and long-term
evidentiary support have only recently begun to provide the
foundation necessary to support such treatment in the
everyday practice.
CONCLUSION

50. Conclusion
G . V Black (1990)
The day is surely coming… when we will be engaged in
preventive rather than reparative dentistry…..
…. today !!!

51. References
• Tyas MJ, Anusavice KJ, Frencken JE,Mount GJ. Minimal
intervention dentistry-a review. FDI Commission Project 1-97.
Int Dent J. 2000;50:1–12.
• Vimal k sikri. Textbook of operative dentistry.2nd edition.
• Ramya raghu, clinical operative dentistry, principles and
practice.
• Graham j mount, an atlas of glass ionomer cements. A
clinicians guide.
• White JM, Stephan EW, Rationale and treatment approach in
minimally invasive dentistry. J Am Dent Assoc. 2000;131: 13s-
19s.
• Mount GJ, Hume WR. A new cavity classification. Australian
Dental Journal.1998;43(3):153-159.

52. • Roberson TM, Lundeen TF. Sturdvent’s Art & Science of Operative
Dentistry, 4th edition, Cariology: The Lesion, Etiology,Prevention, and
Control; 2002.
• Walsh LJ. The current status of laser application in dentistry. Aust
Dent J 2003;48:146-55.
• A.Banerjee . Minimal intervention dentistry: part 7. Minimally
invasive operative caries management: rationale and techniques.
BRITISH DENTAL JOURNAL VOLUME 214 NO. 3 FEB 9 2013.
• Shefally Garg. Minimal Invasive Dentistry- A Comprehensive Review
BJMMR, 17(5): 1-9, 2016; Article no.BJMMR.27526.
• Avijit Banerjee The contemporary practice of minimally invasive
dentistry FACULTY DENTAL JOURNAL April 2015 • Volume 6 • Issue 2
• Simonsen RJ. Preventive resin restorations (PRR) and Sealants In Light
Of Current Evidence: DCNA. 2005;49:815-823.