Minimally Invasive Dentistry part 1.ppt

Minimally invasive dentistry procedures

1. Presented by: Dr.Walid Al anesi

2. Minumum
Intervention
Identify
Treatment
and control
Prevention
Concept of MID

3. •Minimuminterventiondentistry(MI)canbedefined
asaphilosophyofprofessionalcareconcernedwith
thefirstoccurrence,earlydetection,andearliest
possiblecureofdiseaseonmicrolevels,followedby
minimallyinvasive,patient-friendlytreatmenttorepair
irreversibledamagecausedbysuchdisease.

4. Minimal intervention operative dentistry is dependent
on the following factors:
1.The demineralization -remineralization cycle
2.Adhesion in restorative dentistry
3.Biomimetic restorative materials

5. Goals of Minimal Intervention Include
1.Preventionofcaries.
2.Reductionincariogenicbacteria.
3.Remineralizationofearlylesions.
4.Minimumsurgicalinterventionofcavitatedlesion.
5.Repairratherthanreplacementofdefective
restorations

6. Objectives Include
1. Identification
a) Evaluation of saliva.
b) Evaluation of caries activity.
c) Assessing occlusion & other tooth factors.
d) Understanding patient environment like socioeconomic condition.
e) Health & education.
f) Diet analysis & counselling.
2. Prevention
a) Combating caries inducing microorganism.
b) Modify caries promoting factor & use sugar substitute (Xylitol).
c) Increase resistance of teeth to decay.
3. Control
Minimally Invasive Dentistry

7. 1. Reduction of cryogenic flora
•Modificationoftheoralmicrofloraisessentialinthe
initialstage,andanumberoforallavagesareavailable
tomodifythebalanceoftheoralfloraalthough
chlorhexidineisprobablythemosteffectiveofthese.
Adopted by the FDI General Assembly, 1st October 2002,
Vienna, (FDI Statement, 2002)

8. 2. Remineralizeearly lesions
•Ithasbeenknownformanyyearsthat“white-spot”lesionson
thevisiblesurfacesofteethcanberemineralizedandrepaired.
•Successfulremineralizationrequiresintensivelythepatientto
haveafullunderstandingoftheimplicationoffoodtypes,the
needforplaqueremoval,andthepossibleneedforadditional
orallavagesforcontrolofbacterialpopulations.

9. RemineralisingAgents
1.CaseinPhosphopeptide-AmorphousCalciumPhosphate(CPP-ACP):
CPP-ACPbindsreadilytothesurfaceofthetooth,underacidicconditions,
thissubstantiallyincreasesthelevelofcalciumphosphateinplaqueand,
therefore,maintainsastateofsupersaturationthatinhibitsenamel
demineralisationandenhancesremineralisation.
2.CombinationofCPP-ACPandfluoride:
Thereareaconsiderablenumberofstudiesindicatingasynergismin
remineralisingpotentialwhenCPP-ACPiscombinedwithfluoride.
3.Novamin:Chemicallyknownascalciumsodiumphosphosilicate.
Thecompoundisabioactiveglasscomposedofmineralsnaturallyoccurringin
thebodyandreactswhenitcomesintocontactwithwater,saliva,orother
bodyfluids.
Thisreactionreleasescalcium,phosphate,sodiumandsiliconionsresultingin
theformationofnewhydroxycarbonateapatite.
Theproductsareavailableintheformoftoothpastes,varnishesandaroot
desensitizer.

10. RemineralisingAgents
4.TiF4technology:
TitaniumioncanrenderthesolutionoflowpHvalue.Thisattributestothefactthat
TiF4solutionisveryacidic.Thisgreatattractionoftitaniumiontooxygenimpartsa
strongtendencytoformtitaniumphosphatecomplex(i.e.,titaniumionreactingwiththe
oxygenatomofthephosphatesofthetoothstructure).
Thebondofthecomplexthusformedissostrongthatitisnoteasilysubstitutedby
protons(H+)evenatlowpH(pH1),therebyrenderingthealteredtoothsurfacemore
resistanttodemineralization.
5.Resininfiltranttechnology:
Combiningthisultraconservativerestorativeapproachwithasubstantialcaries
remineralisationprogrammayprovidetherapeuticbenefitsandsignificantlyreduceboth
long-termrestorativeneedsandcosts,thuscomplementingtheconceptofminimal
interventiondentistry.

11. RemineralisingAgents
6.Nanohydroxyapatite:
Nano-hydroxyapatite(n-HAp)isconsideredoneofthemostbiocompatible
andbioactivematerials,andhasgainedwideacceptanceinmedicineand
dentistryinrecentyears.
Nano-sizedparticleshavesimilaritytotheapatitecrystalsoftoothenamelin
morphologyandcrystalstructure.
7.Enamelon:
Enamelonconsistsofunstabilizedcalciumandphosphatesaltswithsodium
fluoride.
AninherenttechnicalissuewithEnamelonisthatcalciumandphosphateare
notstabilized,allowingthetwoionstocombineintoinsolubleprecipitates
beforetheycomeintocontactwithsalivaorenamel.

12. 3. Minimum surgical intervention of cavitated lesion
•Ifthediseasehasprogressedtocavitationonthetooth
surface,itisnolongerpossibletocompletelycontrol
plaqueaccumulationwithoutsomedegreeofsurgical
intervention.

13. •Atraumatic restorative technique.
•Sandwich technique.
•Chemomechanical caries removal (CMCR).
•Pit and fissure sealants and preventive resin restorations.
•Tunnel, box and slot preparation.
•Tooth preparation using air abrasion.
•Tooth preparation using lasers.
•Tooth preparation using Ultrasonics.
•Tooth preparation using Smart bur(Smartprep).
•Ozone therapy

14. Introduction of adhesive materials have
played a major role in minimally
intervention dentistry because they do
not require the incorporation of
mechanical retention features.

15. •Glass ionomer cement has various
advantages like
•Chemical adhesion to tooth structure,
•Fair esthetics
•Anticariogenicity
•Rechargeable

16. Effective bonding
to enamel and
dentin
micromechanical
retention
Minimal cavities

17. •Preservationofnaturaltoothstructureshouldbethe
guidingfactorforthesmallest,aswellasthelargest,
cavity.Cavitypreparationdesignandrestorative
materialselectiondependonocclusalloadandwear
factors.
•Therationalebehindthenewcavityclassification
systemisthatitisonlynecessarytogainaccesstothe
lesionsandremoveareasthatareinfected.

18. •Internal Factors (from Dentine & Pulp):
•Intact Collagen Fibers
•Active Odontoblasts
•Active Mineral supply (Calcium, Phosphate) from the Pulp
to the Dentine

19. •External Factors (from Cavity):
•Reduced bacteria number
•Reduced bacteria activity
•Fluoride
Remineralisation of Affected Dentine
Selective caries removal

20. •Preserves the marginal ridge -conservative approach
•Less potential for a restorative overhang
•Border of the restoration is reduced, decreasing the
potential for micro leakage.
•Potential for disturbance of the adjacent tooth is
reduced

21. Tunnelpreparationsaretechnicallydifficulttodobecause
ofaccessandvisibilityandthesmallamountoftooth
structureremoved
Angulationsofpreparationoftenpassesclosepulp
Visibilityisdecreasedandcariesremovalismoreuncertain
-cariesdetectingsolution
Fragilemarginalridge-atleast2.5mmapicaltocrestof
themarginalridge(Mount1997)