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04/13/23 www.midentistry.com/academia.html --- (c) midentistry cc, 2006

Minimum Intervention

Dentistry (MI) (Overview)

Evidence based Compendium


MI Definition

Disease risk assessment

Earliest disease detection

Minimally invasive treatment

… a philosophy of health care including:



Minimum Intervention (MI)Focus on disease Etiology!

Prophylaxis Diagnostic Treatment

Past Now



Caries = multifactoral disease

ORAL BALANCE

Demineralization = Remineralization

Disturbance of oral balance

Demineralization > Remineralization

•Higher bacteria count (S.mutans, Lactobacilli)

• Reduced saliva function (flow rate, buffer capacity)

• Decreased plaque pH, Increased plaque rate

• Hypomineralization / Lesions

• Cavities

Disease Etiology: CariesEvidence based Compendium


•bacteria

•saliva function

•plaque pH

• etc.

Risk factorsRisk factorsIdentified

Modified / Reduced

1. Stop of disease = regain of ORAL BALANCE

2. Repair of reversible damage = Lesions (Remineralisation)

3. Repair of irreversible damage = Cavities 3.a) Classification

3.b) Restoration


Classification, according to lesion:

1. Location (Site)

2. Progress (Size) 1

3

21. Pits/Fissures2. Contact area3. Cervical

caries classification(Mount/Ngo, 1998)



caries classification(Mount/Ngo, 1998)

Size

0 1 2 3 4

Site

1 1.0 1.1 1.2 1.3 1.4

2 2.0 2.1 2.2 2.3 2.4

3 3.0 3.1 3.2 3.3 3.4

Size

0 1 2 3 4

Site

1 1.0 1.1 1.2 1.3 1.4

2 2.0 2.1 2.2 2.3 2.4

3 3.0 3.1 3.2 3.3 3.4

1

2

3



MI principles of cavity restoration

1. Minimal necessary cavity access

2. Selective caries removal (atraumatic, minimally invasive)



Removal of infected, denatured, demineralised, non-sensitive dentine = outer infected dentineTreatment of affected non-denatured, sensitive, remineralisable dentine = inner affected dentine

Carious dentine

Selective caries removalSelective caries removal

Infected Infected Outer LayerOuter Layer

Affected Affected Inner LayerInner Layer



DENTINE - STRUCTURE

Odontoplast cell

Odontoplast process

Intertubular dentine

Peritubular dentinePeritubular dentine

Pulp

Dentine tubule

Dentine fibersDentine fibersDentine fibersDentine fibers



BACTERIAL INVASION

Odontoplast cell

Odontoplast process

Pulp

Dentine fibersDentine fibersDentine fibersDentine fibers

Biomass on top of Tubuli: ~ 90% of Bacteria

Biomass on top of Tubuli: ~ 90% of Bacteria

Tubuli invaded by ~ 10% of Bacteria

Tubuli invaded by ~ 10% of Bacteria

Tubuli infiltrated by Bacteria Acid

Tubuli infiltrated by Bacteria Acid


DENTINE - DEFENCE REACTION

Remaining of some INTERTUBULARINTERTUBULAR CRYSTALS after Demineralization

BLOCKING of Dentine tubuli =

“ TUBULAR SCLEROSIS”

= YELLOW / BROWNISH discoloration of Dentine

NATURAL BARRIER AGAINST FURTHER BACTERIA

INVASION


Carious dentine

Selective caries removalSelective caries removal

Infected Infected Outer LayerOuter Layer

Affected Affected Inner LayerInner Layer


Infected Outer LayerInfected Outer Layer

Most of bacteria located

Not sensitive, dead tooth tissue

Soft

Collagen fibers damaged

Can not remineralize


Affected Inner LayerAffected Inner Layer

Few bacteria located

Sensitive, vital tooth tissue

Hard

Collagen fibers intact

Can remineralize


Remineralisation of Affected Dentine

+

•Internal Factors (from Dentine & Pulp):•Intact Collagen Fibers

•Active Odontoblasts

•Active Mineral supply (Calcium, Phosphate) from the Pulp to the Dentine


• External Factors (from Cavity):• Reduced bacteria number• Reduced bacteria activity• Fluoride

Remineralisation of Affected Dentine

Selective caries Selective caries removalremoval


Mechanical concept:

Difference in physical resistance to sharp hand instrumentation

Chemo-mechanical concept:

Electrostatic splitting

MI treatment concepts & procedures

2 ways of Selective caries removal:2 ways of Selective caries removal:



MI treatment concepts & procedures

• Chemical softening of denatured (infected) carious dentine• Mechanical removal with non-cutting hand instruments

Chemo-mechanical concept:

Electrostatic splitting

Selective caries Selective caries removalremoval






3. Cavity design according to extend of caries

4. Use of therapeutic materials (adhesive, remineralizing)







5. Biomimetic replacement of tooth hard substances







5. Biomimetic replacement of tooth hard substances

Ultra-conservative, smaller restorations + maximum tissue preservation


… in practice:

Ensuring maximum tooth tissue preservation

Be generally perceived as non-threatening (from Patients’ point of view)

Minimal Intervention Dentistry



Minimum Intervention (MI)

Patient friendly

Positive impact on health

7/17/10 --- (c) midentistry ...

Documents

caries evidence

remineralisable dentine

nonsensitive dentine

invasive evidence

inner layer evidence

dentine defence reaction

invasive cavity design

bacteria invasion