6/25/2013 1 Dr. Zahra Saied Moallemi Minimally Invasive Dentistry Dr. Zahra Saied Moallemi DDS, PhD Oral Public Health Dept., Isfahan Univ. of Medical Sciences Esfand 1391 Dr. Zahra Saied Moallemi SPECIFIC OBJECTIVES • Dental students should be able to: • 1. State definition and goals of Minimally invasive dentistry. • 2. Understand the concept of this modern approach of care. • 3. Describe rationale and clinical recommendations for professional caries management. • 4. Define the iceberg of dental caries and intervention thresholds. Dr. Zahra Saied Moallemi Markley, 1951 Dr. Zahra Saied Moallemi
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6/25/2013
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Dr. Zahra Saied Moallemi
Minimally Invasive Dentistry
Dr. Zahra Saied MoallemiDDS, PhD
Oral Public Health Dept.,Isfahan Univ. of Medical Sciences
Esfand 1391
Dr. Zahra Saied Moallemi
SPECIFIC OBJECTIVES
• Dental students should be able to:
• 1. State definition and goals of Minimally invasive dentistry.
• 2. Understand the concept of this modern approach of care.
• 3. Describe rationale and clinical recommendations for professional caries management.
• 4. Define the iceberg of dental caries and intervention thresholds.
Dr. Zahra Saied Moallemi Markley, 1951 Dr. Zahra Saied Moallemi
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Historical Development of Dentistry
- Extraction;
- Surgical approach: Drilling and filling;
- Medical approach: Minimal Intervention.
Dr. Zahra Saied Moallemi
- Extraction
Dr. Zahra Saied Moallemi
- Surgical approach: drilling and filling
- Developed in the 1890s by G.V. Black;- Highly formalised cavity design;- “Extension for prevention”.
Dr. Zahra Saied Moallemi
• To remove more of the tooth the decay
dictated in order to obtain
resistance form of retention.
• Still the prevailing paradigm in the profession.
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- Dental caries is an irreversible microbial disease of the calcified tissues of the teeth, characterized by de-mineralization of the hard tissue of tooth
Dr. Zahra Saied Moallemi
- Dental caries is an irreversible microbial disease of the calcified tissues of the teeth, characterized by de-mineralization of the hard tissue of tooth
Dr. Zahra Saied Moallemi
• Modern dentistry has made G. V. Black model
obsolete and has introduced the
New standard of care
Dr. Zahra Saied Moallemi
• Modern approach to the treatment of caries management
• Dental caries progression or reversal depends upon the balance between demineralization and remineralization. The 'Caries Balance' is determined by the relative weight of the sums of pathological factors and protective factors.
Medical approach: Minimal Intervention
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Dr. Zahra Saied Moallemi
Minimally Invasive Dentistry
• respecting the health, function and aesthetics of oral tissue by preventing disease from occurring or intercepting its progress with minimal tissue loss
• MID, the Leading Edge Model in Dentistry
Dr. Zahra Saied Moallemi
Infectious approach of caries
• Dental caries is a preventable disease of the
mineralized tissues of the teeth with a multi-
factorial etiology related to the interactions
over time between tooth substance and
certain micro-organisms and dietary
carbohydrates producing plaque acids.
Dr. Zahra Saied Moallemi
Kidd kid
Kidd and Joyston-Bechal, 1997 Dr. Zahra Saied Moallemi
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Fejerskov and Manji, 1990
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• Minimally invasive dentistry aims at the least
possible removal of enamel or dentin, including
reducing pathological factors and enhancing
remineralization to avoid any removal of hard
tissues.
Dr. Zahra Saied Moallemi
• Restoration of teeth will not cure the disease.Dr. Zahra Saied Moallemi
• MID is based on a medical model that controls
the disease first and then uses minimally
invasive techniques to restore the mouth to
form, function, and aesthetics.
• Caries treated as a biological infection
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• MID allows dentists to become true physicians of the mouth, rather than tooth technicians.
• MID dentists continue to treat symptoms, but also manage the underlying disease and associated risk factors.
• MID focuses on the use of highly researched, leading edge, dental materials and products to control disease and to restore hard and soft tissue to the highest standard of form, function and aesthetics.
• The MID practitioner strives to use the most bio-mimetic and biocompatible materials currently available.
Required:• Microdentistry (technical procedures)• Microscope Dentistry• Caries Diagnostic Technology Development
Dr. Zahra Saied Moallemi
Levels of interventions in MID• Primary prevention• Primary prevention protects individuals against disease, often
by placing barriers between the aetiological agent and the host.
• Secondary prevention• Secondary prevention aims to limit the progression and effect
of a disease at as early a stage as possible after onset. It includes further primary prevention.
• Tertiary prevention• Tertiary prevention is concerned with limiting the extent of
disability once a disease has caused some functional limitation.
Dr. Zahra Saied Moallemi
• When considering dental caries, tertiary prevention is aimed not only at restoring decayed teeth but must include further primary and secondary prevention in order to prevent further carious attack.
• This means that in addition to placing a filling the causes of caries must also be addressed as part of clinically effective caries management.
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9-year-old girl
Dr. Zahra Saied Moallemi In adult
Why we should move to MID?
Worldwide, more than half and as high as 71%
of dentist’s activities are replacement and
repair of existing restorations, that do not last
very long.(Forss and Widstrom, 2004; Mjör, 2000)
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How we spend our time in dental office
65%35%
Replacement and repair
New restorationsDr. Zahra Saied Moallemi Dr. Zahra Saied Moallemi
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Advantages of MID• Patients prefer the least invasive procedure.
– Need sufficient explanation
• Less invasive procedure provide greater degree of predictability:– Marginal ridges provide up to 50% support for
cusps (Milicich and Rainey, 2000).
– small fillings survive better than large ones (Lucarottiet al., 2005).
• Longevity of teeth for patientsDr. Zahra Saied Moallemi Dr. Zahra Saied Moallemi
Advantages of MID• For dentists:
– Trust and understanding by patients:• Patients left the previous dentist due to dental fear and
bad experiences: 14 concerns of dental fear refer back to dentist (Rankin and Harris, 1985).
– Fewer injection,– Less frequent drilling,
(Whitehouse, 2009)
– Less stressDr. Zahra Saied Moallemi
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What patients imagine by a Dental Drill
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Figure 1. The “iceberg of dental caries”—diagnostic thresholds in clinical trials and practice.
• Are we ready to move from Operative to Non-Operative/Preventive treatment of Dental Caries in clinical practice? Pitts NB. Caries Res 2004;38:294-304.