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Minimum Intervention
Dentistry (MI) (Overview)
Evidence based Compendium
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MI Definition
Disease risk assessment
Earliest disease detection
Minimally invasive treatment
… a philosophy of health care including:
Evidence based Compendium
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Minimum Intervention (MI)Focus on disease Etiology!
Prophylaxis Diagnostic Treatment
Past Now
Evidence based Compendium
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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
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•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
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Classification, according to lesion:
1. Location (Site)
2. Progress (Size) 1
3
21. Pits/Fissures2. Contact area3. Cervical
caries classification(Mount/Ngo, 1998)
Evidence based Compendium
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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
Evidence based Compendium
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MI principles of cavity restoration
1. Minimal necessary cavity access
2. Selective caries removal (atraumatic, minimally invasive)
Evidence based Compendium
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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
Evidence based Compendium
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DENTINE - STRUCTURE
Odontoplast cell
Odontoplast process
Intertubular dentine
Peritubular dentinePeritubular dentine
Pulp
Dentine tubule
Dentine fibersDentine fibersDentine fibersDentine fibers
Evidence based Compendium
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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
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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
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Carious dentine
Selective caries removalSelective caries removal
Infected Infected Outer LayerOuter Layer
Affected Affected Inner LayerInner Layer
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Infected Outer LayerInfected Outer Layer
Most of bacteria located
Not sensitive, dead tooth tissue
Soft
Collagen fibers damaged
Can not remineralize
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Affected Inner LayerAffected Inner Layer
Few bacteria located
Sensitive, vital tooth tissue
Hard
Collagen fibers intact
Can remineralize
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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
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• External Factors (from Cavity):• Reduced bacteria number• Reduced bacteria activity• Fluoride
Remineralisation of Affected Dentine
Selective caries Selective caries removalremoval
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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:
Evidence based Compendium
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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
Evidence based Compendium
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MI principles of cavity restoration
1. Minimal necessary cavity access
2. Selective caries removal (atraumatic, minimally invasive)
3. Cavity design according to extend of caries
4. Use of therapeutic materials (adhesive, remineralizing)
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MI principles of cavity restoration
1. Minimal necessary cavity access
2. Selective caries removal (atraumatic, minimally invasive)
3. Cavity design according to extend of caries
4. Use of therapeutic materials (adhesive, remineralizing)
5. Biomimetic replacement of tooth hard substances
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MI principles of cavity restoration
1. Minimal necessary cavity access
2. Selective caries removal (atraumatic, minimally invasive)
3. Cavity design according to extend of caries
4. Use of therapeutic materials (adhesive, remineralizing)
5. Biomimetic replacement of tooth hard substances
Ultra-conservative, smaller restorations + maximum tissue preservation
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… in practice:
Ensuring maximum tooth tissue preservation
Be generally perceived as non-threatening (from Patients’ point of view)
Minimal Intervention Dentistry
Evidence based Compendium
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Minimum Intervention (MI)
Patient friendly
Positive impact on health