Minimum Intervention Dentistry (MI) (Overview)

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Minimum Intervention Dentistry (MI)

(Overview)

Evidence based Compendium

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MI Definition

Disease risk assessmentEarliest disease detectionMinimally 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 BALANCEDemineralization = 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

4Site1 1.0 1.1 1.2 1.3 1.42 2.0 2.1 2.2 2.3 2.43 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 fibers

Evidence based Compendium

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BACTERIAL INVASION

Odontoplast cell

Odontoplast process

Pulp

Dentine fibersDentine fibers

Biomass on top of Tubuli: ~ 90% of Bacteria

Tubuli invaded by ~ 10% of Bacteria

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 locatedNot sensitive, dead tooth tissue

SoftCollagen fibers damaged

Can not remineralize

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Affected Inner LayerAffected Inner Layer

Few bacteria locatedSensitive, vital tooth tissue

HardCollagen 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 instrumentationChemo-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

04/22/23 www.midentistry.com/academia.html --- (c) midentistry cc, 2006

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