Embed Size (px)
DESCRIPTION
Evidence based Compendium. Minimum Intervention Dentistry (MI) (Overview). Evidence based Compendium. MI Definition. … a philosophy of health care including:. Disease risk assessment Earliest disease detection Minimally invasive treatment. Evidence based Compendium. - PowerPoint PPT Presentation
Citation preview
04/22/23 www.midentistry.com/academia.html --- (c) midentistry cc, 2006
Minimum Intervention Dentistry (MI)
(Overview)
Evidence based Compendium
04/22/23 www.midentistry.com/academia.html --- (c) midentistry cc, 2006
MI Definition
Disease risk assessmentEarliest disease detectionMinimally invasive treatment
… a philosophy of health care including:
Evidence based Compendium
04/22/23 www.midentistry.com/academia.html --- (c) midentistry cc, 2006
Minimum Intervention (MI)Focus on disease Etiology!
Prophylaxis Diagnostic Treatment
Past Now
Evidence based Compendium
04/22/23 www.midentistry.com/academia.html --- (c) midentistry cc, 2006
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
04/22/23 www.midentistry.com/academia.html --- (c) midentistry cc, 2006
•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
04/22/23 www.midentistry.com/academia.html --- (c) midentistry cc, 2006
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
04/22/23 www.midentistry.com/academia.html --- (c) midentistry cc, 2006
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
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)
Evidence based Compendium
04/22/23 www.midentistry.com/academia.html --- (c) midentistry cc, 2006
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
04/22/23 www.midentistry.com/academia.html --- (c) midentistry cc, 2006
DENTINE - STRUCTURE
Odontoplast cell
Odontoplast process
Intertubular dentine
Peritubular dentinePeritubular dentine
Pulp
Dentine tubule
Dentine fibersDentine fibers
Evidence based Compendium
04/22/23 www.midentistry.com/academia.html --- (c) midentistry cc, 2006
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
04/22/23 www.midentistry.com/academia.html --- (c) midentistry cc, 2006
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
04/22/23 www.midentistry.com/academia.html --- (c) midentistry cc, 2006
Carious dentine
Selective caries removalSelective caries removal
Infected Infected Outer LayerOuter Layer
Affected Affected Inner LayerInner Layer
04/22/23 www.midentistry.com/academia.html --- (c) midentistry cc, 2006
Infected Outer LayerInfected Outer Layer
Most of bacteria locatedNot sensitive, dead tooth tissue
SoftCollagen fibers damaged
Can not remineralize
04/22/23 www.midentistry.com/academia.html --- (c) midentistry cc, 2006
Affected Inner LayerAffected Inner Layer
Few bacteria locatedSensitive, vital tooth tissue
HardCollagen fibers intact
Can remineralize
04/22/23 www.midentistry.com/academia.html --- (c) midentistry cc, 2006
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
04/22/23 www.midentistry.com/academia.html --- (c) midentistry cc, 2006
• External Factors (from Cavity):• Reduced bacteria number• Reduced bacteria activity• Fluoride
Remineralisation of Affected Dentine
Selective caries Selective caries removalremoval
04/22/23 www.midentistry.com/academia.html --- (c) midentistry cc, 2006
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
04/22/23 www.midentistry.com/academia.html --- (c) midentistry cc, 2006
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
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)
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
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
04/22/23 www.midentistry.com/academia.html --- (c) midentistry cc, 2006
… in practice:
Ensuring maximum tooth tissue preservation
Be generally perceived as non-threatening (from Patients’ point of view)
Minimal Intervention Dentistry
Evidence based Compendium
04/22/23 www.midentistry.com/academia.html --- (c) midentistry cc, 2006
Minimum Intervention (MI)
Patient friendly Positive impact on health
