Minimal Intervention Dentistry – The Challenge for Materials
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Transcript of Minimal Intervention Dentistry – The Challenge for Materials
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Minimal Intervention Dentistry – The Challenge for Materials
John W. NicholsonUniversity of Greenwich
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Minimal Intervention Dentistry
- Modern approach to the treatment of tooth decay- Based on “Medical Model” of caries management
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Historical Development of Dentistry
- Extraction; - Surgical approach (“drilling and filling”): after G.V. Black;- Medical approach – Minimal Intervention.
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G.V. Black
- Developed in the 1890s;
- Highly formalised cavity design;
- “Extension for prevention”.
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Critique of G.V. Black’s approach
- A surgical model; - Caries “cured” by excision, then filling;- Appropriate for weak, non-adhesive materials; - Still the prevailing paradigm in the profession.
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The Minimal Intervention approach
- A medical model;
- Caries treated as a biological infection;
- Surgical techniques are minor and stress retention of tooth tissue.
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Details of the MI approach
- (1) Reduces cariogenic bacteria;
- (2) Uses preventive measures;
- (3) Early lesions remineralised;
- (4) Minimal surgery on cavities;
- (5) Repair of defective restorations.
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(1) Cariogenic bacteria
• Caries is a bacterial disease;
• Depends on dietary sucrose;
• Driven by frequency of eating;
• Modified by saliva.
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(2) Preventive measures
• Topical fluoride;
• Fissure sealants;
• Patient education on oral hygiene
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(3) Remineralisation
• Requires management by non-intervention;
• Enhanced by fluoride ion in saliva.
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(4) Minimal surgery
• Requires adhesive materials (glass-ionomers, adhesive composite systems);
• Innovative, bespoke cavity design:– Possibly without drilling (ART technique).
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(5) Repair of materials
• To prevent cavity extension;
• Not “botch job”, but appropriate.
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The challenge for materials
• Adhesion– Occurs naturally for glass-ionomers; problematic for
composites.
• Fluoride-release;
• Release of other mineralising ions (PO4, Ca2+);
• Repairable.
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Conclusions
• Minimal Intervention dentistry is the future:– Advocated by FDI;– Cost effective;– Less trauma for the patient.
• A biological approach, not a mechanical one.
• Makes significant demands on materials.