Mininmal Intervention Dentistry

MINIMAL INTERVENTION
DENTISTRY
Life and health are Gods precious
gifts to be treasured, nurtured and
protected.

Macro-dentistry
Extension for prevention
Micro dentistry
Prevention of extension

Terminology
very small in amount or extent;
smallest possible in amount or least possible in
extent;
an action undertaken in order to change what is
happening or might happen in anothers affairs,
especially in order to prevent something
undesirable.
Minimal intervention (MI) in dentistry
Mount GJ.
Minim Interv Dent 2011; 4 (6)
DEFINITION
philosophy of professional care
concerned with the first occurrence, earliest
detection, and earliest possible cure of disease
on micro (molecular) levels, followed by
minimally-invasive and patient-friendly
treatment to repair irreversible damage caused
by such disease
Tyas MJ, Anusavice KJ, Frencken JE, Mount GJ.
Minimal intervention dentistry --a review.
Int Dent J 2000 Feb; 50(1): 1-12.
Paradigm Shift
Dental caries as an infectious disease
model involves focusing on treatment of
the entire disease process not just
surgically treating cavities.
Drilling and filling a tooth is not the only
solution to the damage caused by the caries
process and is not an effective method to
treat the Cariogenic infection.
A comprehensive preventive and treatment
program is necessary to manage dental caries.
Minimal intervention is modern approach for
management of caries
Minimally invasive dentistry
CAROL ANNE MURDOCH-KINCH
JADA, Vol. 134, January 2003
CORE PRINCIPLES OF MID
Recognition
Reduction
Regeneration
Repair
identify and assess any potential
caries risk factors
eliminate or minimize caries risk
factors, through altering DIET &
increase pH of oral enviorment
To arrest and reverse incipient
lesions, regenerating enamel
subsurface lesions
Bioactive materials are used
to restore the tooth and
promote internal healing of
the dentine
.
Minimum intervention dentistry principles
and objectives.
Walsh LJ, Brostek AM.
Aust.dent.jrnl 2013 Jun;58 Suppl 1:3-16
Patient Centred Management Cycle
On Which MITP Is Based

MITP-PRACTICAL IMPLEMENTATION IN GENERAL PRACTICE
IDENTIFY
PREVENT
RESTORE
A SYSTEM FOR TOTAL
ENVIRONMENTAL MANAGEMENT
(STEM) OF THE ORAL CAVITY
Aspects Of The Oral Environment
A SYSTEM FOR TOTAL ENVIRONMENTAL MANAGEMENT(STEM) OF THE ORAL CAVITY, AND ITS
APPLICATION TODENTAL CARIES CONTROL Laurence J Walsh

INTERNATIONAL DENTISTRY SA VOL. 10, NO. 1
Simplified scheme of how medical and lifestyle factors can
influence resting salivary parameters.
APPLICATION TO DENTAL CARIES CONTROL Laurence J Walsh

APPLICATION TODENTAL CARIES CONTROL Laurence J Walsh

CONCEPTS OF MID
The focus is on maximum conservation of
demineralized, noncavitated enamel and
dentin.

Golden triangle of MID
The histology of the dental
substrate being treated
The chemistry/handling of the
adhesive materials used to
restore the cavity
Consideration of the practical
operative techniques available
to excavate caries minimally

Minimal intervention dentistry: part 7. Minimally invasive operative caries management:
rationale and techniques
A. Banerjee
1) Early Caries Diagnosis
2) The Assessment Of Individual Caries Risk
(high, moderate, low)
3) The Classification Of Caries Depth And
Progression Using Radiographs
4) The Reduction Of Cariogenic Bacteria To
Decrease The Risk Of Further
Demineralization And Cavitation
5) The Arresting Of Active Lesion
6) The Remineralization And Monitoring Of Non
Cavitated Arrested Lesions
7) The Placement Of Restorations In Teeth With
Cavitated Lesions using Minimal Cavity
Designs.
8) The Repair Rather Then The Replacement Of
Defective Restorations
9) Assessing Disease Management Outcomes
At Pre-established Levels.

EARLY DIAGNOSIS OF
DENTAL CARIES

G.V.Black a sharp
explorer should be used
with some pressure & if a
very slight pull is required
to remove it i.e. CATCH
POINT, the pit should be
marked for restoration even
if there are no signs of
decay .
CLINICAL EXAMINATION
BASCD & WHO:
if in the opinion of the examiner after visual
inspection a doubt exists, the surface should
be investigated with a blunt probe & unless
the point enters the lesion ,the surface will be
regarded as sound. The blunt probe should
have a tip of 0.5 mm
Clinicians are forced to measure a dynamic
process as a dichotomous variable of presence
or absence of disease, using
i. Clinical criteria (e.g. color, softness or
resistance to removal)
ii. Tools (Sharp explorer)
Healthy occlusal fissure
SHARP EYES BUT BLUNT PROBE

The enamel is damaged by forceful probing
with sharp sickle probes, so probes used to
examine occlusal surfaces should be
blunt and the probing forces light

Unaided caries diagnosis
Less then 50% of caries incidences are
correctly diagnosed!
- occlusal caries = 41% diagnosed
- approximal caries = 21% diagnosed

Caries diagnostic with magnification
- occlusal caries = 53% diagnosed
- approximal caries = 31% diagnosed

Disadvantages

Still not all carious lesions are identified
Additional aids (Bitewing etc) needed
Costs
poor fit and adjustment - eye strain
No longer consider to be an appropriate
means of diagnosing occlusal caries because
of the
i. possibility of extending the lesion or
ii. inoculation of additional sites with
cariogenic microbes
Radiographic Assessment
Minimal depth-500 micro meters
2D image
Faulty angulation
Ionizing radiation

Caries Detecting Dyes
Dyes for detection of enamel caries:
Procion dye
Calcein dye
Fluorescent dye
Brilliant blue
Dyes for detection of dentinal caries:
Basic fuchsin
Acid red
Carbolan green
Comassie blue
Lissamin blue

DISADANTAGES:

Does not stain bacteria
Risk of over treatment
few are carcinogenic
some may cause irreversible staining

Recent diagnostic methods

Electrical Conductance Measurement (ECM)
Quantitative Light Induced Fluorescence (QLF)
Dye Enhanced Laser Fluorescence (DELF)
Diagnodent
Fibre optic Trans Illumination (FOTI)
Direct Magnification (DIMA)
Digital Subtraction Radiography
Optical Coherence Tomography (OCT)
Tuned Aperture Computed Tomography (TACT)
Electrical Impedence Tomography (EIT)
Digital Radiology (DR)

DIFOTI
Electronic Caries Monitor
DIAGNOdent
Laser detector
Explorer
ULTRASONOGRAPHY
ENDOSCOPE
Fluorescence
Blue light

White light endoscopy
Small carious lesion
Camera + endoscope = VIDEOSCOPE

CARIES RISK
ASSESSMENT
According To AAPD
The Caries Balance
Pathological Factors
Acid-producing bacteria
Sub-normal saliva flow
and/or function
Frequent eating/drinking of
fermentable carbohydrate
Protective Factors
Saliva flow and components
Fluoride: remineralization
Antibacterials: - chlorhexidine,
iodine?, xylitol, new?
Ph controling rinses
Caries
No Caries
Featherstone JD 2000
Cariogram is a new way in which to illustrate the
interaction between caries related factors
CARIOGRAM - THE FIVE SECTORS
AIMS

Illustrates the interaction of caries related factors.
Illustrates the chance to avoid caries.
Expresses caries risk graphically.
Recommends targeted preventive actions.
Can be used in the clinic.
Can be used as an educational programme.
CARIES MANAGEMENT BY RISK
ASSESSMENT (CAMBRA)
2002 FDI BASIC CAMBRA PRINCIPLES
Modification of the oral flora to favor health.
Patient education and informed participation.
Remineralization of non-cavitated lesions of
enamel and dentin/cementum
Minimal operative intervention of cavitated
lesions and defective restorations.
Repair of defective restorations
1. Modification of the oral flora

Dental caries is an infectious disease, and the
primary focus should therefore be on-
i. control of the infection,
ii. plaque control and
iii. reduced carbohydrate intake.
2. Patient education

The etiology of dental caries should be
explained to the patient, together with the
means of prevention through dietary and oral
hygiene measures.
3. Remineralization of non-cavitated lesions
of enamel and dentine
Saliva plays a critical role in the
demineralization/remineralization cycle, and
its quantity and quality should therefore be
assessed.

There is strong evidence that white spot
lesions of enamel and non-cavitated lesions of
dentine can be arrested or reversed.
Such lesions should therefore be managed
initially by remineralization techniques.

The extent of the lesion should be objectively
recorded such that any progression can be
identified at recall.

4. Minimal operative intervention of
cavitated lesions

Operative intervention should focus on the preservation of
natural tooth structure and be limited to the removal of
friable enamel and infected dentine.

This can be done with hand, rotary, sonic, ultrasonic, air
abrasive or laser instruments, depending on the
circumstances.

Preparation of minimal cavities enables their restoration with
adhesive materials such as glass-ionomer cement and/or resin
composite.

5. Repair of defective restorations
Removal of restorations results in an inevitable
increase in cavity size as a consequence of
removal of sound tooth structure.

Depending on the clinical judgment of the
dentist, repair could be considered as an
alternative to replacement in some
circumstances.
LANIMA-lesions for which appropriate non-
invasive management is advised.

LOCA-lesions for which operative care is
advised
Five treatment categories for the protocol:
1. Caries-Balanced Low-Risk
2. Caries-Balanced Moderate-Risk
3. Caries-Active Moderate-Risk
4. Caries-Active High-Risk
5. Caries-Active Extreme-Risk
NEW CARIES
CLASSIFICATION
MOUNT AND HUME CLASSIFICATION
SITE 1
SITE 2
SITE 3
4.REMINERALIZATION OF EARLY
LESIONS
AND REDUCTION OF CARIOGENIC
BACTERIA
Enamel and dentin demineralization is not a
continuous, irreversible process.

Through a series of demineralization and
remineralization cycles, the tooth alternately
loses and gains calcium and phosphate ions,
depending on the microenvironment
When the pH is less than 5.5, subsurface enamel or
dentin will demineralize.

Fluoride enhances the uptake of calcium and
phosphate ions and can form fluoroapatite.

Fluorapatite demineralizes at a pH less than 4.5,
making it more resistant to demineralization from an
acid challenge than hydroxylapatite.

In early carious lesions, there is subsurface
demineralization of the enamel.

As caries progresses into dentin, the surface of the
enamel eventually cavitates.
surgical treatment caries removal and
restorationis indicated for the cavitated
lesion

In the noncavitated lesion, to take advantage
of the tooths capacity to remineralize, one
must first alter the oral environment, to tip
the balance in favor of remineralization and
away from demineralization.

This is achieved by:
1. Rebalancing the oral environment
2. Approach to remineralization
3. Surface protection
Changing the microflora, using agents such as topical
chlorhexidine and topical F
Reducing the amount of dietary sucrose
Decreasing the intake of fermentable carbohydrates
Adding fluoride, particularly through daily application
during tooth brushing
Increasing salivary flow, using mechanical stimulation
during vigorous chewing to enhance flow, by changing
drugs which reduce flow, or by using drugs to enhance
flow.
Fissure protection by use of sealants.
Rebalancing the Oral Environment
i. Use a chlorhexidine mouthwash twice a day,
ii. Limit intake of fermentable carbohydrates,
iii. Ensure an optimum salivary flow,
iv. Use buffering agents to control oral ph,
v. And practice good oral hygiene to prevent
plaque accumulation.

The goal is to change the local biochemistry so
that the patient is no longer losing tooth mineral
and further cavitation does not occur
Approach to Remineralization
Fluoride is widely known molecule that enhance
remineralization.

It is used in various forms, topical application of
gel/foam, mouthwash, varnish, in toothpastes.

Fluoride combines with hydroxyapatite to form
fluorapatite layer that is resistant to dissolution in
acid produced bymicroorganisms.
Non-Fluoride Remineralizing Agents
CPP-ACP complex
Demineralized Enamel
Remineralized enamel using
fluoride and CPP-ACP
Body of lesion
remineralized with CPPACP
NovaMin (calcium sodium
phosphosilicate)
is a bioactive glass composed of minerals that
naturally occur in the body and reacts when it comes
into contact with water, saliva or other body fluids.

This reaction releases calcium, phosphorus, sodium
and silicon ions in a way that results in the formation
of new hydroxycarbonate apatite (HCA) crystals.

NovaMin forms a mineralized layer that is
mechanically strong and more resistant to acid
Xylitol containing chewing gums increase salivary flow
rate and enhance protective properties of saliva by
increasing the buffering activity.

The concentration of bicarbonate and phosphates ions
in stimulated saliva is high which help in preventing
demineralizationXylitol containing chewing gums
increase salivary flow rate and enhance protective
properties of saliva by increasing the buffering activity.

The concentration of bicarbonate and phosphates ions
in stimulated saliva is high which help in preventing
demineralization
7.MINIMAL INTERVENTION
TOOTH PREPARATION
Conventional caries removal and cavity preparation
entail the use of the burs.
Disadvantages of this system include:
(1) The perception by patients that drilling is
unpleasant.
(2) Local anesthesia is frequently required.
(3) Drilling can cause deleterious thermal effect
combined with the use of pressure for caries
removal, causing pulpal effects.
(4) The use of a hand piece may result in removal of
softened, but affected dentine, resulting in an
excessive loss of sound tooth tissue.
An Introduction To Minimal
Intervention Dentistry (MI)
S Mickenautsch
DENTAL NEWS, VOLUME XIV, NUMBER IV, 2007
1.MECHANICAL ROTARY
i. BURS
2.MECHANICAL,NON ROTARY
i. AIR ABRASION
ii. AIR POLISHING
iii. ATRAUMATIC RESTORATIVE TECHNIQUE
iv. ULTRASONICS
v. SONIC ABRASION
3.CHEMO-MECHANICAL
i. CARISOLV,CARIDEX
ii. ENZYMES
4.PHOTOABLATION
i. LASER

MECHANICAL
ROTARY BURS
The Fissurotomy Bur

1. It can be used to progressively explore suspect fissure
systems or portions of fissure systems.

2. The bur can be used to create one pass cutting to the
DEJ, when its depth is accurately judged by knowing
the bur head length (2.5 mm) and gauging depth by
relating the bur head/neck junction to the cavosurface
cavity preparation margin.

3. The bur can be used to remove very small amounts of
carious dentin..
The bur can be used to gain access to larger
dentin carious lesions by efficiently removing
overlying enamel

Finally, the bur can be used for enameloplasty
procedures to remove irregular surface and
fissurerelated defects, and to prepare an area
for restoration or sealing.
The goals of ultraconservative preparation are
quite simple:
1. Recontouring the fissure and pit anatomy for
access and visibility.
2. Exploration of the cavity to ensure that no
decay remains undetected.
3. Ultraconservative (but complete) caries
removal.
Variations In Dealing With A
Proximal Lesion
Smart Polymer Burs !!!
Dream or Reality ?
SMART PREP KIT
KNOOP HARDNESS NUMBER
ATRAUMATIC
RESTORATIVE
TREATMENT
No Needle,
No Drill,
No Noise
The correct use of the ART approach
Jo E. FRENCKEN1, Soraya Coelho LEAL
J Appl Oral Sci. 2010;18(1):1-4
DEFINITION
Elementary technique of caries removal using
hand instruments only ,combined with the use
of modern restorative material with adhesive
characteristics
Pioneers
Frencken Joe, Makoni F. in Tanzania 1980

PRINCIPLE
Removal of cariogenic
biomass

Seal & protect tooth

Place an adhesive
restorative material

ART Indications
Limited access to traditional care
Pediatric & Geriatric care
High caries risk management
Extreme dental fear/anxiety
management
ADVANTAGES OF ART
Easy Caries Removal
Conserve tooth structure
Hand Instruments
Limitation of Pain, Non threatening
Restore with an adhesive material
No local anesthesia
No high/low speed hand piece
No suction
No water
Simple infection control
Prevent secondary caries(Fluoride)
Ease of repair
Low cost

Procedure
Isolate
Access
Excavate
Condition
Insert
Press
Remove excess

.Instruct patient not to eat for at
least an hour
Atraumatic restorative treatment
(ART)
The most common failures are:-

Partial material loss
Complete material loss
Caries related to restoration margin
Material wear >0.5 mm
Atraumatic restorative treatment (ART) factors affecting success
Mickenautsch S and Grossman E S
Journal Of Minimum Intervention In Dentistry
2008; 1 (2)
ART failures may occur in combination or lead to
each other.
Hand excavation, as a mechanical form of
selective caries removal, is capable to remove
most of the infected dentin.
However, research showed that bacteria
remain present after complete hand
excavation within the tubuli of affected
dentine
Bnecker M, Grossman E, Cleaton-Jones PE, Parak R.
Clinical, histological and microbiological study of hand-excavated carious dentine in
extracted permanent teeth.
South Afric Dent J 2003; 58: 273-8.
Caries activity can be reduced through-
effective nutrient deprivation by sealing the
cavity using filling materials which chemically
bond to the cavity walls
assist remineralisation of affected dentine
through long-time fluoride and mineral
release
Weerheijm KL, Groen HJ.
The residual caries dilemma.
Community Dent Oral Epidemiol 1999; 27: 436-41
Clinical factors responsible for ART failures are

1. Material Factor
2. Operator Factor
3. Technique Factor


WHAT IS UNDERSTOOD BY
MODIFIED ART?
Modification is most often associated with the
use of rotary equipment: the drill, to open the
tooth cavity, followed by the normal ART
procedure in cleaning and restoring the cavity

It has been suggested that the use of rotary
equipment would make the total procedure
quicker and easier.
The correct use of the ART approach
Jo E. FRENCKEN1, Soraya Coelho LEAL
CHEMO MECHANICAL
CARIES REMOVAL (CMCR)
Chemical softening of carious dentin
followed by its removal by gentle
excavation
Softened the outer dentin
Solution 1: NaOCl
Solution 2: glycine+amino butyric acid+
NaCl+NaOH
pH = 11

CARIDEX

Chemomechanical caries removal (CMCR) agents:
Review and clinical application in primary teeth
M. Ganesh and Dhaval Parikh

MediTeam Sweden-1998
carisolv

2 Syringes
NaOCl
Pink Viscous gel ( Lysine, Leucine,
Glutamic Acid +Carboxymethyl cellulose +
Erythrosine )
Time Required 10 15 mins
Max Volume of Gel 0.2 1 ml
Cloudy - frosty
A silent revolution
Procedure



ADVANTAGES
Painless
No need of local anesthesia
Conservation of sound tooth structure
Reduced risk of pulp exposure
Well suited for anxious patient
LIMITATION
Rotary and hand instruments may still be
needed


ENZYMES
Enzymes for removal of caries !!!!!!

Achromobacter collagenase- In 1989 Goldsberg
and Keil
Enzyme Pronase non specific proteolytic enzyme
Streptomyces griseus

Pepsin- carboxylic protease enzyme ,acts only on
non-helical and denatured collagen segments.
PAPACARIE
MAIN
COMPONENTS
PAPAIN- Enzyme
CHLORAMINE-
Bactericidal and
disinfectant
TOLUIDINE BLUE-
Coloring agent

Journal of Dentistry and Oral Hygiene Vol. 3(3)34-45, 2011
MODE OF ACTION

AIR ABRASION
(Kinetic Cavity Preparation)
Air abrasion utilizes kinetic energy from
alumina particles entrained in high
velocity stream of air to remove tooth
structure
Kavo Rondo Flex

KCP 100

Prep Start

Comparison between drill and air
abrasion
High Speed Drills Air Abrasion
Rotary bur cause micro fractures No micro fractures
Excessive destruction of tooth
structure
Less destruction of tooth structure
Heat,vibration,bone conducted noise-
patient discomfort
Heatless,vibrasion less, minimal
sound
Patient Anxiety Patient friendly
Abrasive particles
Aluminum oxide
Alumina particles alpha alumina, pure,
biocompatible, used in food and medicine, prime
ingredient in tooth paste
Particle size 27 micro meter
Polycarbonate resin alumina- hydroxyapatite
mixtures-selective in removal of caries
Sodium bicarbonate-remove surface stains ,plaque

Applications of Air Abrasion
Cavity preparations
Removal of temporary cement
Micro abrasion of white spot enamel
hypoplasia
Stains removal
Repair of acrylic ,composite, porcelain

Air abrasion cannot be used for
Crown preparation
Large-deep carious defects
Amalgam removal
Class II Cavity preparations
ADVANTAGES
Non traumatic treatment
Biocompatibility
No Chipping
No micro fracturing
Decreased thermal build up
smooth margins
Less invasive procedure
No anesthesia
Less discomfort

DISADVANTAGES
Lack of tactile sensation
Non contact based modality
Messy Spread of aluminium oxide
Danger of air embolism and emphysema
Impaired indirect view
Contraindications
Asthma patients
Severe dust allergy
Chronic pulmonary disease
Recent extraction
Open wound in oral cavity
Sub gingival caries removal
Safety Issues
Masks
Rubber dam
Dry vaccum systems
Eye glasses
Disposable mouth mirror
High speed suction
OZONE THERAPY
THE MOST BEAUTIFUL
THINGS ON EARTH ARE ALSO
THE MOST SIMPLEST AND
MOST NATURAL !!!!!
OZONE
NATURES MOST POWERFUL OXIDANT
CARIOUS LESIONS NOT ONLY BECOME STERILE
AFTER EXPOSURE TO OZONE BUT ALSO TEND TO
RE-MINERALIZE AFTER SOMETIME
Kills bacteria,spores and viruses.
ozone to the rescue .
completely eliminates acidophilic
bacteria ,fungi and viruses
Sterile environment
10 secs of 2200 ppm ozone eliminates
99 % of the carious micro flora
Niche is very unlikely to re-develop
Effects of ozone
kills microbes

Plaque
Little influence on alloys
Ozone A powerful biocide
Heal ozone Tec3 ( Curosone, USA)
POLYURETHANE CONSOLE HAND PIECE PATIENT KIT
Ozone Generator
Vacuums pump
Flow sensors
Peristaltic pump
Desiccant
Ozone destructor
Back-lit LCD Display
Hand piece
Disposable
sealing cup
Push button
Re-Mineralizing
tooth paste
Oral rinse
Travel spray
Clinical steps
Polymer Cup is adapted to carious lesion and air is sucked to create
a vacuum
Ozone gas is delivered at a
preset conc. ,for 10 secs if
the seal is good
If the seal is defective the unit
switches off
Suction activated for 10 secs to remove debris from the surface
Suction system passes gas through Granular activated
carbon filter to remove all traces of ozone
Reductant fluid is pumped for 5 secs onto treatment site to
start the remineralization process
Patient is instructed to use home care kit and recalled after 3
months for check up ,when a cosmetic restoration can be placed if
needed
OZONE THERAPY
Indications for Ozone Therapy
Primary root carious lesions
Early carious lesions
Pit and Fissure caries
Caries around crowns and bridges
Advantages
Kills 99%micro organisms
Oxidizes caries and speeds up re-
mineralization
Removes organic debris on carious lesions
Removes volatile sulphur which cause halitosis
Decrease treatment time
Microbes dont become resistant
Non allergic, noiseless, painless and Phobic
friendly and pedo friendly
BIDDING A FINAL FAREWELL TO
OUR DRILL,
FILL AND BILL
PHILOSOPHY !!!!

LASER THERAPY
Efficacy of laser depends on
Wavelength characteristics
Pulse energy
Optical properties of incident tissue
Applications
Selective Hard Tissue Ablation
Selective Carious Dentin Removal
Destroy S.Mutans
Sealing of Fissures
Cut Dental Hard Tissue
Adjunctive treatment in caries prophylaxis
Modify structures of dentin and enamel
Lasers used for selective hard tissue
ablation

Er:YAG :Yttrium Aluminium-Garnet and Nd:YAG Neodymium-YAG-IR
Emission
C02 Laser IR Emission
Excimer Lasers (ArF- Argon: Freon and XeCl Xenon : Chlorine
U.V.Emission
Holomium lasers
Dye enhanced laser ablation Indocyanine Green & Diode Laser
Carious Dentin Removal UV Excimer (377nm)
Destroy S.Mutans Excimer with Dye

Sealing of fissures CO2

Advantages
Effect of vibrations,pressure and unfavorable
temperatures associated with rotary cutting
instruments avoided
Safe and efficacious modality of caries
removal and cavity preparation
Limitations
Expensive
Size of the instrument
POINTS TO REMEMBER
GENTLY TOUCH TARGET TISSUE
CUTTING RADIATION ONLY FROM THE END OF
TIP
WATER STREAM TO TARGET TISSUE
OPERATION AREA SHOULD BE WET
KEEP TIP MOVING
WIDE CUT- TIP OVER THE SURFACE
DEEP CUT- TIP UP & DOWN
Laser safety

SONIC OSCILLATION
(SONOABRASION)
SONO ABRASION
Removal of carious dentin using high
frequency ,sonic air scaler with modified
abrasive tips
First Design
Sonic micro unit deigned by Dr.Hugo
Unterbrink and Mosele
Based on Soniflex Air scaler Hand piece
Oscillations - < 6.5 KHZ
Mechanics
Elliptical motion Transverse 0.08 - 0.15mm
Longitudinal - 0.055 -0.135mm

Diamond Coated 40 micro meter grit
Water irrigation 20-30ml/min
Air pressure 3.5 bar

Torque Applied 2N
More pressure - dampens oscillations

Indications

Carious dentin removal
Finishing cavity preparations
More studies needed to prove its efficiency
Principals of Minimally Invasive Restoration
1. Shape of cavity is dictated by the caries and unique for
each carious lesion (conservative cavity preparation).
2. Only demineralized enamel and infected dentine is
removed, affected dentine can be left.
3. Macromechanical retention not required.
4. Undermined enamel cavity can be restored with
adhesive materials.
Casein phosphopeptide- amorphous
calcium phosphate

releases Ca and Phosphate ions

GC tooth mousse,ACP composite

Remineralization effect
of 0.5 - 1.0% CPP-ACP
solution, equivalent to
500 ppm of Fluoride
GC TOOTH
MOUSSE
flavor helps stimulate
salivary flow

ARISTON pHc
Introduced by ivoclar-vivadent in 1998
Light activated alkaline glass restorative material
Intelligent restorative material as it releases
calcium,flouride and hydroxyl ions when intraoral pH
values dropes below critical 5.5 level
Restoration of class I and II lesions.
BIODENTINE
Bio-active dentin substitute
All-in-one, biocompatible, bulk filling material.
Ca3SiO5 based cement
A supra plasticizing admixture to reduce the water
content to the mix and retain its workability.
Improved handling properties.
Setting time - 10 min.
Helps in re-mineralization of dentin.

8.REPAIR VS. REPLACEMENT OF
DEFECTIVE RESTORATIONS
caries under well-sealed restorations fails to
progress and that caries progresses slowly In
most populations, repairing defective
restorations rather than replacing them is a
valid and more conservative option for
treatment
PEDIATRIC MINIMAL
INTERVENTION DENTISTRY
Caries Management Protocol for 1-2
Year Olds
Caries Management Protocol for 3-5
Year Olds
Caries Management Protocol for 6
Year-Olds
GERIATRIC MINIMAL
INTERVENTION DENTISTRY
COMPLEX
RESTORATIVE CHALLENGES IN
OLDER PATIENTS

Erosion,
Abrasion,
Demineralization,
Rampant coronal and root caries,
Sound and decayed retained roots,
Recurrent caries (necessitating crowns and other
repairs),
Subgingival caries,
wet oral environments
Salivary gland hypofunction,
Disruptive behaviours,
Poor compliance with preventive care,
High plaque levels,
Bleeding and swollen gingival tissues, and
Financial and
Other restrictions on care options
The use of a blunt or periodontal probe is
advocated for exploring root-surface caries in
older adults
TECHNIQUES
Placement of Glass Ionomers
Sandwich Technique
Remineralization and Restoration to Counteract
Erosion and Abrasion
Tunnel and Slot Preparations
Techniques for Wet Subgingival Environments
Vital Pulp Therapy
Geriatric Atraumatic Restorative Technique
Placement of Glass Ionomers

Sandwich Technique

2 direct restorative materials can be used to
make the most of the biological, physical
and/or aesthetic properties of each material,
and in the presence of adhesion, to achieve as
close as possible to a single monolithic
reconstruction of a tooth.

useful in situations when strength and
pleasing esthetics are essential
FULL SANDWICH TECHNIQUE

PARTIAL SANDWICH TECHNIQUE
Remineralization and Restoration to
Counteract Erosion and Abrasion

Remineralization involves the use of products
such as-
Topical fluorides and
Amorphous calcium phosphates
MI Paste (GC America)
Restoration of cervical lesions may be
undertaken when esthetics is an issue or when
soft caries and cavitation have occurred.
The use of glass ionomers and composite
resins either alone or in combination (with a
sandwich technique) is generally
recommended
Tunnel and Slot Preparations
Slot preparations are indicated for lesions that
are less than 2.5 mm from the marginal ridge.

The lesion is more than 2.5 mm from the
marginal ridge, a tunnel preparation can be
used.
Techniques for Wet Subgingival
Environments
In many older patients it can be extremely
challenging to control bleeding and saliva during
restoration of subgingival carious lesions, which
tend to recur around large restorations and
crowns.

A glass ionomer such as Fuji Triage works well in
these wet environments because it has low
viscosity and does not run
Caries Classification And Treatment
Options For Geriatric Minimal
Intervention Dentistry
STRATEGIES FOR ADDRESSING THE NEW
CARIES
CHALLENGE IN OLDER PATIENTS
For older patients, the practitioner may need
to assess modifying factors such as those
i. Social support,
ii. Transportation
iii. Fear and anxiety,
iv. Consent,
v. Restraint and
vi. Perceived need
Chemoprophylactics
CATIONIC

chlorhexidine gluconate (CHX),
cetylpyridinium chloride (CPC),
benzalkonium chloride,
hexetidine and
metal salts;
ANIONIC
sodium lauryl sulfate;

NONIONIC
Phenolic compounds (essential oils) and
triclosan.

OXYGENATING AGENTS

hydrogen peroxide and
surface-modifying agents
(e.g., delmopinol).

Treatment of xerostomia and
salivary gland hypofunction
General treatment
Change medications to classes that are less
anticholinergic lead to less fluid retention
Increase water intake (if not contraindicated by
medications and medical conditions).
Avoid dental products with additives (e.g.,
sodium lauryl sulfate) or alcohol (e.g.,
mouthrinses)
Use a room humidifier during the day and at
night.
Saliva substitutes and oral lubricants
Oral Balance Gel,
Denture Grip,
Biotene Range (mouthrinse, toothpaste and
gum)
MI Paste (GC America, Alsip, Ill;
Range of other products such as Moi-Stir
(Kingswood Laboratories, Indianapolis, Ind.),
MouthKote
XeroLube
Saliva stimulants
Sugar-free gum and candy several times daily (e.g.,
xylitol gum and candy products,
Trident White with Recaldent gum (Cadbury Adams
USA LLC, Parsippany, N.J.)
SalivaSure tablets (Scandanavian Formulas, Sellersville,
Penn.) Place near major salivary ducts several times
daily and suck.
Contains fruit acid which is pH buffered.
Systemic sialogogue therapy with pilocarpine or
cevimeline;
Future
of
Minimal Intervention Techniques
NANOTECHNOLOGY
Richard.P.Feynman
Think twice before you pick up
that hand piece . .Because
the cutting edge is not a dental
bur anymore !!!
CONCLUSION
Thank you
Types of caries lesions
Cavitated
caries lesions
Non-
cavitated
caries lesions
Causes structural alteration of the
surface of the tooth enamel,
without loss of macroscopic
substance and
led to structural
alterations to such a
degree that there is loss
of dental substance
and the formation of a
cavity, whether shallow
or deep
Tooth restoration Non Invasive Techniques
Basso M

J Minim Interv Dent 2011; 4 (3)
As a rule of thumb, it can be said

cavitated lesions we have no choice but to carry out
invasive restorative procedures,

while with non-cavitated surface lesions we can
instead opt for restorative solutions that do not
involve working with abrasives and hence, do not
entail procedures of a locally invasive nature.
Tooth restoration Non Invasive Techniques
Basso M

J Minim Interv Dent 2011; 4 (3)

Mininmal Intervention Dentistry

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