Principles of Minimal Intervention Dentistry PDF Lecture Notes

Principles of Minimal Intervention Dentistry Associate Prof. Dr Nurul Asyikin Yahya Dept of Family Oral Health, Faculty of Dentistry, UKM January 2024 Slides courtesy of Dr Amy Liew Lecture Outline Definition Minimally Invasive Dentistry V...

Principles of Minimal Intervention Dentistry Associate Prof. Dr Nurul Asyikin Yahya Dept of Family Oral Health, Faculty of Dentistry, UKM January 2024 Slides courtesy of Dr Amy Liew Lecture Outline Definition Minimally Invasive Dentistry Vs. Minimal Intervention Dentistry FDI Principles of Minimal Intervention Dentistry Special Techniques Minimal Intervention Dentistry A response to the traditional, surgical manner of managing dental caries, that is based on the operative concepts of G.V. Black of more than a century ago. A philosophy that attempts to ensure that teeth are kept functional for life. This term, therefore, is not restricted to the management of dental caries but is also applicable to other areas of oral health; such as periodontology, oral rehabilitation and oral surgery. Frencken JE, Peters MC, Manton DJ, Leal SC, Gordan VV, Eden E. Minimal Intervention Dentistry (MID) for managing dental caries - a review. Int Dent J. 2012 Oct;62(5):223–43.  Minimal Intervention Dentistry A concept that is based on all the factors that affect the onset Minimal and progression of disease, therefore integrates concepts of Invasive prevention, control and treatment. Dentistry A concept that is aimed at conserving the maximum amount of dental tissue.  Minimal Intervention Dentistry Minimal Invasive Dentistry Featherstone JDB, Doméjean S. Minimal intervention dentistry: part 1. From ‘compulsive’ restorative dentistry to rational therapeutic strategies. BDJ 2012:9;442. MID for Managing Caries Early caries Remineralisation Optimal caries detection and of enamel and preventive caries risk dentine carious measures assessment lesions Minimally invasive operative Repair rather than approaches for replace defective Frencken JE, Peters MC, managing restoration Manton DJ, Leal SC, Gordan VV, Eden E. Minimal cavitated dentine intervention dentistry for managing dental caries – a carious lesions review. Int Dent J. 2012 Oct 1;62(5):223–43. Early caries detection and caries risk assessment Caries Risk Assessment  Fluoride exposure  Sugary foods or drinks  Caries experience of mother/ caregiver/ siblings  Dental home  Special Health Care Needs  Chemo/radiation therapy  Eating disorders  Medications ↓ saliva  Drug/alcohol abuse  Cavitated/non-cavitated lesions/restorations within 36mth  Teeth missing d/t caries  Visible plaque  Unusual tooth morphology  Root caries  Overhang/deficient margin  Dental/ortho appliance  Xerostomia American Dental Association, 2009, 2011. Diagnostic Aids  Radiographs  Optical aids (loupe, microscope)  Fiberoptic transillumination (FOTI)  Intraoral cameras  Fluorescence systems  Infrared laser (DIAGNOdent®)  Quantitative light fluorescence  LED cameras Caries Detection Probing Does not improve the diagnostic sensitivity of visual examination, especially in detecting pits and fissure lesions. It is not reliable, depending on the size of the probe tip, the resistance of the enamel, and the force exerted by the probe. Iatrogenic damage to enamel, loss of the possibility of remineralization, favour lesion progression. Guerrieri A, Gaucher C, Bonte E, Lasfargues JJ. Minimal intervention dentistry: part 4. Detection and diagnosis of initial caries lesions. Br Dent J. 2012 Dec;213(11):551–7. ICDAS ICDAS Remineralisation of enamel and dentine carious lesions Remineralisation of enamel and dentine carious lesions Plaque Control Fluoride (self-care) Fluoride (professional care)  Optimal caries preventive measures  Diet Counseling Fluoride agents Non-Fluoride agents Community-based methods Sugar Substitutes -Water fluoridation - Xylitol - Salt fluoridation - Sorbitol - Milk fluoridation? Chlorhexidine? Professional-based methods - Fluoride gels & varnish Pit and fissure sealants Individual methods - Toothpaste & mouthwash Non-fluoride agents Chlorhexidine Evidence regarding chlorhexidine gel and varnish for carious control is inconclusive, and there is a lack of evidence that chlorhexidine rinses are useful as a preventive measure against dental caries. Sugar Substitutes Xylitol and sorbitol are the most frequently used sugar substitutes. The use of sugar-free dental chewing gum had proved to be effective for carious lesion control on school premises. Non-cavitated lesions of enamel and dentine Holmgren C, Gaucher C, Decerle N, Doméjean S. Minimal intervention dentistry II: part 3. Management of non-cavitated (initial) occlusal caries lesions – non-invasive approaches through remineralisation and therapeutic sealants. Br Dent J. 2014 Mar 7;216(5):237–43. Fissure Sealant Fissure Sealant “Even when a minimal invasive approach such as air-abrasion or micro-preparation is used, it condemns the tooth irreversibly to a repeat restoration cycle, since no restoration can be considered permanent and will ultimately need to be replaced.” Elderton R J. Clinical studies concerning re-restoration of teeth. Adv Dent Res 1990; 4: 4–9. Fissure Sealant Routine mechanical enamel preparation before acid etching is NOT recommended (B). NOT for teeth with evidence of a shadow indicating dentinal caries or radiographic evidence of occlusal or proximal signs of dentinal caries ADA Evidence-based Sealant Chairside Guide Minimally invasive operative approaches for managing cavitated dentine carious lesions Cavity design Extension for Prevention Extension for prevention Minimal Invasive Dentistry Conservation of tooth structure. Each prepared cavity is therefore unique and is primarily dependent on the extent of infected dentine rather than on a predetermined cavity design. Minimally Invasive Approaches Cutting & caries excavation Adhesive Special restorative Techniques materials  Affected dentine Infected dentine Few bacteria Bacterial invasion Remineralizable Unremineralizable Vital Dead Sensitive Without sensation Useful Not useful Holmgren CJ, Roux D, Doméjean S. Minimal intervention dentistry: part 5. Atraumatic restorative treatment (ART)--a minimum intervention and minimally invasive approach for the management of dental caries. Br Dent J. 2013 Jan;214(1):11 –8.  How much dentine should be removed? Extent of viable Pulp status Lesion depth tooth structure Clinical factors: access, moisture Patient’s caries risk control, gingival margin Banerjee A. Minimal intervention dentistry: part 7. Minimally invasive operative caries management: rationale and techniques. Br Dent J. 2013 Feb;214(3):107–11.  Cutting & Caries Excavation Mechanism Dental substrate Tooth-cutting technology affected Mechanical, rotary Sound or carious SS, CS, diamond, TC and plastic burs* enamel & dentine Mechanical, non- Sound or carious Hand instruments (excavators, chisels), air-abrasion, rotary enamel & dentine air-polishing**, ultrasonics, sono-abrasion Chemomechanical Carious dentine Caridex , Carisolv gel (amino acid-based), Papacarie® gel (papain-based), pepsin-based solutions/gels Photo-ablation Sound or carious Lasers enamel & dentine Others Bacteria Photo-active disinfection (PAD), ozone Key: * = works only on carious dentine; ** = used for stain-removal3 Banerjee A. Minimal intervention dentistry: part 7. Minimally invasive operative caries management: rationale and techniques. Br Dent J. 2013 Feb;214(3):107–11. Adhesive Restorative Materials GIC Composite Resin  Special Techniques Preventive Resin Restoration Sandwich Technique Tunnel preparation ART Tyas MJ, Anusavice KJ, Frencken JE, Mount GJ. Minimal intervention dentistry--a review. FDI Commission Project 1-97. Int Dent J. 2000 Feb;50(1):1–12.  Atraumatic Restorative Treatment Use enamel access cutter Clean tooth surface Access using hatchet when access is small Caries removal using Insertion of GIC using Slightly overfill to spoon excavator plastic instrument adjacent pit and fissure Press-finger technique to Remove excess Restored compact GIC Holmgren CJ, Roux D, Doméjean S. Minimal intervention dentistry: part 5. Atraumatic restorative treatment (ART)--a minimum intervention and minimally invasive approach for the management of dental caries. Br Dent J. 2013 Jan;214(1):11 –8. Repair rather than replace defective restoration Replace or repair? Removal of restorations results in an inevitable increase in cavity size because of the removal of sound tooth structure. Depending on the dentist's clinical judgement, repair could be considered an alternative to replacement in some circumstances. FDI Policy Statement: Minimal Intervention in the Management of Dental Caries. Adopted by the FDI General Assembly: 1 October 2002 – Vienna, Austria  Extension for Prevention Ensure all carious tissue was removed Recontouring Patch with a originally, and Consider and compatible that caries risk repolishing material secondary caries has not developed Tyas MJ, Anusavice KJ, Frencken JE, Mount GJ. Minimal intervention dentistry--a review. FDI Commission Project 1-97. Int Dent J. 2000 Feb;50(1):1–12.  Extension for Prevention 2003 2004 2005 2007 Holmgren C, Gaucher C, Decerle N, Doméjean S. Minimal intervention dentistry II: part 3. Management of non-cavitated (initial) occlusal caries lesions – non-invasive approaches through remineralisation and therapeutic sealants. Br Dent J. 2014 Mar 7;216(5):237–43.  MID for Managing Caries Early caries Remineralisation Optimal caries detection and of enamel and preventive caries risk dentine carious measures assessment lesions Minimally invasive operative Repair rather than approaches for replace defective Frencken JE, Peters MC, managing restoration Manton DJ, Leal SC, Gordan VV, Eden E. Minimal cavitated dentine intervention dentistry for managing dental caries – a carious lesions review. Int Dent J. 2012 Oct 1;62(5):223–43.