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Minimum Intervention Dentistry (MI) (Overview)

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.

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Minimum Intervention Dentistry (MI) (Overview)

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  1. Evidence based Compendium Minimum Intervention Dentistry (MI) (Overview) www.midentistry.com/academia.html --- (c) midentistry cc, 2006

  2. Evidence based Compendium MI Definition … a philosophy of health care including: Disease risk assessment Earliest disease detection Minimally invasive treatment www.midentistry.com/academia.html --- (c) midentistry cc, 2006

  3. Evidence based Compendium Minimum Intervention (MI) Focus on disease Etiology! Past Now Prophylaxis Diagnostic Treatment www.midentistry.com/academia.html --- (c) midentistry cc, 2006

  4. Evidence based Compendium Disease Etiology: Caries ORAL BALANCE Demineralization = Remineralization Caries = multifactoral disease 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 www.midentistry.com/academia.html --- (c) midentistry cc, 2006

  5. Risk factors • bacteria • saliva function • plaque pH • etc. Identified Modified / Reduced • Stop of disease = regain of ORAL BALANCE • Repair of reversible damage = Lesions (Remineralisation) • Repair of irreversible damage = Cavities 3.a) Classification 3.b) Restoration www.midentistry.com/academia.html --- (c) midentistry cc, 2006

  6. Evidence based Compendium caries classification(Mount/Ngo, 1998) Classification, according to lesion: 1.Location (Site) 2. Progress (Size) 1 1. Pits/Fissures 2 2. Contact area 3. Cervical 3 www.midentistry.com/academia.html --- (c) midentistry cc, 2006

  7. Evidence based Compendium caries classification(Mount/Ngo, 1998) 1 2 Size 0 1 2 3 4 Site 1 1.0 1.1 1.2 1.3 1.4 2 2.0 2.1 2.2 2.3 2.4 3 3.0 3.1 3.2 3.3 3.4 3 www.midentistry.com/academia.html --- (c) midentistry cc, 2006

  8. Evidence based Compendium MI principles of cavity restoration • Minimal necessary cavity access • Selective caries removal (atraumatic, minimally invasive) www.midentistry.com/academia.html --- (c) midentistry cc, 2006

  9. Evidence based Compendium Selective caries removal Removal of infected, denatured, demineralised, non-sensitive dentine = outer infected dentine Treatment of affected non-denatured, sensitive, remineralisable dentine = inner affected dentine Carious dentine Infected Outer Layer Affected Inner Layer www.midentistry.com/academia.html --- (c) midentistry cc, 2006

  10. Evidence based Compendium DENTINE - STRUCTURE Peritubular dentine Dentine tubule Intertubular dentine Dentine fibers Odontoplast process Odontoplast cell Pulp www.midentistry.com/academia.html --- (c) midentistry cc, 2006

  11. BACTERIAL INVASION Biomass on top of Tubuli: ~ 90% of Bacteria Tubuli invaded by ~ 10% of Bacteria Tubuli infiltrated by Bacteria Acid Dentine fibers Odontoplast process Odontoplast cell Pulp www.midentistry.com/academia.html --- (c) midentistry cc, 2006

  12. DENTINE - DEFENCE REACTION Remaining of some INTERTUBULAR CRYSTALS after Demineralization BLOCKING of Dentine tubuli = “ TUBULAR SCLEROSIS” = YELLOW / BROWNISH discoloration of Dentine NATURAL BARRIER AGAINST FURTHER BACTERIA INVASION www.midentistry.com/academia.html --- (c) midentistry cc, 2006

  13. Selective caries removal Carious dentine Infected Outer Layer Affected Inner Layer www.midentistry.com/academia.html --- (c) midentistry cc, 2006

  14. Infected Outer Layer Most of bacteria located Not sensitive, dead tooth tissue Soft Collagen fibers damaged Can not remineralize www.midentistry.com/academia.html --- (c) midentistry cc, 2006

  15. Affected Inner Layer Few bacteria located Sensitive, vital tooth tissue Hard Collagen fibers intact Can remineralize www.midentistry.com/academia.html --- (c) midentistry cc, 2006

  16. 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 + www.midentistry.com/academia.html --- (c) midentistry cc, 2006

  17. Remineralisation of Affected Dentine • External Factors (from Cavity): • Reduced bacteria number • Reduced bacteria activity • Fluoride Selective caries removal www.midentistry.com/academia.html --- (c) midentistry cc, 2006

  18. Evidence based Compendium MI treatment concepts & procedures 2 ways of Selective caries removal: Mechanical concept: Difference in physical resistance to sharp hand instrumentation Chemo-mechanical concept: Electrostatic splitting www.midentistry.com/academia.html --- (c) midentistry cc, 2006

  19. Evidence based Compendium MI treatment concepts & procedures Selective caries removal Chemo-mechanical concept: Electrostatic splitting • Chemical softening of denatured (infected) carious dentine • Mechanical removal with non-cutting hand instruments www.midentistry.com/academia.html --- (c) midentistry cc, 2006

  20. MI principles of cavity restoration • Minimal necessary cavity access • Selective caries removal (atraumatic, minimally invasive) • Cavity design according to extend of caries • Use of therapeutic materials (adhesive, remineralizing) www.midentistry.com/academia.html --- (c) midentistry cc, 2006

  21. MI principles of cavity restoration • Minimal necessary cavity access • Selective caries removal (atraumatic, minimally invasive) • Cavity design according to extend of caries • Use of therapeutic materials (adhesive, remineralizing) • Biomimetic replacement of tooth hard substances www.midentistry.com/academia.html --- (c) midentistry cc, 2006

  22. MI principles of cavity restoration • Minimal necessary cavity access • Selective caries removal (atraumatic, minimally invasive) • Cavity design according to extend of caries • Use of therapeutic materials (adhesive, remineralizing) • Biomimetic replacement of tooth hard substances Ultra-conservative, smaller restorations + maximum tissue preservation www.midentistry.com/academia.html --- (c) midentistry cc, 2006

  23. Evidence based Compendium MinimalInterventionDentistry … in practice: • Ensuring maximum tooth tissue preservation • Be generally perceived as non-threatening (from Patients’ point of view) www.midentistry.com/academia.html --- (c) midentistry cc, 2006

  24. Minimum Intervention (MI) Patient friendly Positive impact on health www.midentistry.com/academia.html --- (c) midentistry cc, 2006

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