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Minimal Intervention Dentistry –
The Challenge for Materials
John W. Nicholson
University of Greenwich
Minimal Intervention Dentistry
- Modern approach to the treatment of
tooth decay
- Based on “Medical Model” of caries
management
Historical Development of Dentistry
- Extraction;
- Surgical approach (“drilling and filling”):
after G.V. Black;
- Medical approach – Minimal Intervention.
G.V. Black
- Developed in the 1890s;
- Highly formalised cavity design;
- “Extension for prevention”.
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.
The Minimal Intervention approach
- A medical model;
- Caries treated as a biological
infection;
- Surgical techniques are minor and
stress retention of tooth tissue.
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.
(1) Cariogenic bacteria
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•
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Caries is a bacterial disease;
Depends on dietary sucrose;
Driven by frequency of eating;
Modified by saliva.
(2) Preventive measures
• Topical fluoride;
• Fissure sealants;
• Patient education on oral hygiene
(3) Remineralisation
• Requires management by non-intervention;
• Enhanced by fluoride ion in saliva.
(4) Minimal surgery
• Requires adhesive materials (glass-ionomers,
adhesive composite systems);
• Innovative, bespoke cavity design:
– Possibly without drilling (ART technique).
(5) Repair of materials
• To prevent cavity extension;
• Not “botch job”, but appropriate.
The challenge for materials
• Adhesion
– Occurs naturally for glass-ionomers; problematic for
composites.
• Fluoride-release;
• Release of other mineralising ions (PO4, Ca2+);
• Repairable.
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.