Minimal Intervention Dentistry

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Minimal Intervention Dentistry The Challenge
for Materials

• John W. Nicholson
• University 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. Blacks 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.