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Minimal Intervention Dentistry – The Challenge for Materials John W. Nicholson University of Greenwich.

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Presentation on theme: "Minimal Intervention Dentistry – The Challenge for Materials John W. Nicholson University of Greenwich."— Presentation transcript:

1 Minimal Intervention Dentistry – The Challenge for Materials John W. Nicholson University of Greenwich

2 Minimal Intervention Dentistry - Modern approach to the treatment of tooth decay - Based on Medical Model of caries management

3 Historical Development of Dentistry - Extraction; - Surgical approach (drilling and filling): after G.V. Black; - Medical approach – Minimal Intervention.

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6 G.V. Black - Developed in the 1890s; - Highly formalised cavity design; - Extension for prevention.

7 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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12 The Minimal Intervention approach - A medical model; - Caries treated as a biological infection; - Surgical techniques are minor and stress retention of tooth tissue.

13 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.

14 (1) Cariogenic bacteria Caries is a bacterial disease; Depends on dietary sucrose; Driven by frequency of eating; Modified by saliva.

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16 (2) Preventive measures Topical fluoride; Fissure sealants; Patient education on oral hygiene

17 (3) Remineralisation Requires management by non-intervention; Enhanced by fluoride ion in saliva.

18 (4) Minimal surgery Requires adhesive materials (glass-ionomers, adhesive composite systems); Innovative, bespoke cavity design: –Possibly without drilling (ART technique).

19 (5) Repair of materials To prevent cavity extension; Not botch job, but appropriate.

20 The challenge for materials Adhesion –Occurs naturally for glass-ionomers; problematic for composites. Fluoride-release; Release of other mineralising ions (PO 4, Ca 2+ ); Repairable.

21 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.


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