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.

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

7. 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.

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.

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 (PO4, Ca2+);
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.