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Minimal Intervention Dentistry – The Challenge for Materials

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Presentation on theme: "Minimal Intervention Dentistry – The Challenge for Materials"— 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.



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.

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