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$AN %RICSON
4HE #ONCEPT OF -INIMALLY )NVASIVE
$ENTISTRY
!BSTRACT 4HIS PAPER REVIEWS -INIMALLY )NVASIVE $ENTISTRY -)$ FROM A DAY
TO
DAY DENTISTRY PERSPECTIVE FOCUSING MOSTLY ON CARIOLOGY
AND RESTORATIVE DENTISTRY EVEN THOUGH IT EMBRACES MANY ASPECTS OF DENTISTRY 4HE CONCEPT OF -)$ SUPPORTS A SYSTEMATIC RESPECT FOR THE
ORIGINAL TISSUE INCLUDING DIAGNOSIS RISK ASSESSMENT PREVENTIVE TREATMENT AND MINIMAL TISSUE REMOVAL UPON RESTORATION 4HE MOTIVATION FOR
-)$ EMERGES FROM THE FACT THAT FILLINGS ARE NOT PERMANENT AND THAT THE MAIN REASONS FOR FAILURE ARE SECONDARY CARIES AND FILLING FRACTURE 4O
ADDRESS THESE FLAWS THERE IS A NEED FOR ECONOMICAL RE
ROUTING SO THAT PRACTICES CAN SURVIVE ON MAINTAINING DENTAL HEALTH AND NOT ONLY BY
OPERATIVE PROCEDURES
#LINICAL 2ELEVANCE 3ECONDARY CARIES AND FRACTURED FILLINGS ARE THE MAIN REASONS FOR RESTORING TEETH 4HE PRIMARY ROUTE TO IMPROVE ORAL
HEALTH IS TO AVERT THIS BY A SYSTEMATIC RESPECT FOR THE ORIGINAL TOOTH STRUCTURE
$ENT 5PDATE
4HE CONCEPT PREVENTION
-INIMAL )NTERVENTION $ENTISTRY
-INIMALLY )NVASIVE $ENTISTRY
0RESERVATIVE $ENTISTRY AND !TRAUMATIC
-)$ IS A SYSTEMATIC RESPECT FOR THE ORIGINAL
2ESTORATIVE 4REATMENT !24 n ARE SIMILAR
TISSUE 4HE CONCEPT TRANSLATES
IF NOT IDENTICAL CONCEPTS 0REVENTION OF
&ROM A CORRECT DIAGNOSIS OF RISK AND
DISEASE IS THE ULTIMATE GOAL -ICRODENTISTRY
LESION ASSESSMENT
SEEMS TO RELATE MORE TO TECHNICAL
4HE INSTITUTION OF TARGETED PREVENTIVE
PROCEDURES /BVIOUSLY ALL THESE ASPECTS OF
TREATMENT TO STOP DISEASE
-)$ INCLUDE LESS CUTTING AND LESS REMOVAL
2ESTORATION OF LESIONS WITH AS LITTLE
OF HEALTHY TOOTH TISSUE LEAVING THE NATURAL
REMOVAL OF HEALTHY TISSUE AS POSSIBLE
TISSUE AS SOLID AND AS STRONG AS POSSIBLE
4HE USE OF DURABLE MATERIALS
-)$ IMPLIES SYSTEMATIC RESPECT FOR ORIGINAL &IGURE $EMONSTRATION OF THE AMOUNT OF
4HE PREVENTION OF DISEASE RECURRING
TISSUE AND PREVENTION AS WELL AS CONSIDERABLE PRACTICE TIME SPENT ON REPAIRING AND REPLACING OLD
4HERE IS NO SUCH THING AS A
TECHNICAL COMPETENCE 4HE CONCEPT EMBRACES RESTORATIONS
PERMANENT FILLING YET AND THIS IS MOTIVATION
ALL ASPECTS OF DENTISTRY
ENOUGH TO PROMOTE -)$ FOR THOSE OF US
4HIS PAPER ELABORATES ON THE
THAT CONSIDER THAT THE (IPPOCRATIC /ATH
CONCEPTUAL FACTS AND PHILOSOPHY OF -)$ IN
MAKES SENSE @&IRST DO NOT HARMxETC 4HE
ORDER TO GIVE ONE OR TWO NEW PERSPECTIVES CATCH 4HERE IS YET LITTLE STRUCTURED EVIDENCE FOR
THREE WORDS -INIMALLY )NVASIVE $ENTISTRY
ON THE TOPIC 4HE FACTS MAY BE SUMMARIZED PREVENTIVE TREATMENT
SOUND BENIGN AND THEREFORE MIGHT HAVE
AS FOLLOWS
A POTENTIAL TO AUTHORIZE PREVENTION IN THE
7E SPEND MOST OF OUR TIME IN PRACTICE
WORLD OF DRILLING AND FILLING 4HE PHRASE CAN 4HE CONTEXT
REPLACING AND REPAIRING PREVIOUSLY INSERTED
ALSO HELP TO MOTIVATE PROPER REMUNERATION
RESTORATIONS &IGURE THAT DO NOT LAST 4ODAY WE HAVE THE KNOWLEDGE
OF DIAGNOSIS RISK ASSESSMENT AND
VERY LONG OWING TO SECONDARY CARIES POSSIBILITY AND INTEREST TO PRACTICE -)$ %VEN
AND RESTORATION FRACTURES &IGURE 4HE THOUGH MANY OF US ALREADY DO THE CONCEPT
PHILOSOPHICAL SUMMARY OF -)$ READS IS FAR FROM ESTABLISHED IN THE WORLD 4HE
$AN %RICSON $$3 $R /DONT 0ROFESSOR $EMONSTRATE A SYSTEMATIC RESPECT FOR THE TECHNICAL CONSIDERATIONS ON MINIMAL TISSUE
AND (EAD OF $EPARTMENT OF #ARIOLOGY ORIGINAL TISSUE &IGURE BY ACKNOWLEDGING REMOVAL HAVE BEEN THOROUGHLY DESCRIBED BY
&ACULTY OF /DONTOLOGY -ALMÚ 5NIVERSITY THAT CARIES IS A MULTIFACTORIAL DISEASE THAT IS 0ETERS AND -C,EAN "URKE %RICSON ET AL
3WEDEN 0RESIDENT OF !CADEMY OF NOT CURED BY RESTORATIONS AND THAT CAVITIES 4HE CIRCUMSTANCES THAT HAVE
-INIMALLY )NVASIVE $ENTISTRY WEAKEN THE ORIGINAL TOOTH &IGURE 4HE DRAMATICALLY CONTRIBUTED TO THE INCREASED
*ANUARY&EBRUARY $ENTAL5PDATE
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#ARIOLOGY2ESTORATIVE$ENTISTRY
RISK AND EARLY SYMPTOMS INDIVIDUALIZED
RECALL SYSTEMS ARE PERTINENT 3UCH RECALL
SYSTEMS ARE ALSO NECESSARY TO BE ABLE TO
DELEGATE HEALTH BEHAVIOUR TO THE PATIENT
AND ASSIST IN HISHER SUCCESS 7ITHIN SOME
%UROPEAN COUNTRIES THE DENTIST IS NOT
ALLOWED TO ARRANGE A RECALL APPOINTMENT
AS THE PATIENT MUST HAVE A FREE CHOICE TO
SELECT A DENTIST ON EACH OCCASION )F SUCH
A DENTIST IS NOT SURE THAT THE PATIENT WILL
RETURN IT MIGHT BE LIKELY THAT THE DENTIST
MAKES A RESTORATION RATHER THAN MONITOR A
LESIONS PROGRESS TO INSTITUTE PREVENTION AND
TO SELECT THE OPTIMAL TIMING FOR A FILLING 9ET
IN 3CANDINAVIAN COUNTRIES IT IS BECOMING
MORE COMMON TO USE INDIVIDUALIZED RECALL
INTERVALS AND TO MONITOR CARIES LESIONS FOR
LONGER PERIODS %VEN THOUGH ALL ASPECTS OF
-)$ CANNOT BE IMPLEMENTED AT ALL TIMES
THE MINIMAL REMOVAL OF HEALTHY TOOTH
SUBSTANCE IN OPERATIVE DENTISTRY CAN BE
ACHIEVED
(OWEVER THE PROCEDURES
&IGURE 4HE REASONS FOR FILLING REPLACEMENT ARE DEMONSTRATED IN THIS GRAPH AFTER -JÚR AND CO
WORKERS INCLUDED IN THE MINIMALLY INVASIVE
THE MAIN REASONS BEING SECONDARY CARIES AND RESTORATION FRACTURE -EAN ANNUAL FAILURE RATES OF
PHILOSOPHY ARE NOT IN LINE WITH
STRESS
BEARING RESTORATIONS FOR AMALGAM AND FOR DIRECT COMPOSITE RESTORATIONS
REIMBURSEMENT SYSTEMS IN MANY IF ANY
COUNTRIES 0REVENTIVE MEASURES AND TISSUE
PRESERVING OPERATIVE PROCEDURES MAY TAKE
LONGER THAN DO TRADITIONAL FILLINGS 4HE FEE
FOR FILLINGS ALWAYS ENDS UP BEING HIGHER PER
TIME UNIT )T IS ESSENTIAL TO LEVEL THE PAYMENT
SYSTEMS SO THE PREVENTION AND TISSUE
PRESERVING APPROACH CAN BE REWARDING NOT
ONLY FOR THE PATIENT BUT ALSO FOR THE DENTIST
AS @FILLINGS ARE NOT CURATIVE STATED ALREADY BY
"LACK IN
4HE CONSEQUENCES
)T IS QUITE CLEAR THAT THE
MERE PROCESS OF RESTORING TEETH WITH
DIFFERENT MATERIALS WILL NOT CURE THE
DISEASE THAT CAUSED THE CAVITY IN THE
FIRST PLACE 4HEREFORE IT IS IMPERATIVE THAT
&IGURE 4HIS SYMBOL OF A ROSE
BUR WITH A DISARMING &IGURE 4RADITIONAL PREPARATION TECHNIQUE OFTEN EACH RESTORATIVE PROCEDURE ALSO INCLUDES
KNOT MIGHT GIVE A VISION OF PREVENTION AND MINIMALLY RENDERS REMOVAL OF A SMALLER AMOUNT OF CARIES AS TREATMENT DIRECTED AGAINST THE DISEASE
INVASIVE DENTISTRY &OR MENTAL USE ONLY COMPARED TO HEALTHY DENTINE PROCESS AS THE EVIDENCE BASE DEMONSTRATES
THAT FILLING SURVIVAL IS NOT IMPRESSIVE
&ILLINGS ARE ONLY SECOND TO PREVENTION
FOCUS ON THE TOPIC ARE AMONG OTHERS THE HEALTH IS BEYOND RESTORATIVE ARTEFACTS "UT ON THE OTHER HAND SMALL FILLINGS
VAST TECHNICAL POSSIBILITIES TO MAKE TISSUE
4HE OPTION TO ADOPT THE -)$ CONCEPT SURVIVE BETTER THAN LARGE ONES 3O ONCE A
PRESERVING RESTORATIONS USING ADHESIVE DEPENDS ALSO ON THE RECALL CONVENTION )N DECISION TO RESTORE IS MADE IT IS IMPORTANT
MATERIALS AND THAT RESTORATION THRESHOLDS SOME COUNTRIES EVERY INDIVIDUAL IS RAISED TO MAINTAIN A MAXIMUM AMOUNT OF THE
HAVE CHANGED IN MANY COUNTRIES AND AGED WITHIN A DENTAL RECALL SYSTEM )N ORIGINAL STRUCTURE
&URTHER THE LIMITED SURVIVAL OF TRADITIONAL OTHERS THE TRADITION IS TO VISIT THE DENTIST 4HE INTRODUCTION OF ADHESIVE
RESTORATIONS IN AN INCREASINGLY OLDER WHEN SYMPTOMS ARISE AS THERE ARE JUST RESTORATIVE MATERIALS AND THE DEEPER
POPULATION HAS MADE US AWARE THAT DENTAL TOO FEW DENTISTS 4O ASSESS AND MONITOR KNOWLEDGE OF THE CARIES LESION IN ENAMEL
$ENTAL5PDATE *ANUARY&EBRUARY
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#ARIOLOGY2ESTORATIVE$ENTISTRY
SECONDARY CARIES WERE RECENTLY REVIEWED BY
-JÚR )T IS WELL KNOWN THAT THE EXPLORER WILL
CATCH IN ANY CREVICE WHETHER IT IS CARIOUS OR
NOT AND THAT STAINING IS NOT A PREDICTOR FOR
SECONDARY CARIES 4HE DIAGNOSIS SHOULD BE
SUPPORTED BY OTHER FINDINGS RADIOGRAPHIC
PRESENCE OF SOFT DENTINE ETC 4HE RATIONALE
SUGGESTED BY -JÚR IS TO CONSIDER IT A
LOCALIZED DISEASE AND THAT RESTORATION
SHOULD START WITH A LIMITED EXPLORATORY
PREPARATION AND THAT THE REPARATION SHOULD
NOT EXTEND MORE THAN THE ACTUAL CARIES
LESION 4HE OUTCOME COULD OFTEN BE REPAIR
INSTEAD OF REPLACEMENT
&RACTURES
,ARGE FILLINGS AND TEETH WITH
LARGE RESTORATIONS ARE MORE PRONE TO
FAILURE )N REPLACING A RESTORATION THERE
IS A CONSIDERABLE WASTE OF HEALTHY TOOTH
SUBSTANCE AND INCREASE OF CAVITY SIZE
4HIS IS PARTICULARLY TRUE WHEN REPLACING
TOOTH
COLOURED RESIN COMPOSITES WHEN IT
&IGURE ! SCREENSHOT OF THE #ARIOGRAM MODEL WHICH CAN BE DOWNLOADED FREE HTTPWWWDBOD
MAHSECARCARIOGRAMCARIOGRAMINFOHTML IS DIFFICULT TO IDENTIFY THE BORDER BETWEEN
FILLING AND TOOTH 4HE RESULT OF RESIN
REPLACEMENT IS A FASTER INCREASE IN CAVITY
SIZE 4HE FACT THAT LARGE FILLINGS SURVIVE FOR
AND DENTINE ARE MAIN ACHIEVEMENTS IN TECHNIQUES PROMOTE LESS REMOVAL OF HEALTHY A SHORTER TIME THAN SMALL ONES INCREASES
CLINICAL DENTISTRY THAT HAVE ALLOWED THE TISSUE THE MOTIVES FOR REPAIR AND REFURBISHING
FURTHER APPLICATION OF A TISSUE
PRESERVING 4HE HIGH RISK FOR IATROGENIC EFFECTS PROCEDURES
ATTITUDE IN RESTORING TEETH -ANY %VEN THOUGH FILLINGS ARE NOT
TECHNIQUES HAVE BEEN REVIEWED "UT PERMANENT THEY ARE STILL NEEDED TO FILL
BEFORE ARRIVING AT AN OPERATIVE OR PREVENTIVE 4HE LIMITED SURVIVAL OF RESTORATIONS THE DEFECT AFTER EXCISION OF NECROTIC AND
TREATMENT DECISION WE NEED TO CONSIDER ! HUGE EVIDENCE
BASE CLEARLY HEALTHY TISSUE )T IS ALSO OBVIOUS THAT
7HAT HAPPENS IF ) RESTORE 7HAT IS THE ESTABLISHES THAT SECONDARY CARIES AND DISEASE PREVENTING EFFORTS AND THE TIMING
SURVIVAL RATE OF FILLINGS FRACTURE OF FILLINGS ARE THE MAIN REASONS OF THE RESTORATION PLACEMENT ARE CRUCIAL TO
)F ) DONT 7HAT IS THE @SURVIVAL OF SMALL FOR RESTORATION REPLACEMENT IN GENERAL MAXIMIZE LONGEVITY
AND LARGE CARIES LESIONS BEFORE THEY DENTAL PRACTICES 4HE SURVIVAL TIMES
PROGRESS BEYOND PREVENTION OF RESTORATIONS ARE INCREASING AT LEAST FROM
THE DAYS OF '6 "LACK WHEN A FILLING SHOULD %ARLY DIAGNOSIS OF LESIONS AND ACCURATE RISK
PROTECT THE TOOTH @FOR TWO OR THREE YEARS "UT ASSESSMENT
$RIVES FOR -)$ IN CARIOLOGY THERE IS STILL NO SUCH THING AS A @PERMANENT #ARIES DIAGNOSIS HAS BEEN
)T IS ESSENTIAL TO SHARPEN THE FILLING )T IS ALSO EVIDENT THAT OF THE DESCRIBED AS A MENTAL RESTING PLACE ON THE
MOTIVES FOR -)$ IN RELATION TO HOW FAR THE TIME IN PRACTICE IS SPENT FOR RE
RESTORATION WAY TO A TREATMENT DECISION $IAGNOSIS
TECHNIQUES HAVE COME AND WHERE THE OR REPAIR OF PREVIOUS RESTORATIONS AGAIN THE FROM 'REEK THROUGH KNOWLEDGE IMPLIES
TRADITIONAL ALTERNATIVES LEAD 3OME MOTIVES MAIN REASON BEING SECONDARY CARIES 4HE THAT IT IS NOT MERELY THE RECOGNITION OF
ARE NOT NEW AT ALL AS @FILLINGS ARE NOT CURATIVE MEAN ANNUAL FAILURE RATES OF STRESS
BEARING LESIONS USING MORE AND MORE SOPHISTICATED
AND THIS IS OF COURSE STILL TRUE "EYOND THAT RESTORATIONS HAVE BEEN REPORTED TO BE TOOLS BUT RATHER THE CONCEPTUAL TRIAD
THE CURRENT MOST IMPORTANT MOTIVES ARE FOR AMALGAM AND FOR DIRECT COMPOSITE )DENTIFY THE CARIES LESION
CONDENSED AFTER %RICSON RESTORATIONS %STABLISH WHETHER IT WILL PROGRESS OR NOT
4HE LIMITED SURVIVAL OF RESTORATIONS !SSESS IF MORE LESIONS WILL OCCUR
%ARLY DIAGNOSIS OF LESIONS AND ACCURATE
3ECONDARY CARIES
RISK ASSESSMENT ARE AVAILABLE 4OOLS FOR EARLY DETECTION OF CARIES LESIONS
)T MIGHT BE WISE TO RECOGNIZE
4HE EXTENSIVE KNOWLEDGE ON CARIES ! NUMBER OF TOOLS APART
THAT @SECONDARY CARIES IS NO DIFFERENT FROM
PROGRESSION RATES FROM THE EYE EXPLORER AND TRADITIONAL
PRIMARY CARIES EXCEPT THAT IT OCCURS NEXT
!DHESIVE RESTORATIVE MATERIALS AND RADIOGRAPH HAVE BEEN DEVELOPED %XAMPLES
TO A FILLING 4HE DIFFICULTIES IN DIAGNOSING
$ENTAL5PDATE *ANUARY&EBRUARY
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Use for licensed purposes only. No other uses without permission. All rights reserved.
#ARIOLOGY2ESTORATIVE$ENTISTRY
THE CIRCUMSTANCES THAT PATIENTS ARE RECALLED
ANNUALLY 3UCH STUDIES SHOW THAT RESTORATIVE
INTERVENTION THRESHOLDS SHOULD BE BASED
ON AN INDIVIDUAL RISK ASSESSMENT AND NOT
ONLY ON WHAT IS SEEN ON THE RADIOGRAPH 4HE
PROGRESSION IS FASTER IN PRIMARY TEETH
2ESTORATION THRESHOLDS
)N MANY %UROPEAN COUNTRIES
RESTORATION THRESHOLDS HAVE BECOME
MORE AND MORE @INTO THE DENTINE !S AN
EXAMPLE FOR OCCLUSAL CAVITIES ON A SECOND
MOLAR IN A
YEAR
OLD THE THRESHOLD FOR
OPERATIVE TREATMENT IS A MODERATELY
SIZED
OPEN CAVITY ANDOR RADIOLUCENCY INTO THE
DENTINE FOR APPROXIMATELY OF DENTISTS
IN 3CANDINAVIA 3IMILAR DATA CAN BE FOUND
FOR PROXIMAL CARIES LESIONS
)N THE LIGHT OF CARIES PROGRESSION
RATES AND RESTORATION SURVIVAL DATA OPERATIVE
INTERVENTION SHOULD BE POSTPONED UNTIL ALL
OTHER METHODS OF CONTROLLING THE DISEASE
&IGURE !NNUAL DENTINE CARIES PROGRESSION RATES IN A PROSPECTIVE STUDY BY -EJARE AND CO
WORKERS HAVE BEEN EXHAUSTED 4HIS ALSO MEANS THAT
4HE PROGRESSION OF EARLY DENTINE LESIONS LEFT SIDE OF TOOTH TO DEEP DENTINE LESION RIGHT SIDE IS EARLY LESIONS HAVE TO BE MONITORED MORE
LESS FREQUENT IN THE OLDER AGE GROUPS OR LESS THROUGHOUT LIFE PREFERABLY IN AN
INDIVIDUAL RECALL SYSTEM
!S A CONSEQUENCE OF THE
EVIDENCE OF CARIES DIAGNOSIS ACCURACY
OF OBJECTIVE TOOLS ARE DIGITAL RADIOGRAPHIC MODELS THAT HAVE BEEN VALIDATED THE PROGRESSION AND RESTORATION SURVIVAL DATA
TECHNIQUES $)&/4) DIGITAL IMAGING OPTIC #ARIOGRAM MAY BE OF VALUE &IGURE EVERY FILLING SHOULD BE CAREFULLY CONSIDERED
TRANS
ILLUMINATION ELECTRIC CONDUCTIVITY 3UCH TOOLS CAN HELP THE CLINICIAN TO AND A LESION RESTORED WHEN
METHODS AND LASER AND LIGHT FLUORESCENCE STRUCTURE THE INFORMATION ON CARIES RISK AND 7E ARE CERTAIN OF PROGRESSION AND CANNOT
TECHNIQUES (OWEVER LITTLE CLINICAL DATA ARE ALSO INSTITUTE MEASURES DIRECTED TOWARDS THE STOP IT
AVAILABLE TO VALIDATE THE TECHNOLOGIES SPECIFIC RISK SITUATION )T CAN BE DOWNLOADED 4HERE ARE SYMPTOMS
4HE LASER FLUORESCENCE METHODS HAVE BEEN FREE HTTPWWWDBODMAHSECAR 4HERE ARE AESTHETIC CONSIDERATIONS
DEBATED LATELY
AND VISUAL CRITERIA FOR CARIOGRAMCARIOGRAMINFOHTML 4HE SURFACE IS NEEDED FOR ORAL FUNCTION
DETECTION OF EARLY OCCLUSAL CARIES ARE STILL
APPLICABLE PROVIDED THE SURFACES ARE CLEAN
AND DRY 0ROBING CAN CAUSE IATROGENIC #ARIES PROGRESSION RATES !DHESIVE RESTORATIVE MATERIALS AND TECHNIQUES
DAMAGES #OMBINING RADIOGRAPHS AND 4HE ACTUAL PROGRESSION OF CARIES PROMOTE LESS REMOVAL OF HEALTHY TISSUE
VISUAL CRITERIA
BASED DIAGNOSES INCREASES HAVE BEEN STUDIED IN VARIOUS POPULATIONS
/NE OF THE MOST IMPORTANT
DIAGNOSTIC ACCURACY 4HE SPOTTING OF AN -EAN VALUES IN SUCH STUDIES DEMONSTRATE PREREQUISITES FOR -)$ WITHIN CARIOLOGY IS
ACTIVE INCIPIENT CARIES LESION IS A CLINICAL THAT EARLY ENAMEL LESIONS PROGRESS RATHER THE DEVELOPMENT OF ADHESIVE RESTORATIVE
SYMPTOM TO BE ACTED UPON AS THIS PROVES SLOWLY AND FOR EARLY DENTINE LESIONS THE MATERIALS USEFUL FOR A NUMBER OF
BEYOND ANY REASONABLE DOUBT THAT THE ANNUAL PROGRESSION RATE TO DEEP DENTINAL PROCEDURES FROM PREVENTIVE RESTORATIONS
PATIENT IS HIGHLY SUSCEPTIBLE TO CARIES LESIONS IS APPROXIMATELY OF ALL DENTINAL AS FISSURE SEALANTS TO LARGE FILLINGS AND
#ARIES RISK ASSESSMENT INVOLVES LESIONS /NE COULD ALSO SAY THAT DO NOT EVEN CROWN
REPLACEMENTS 4HESE
THE PROCESS OF ANALYSING AND WEIGHING UP PROGRESS SIGNIFICANTLY DURING ONE YEAR ADHESIVE MATERIALS HAVE REVOLUTIONIZED
RISK FACTORS AND THEN COMING UP WITH A !LSO AVERAGE PROGRESSION TIMES FOR DENTINE DENTISTRY BY OPENING THE ALTERNATIVES IN
VALUE OF THE RISK TO DEVELOP CARIES LESIONS CARIES PROGRESSION VARY WITH PATIENT AGE CAVITY PREPARATION 3MALLER CAVITIES CAN BE
OR NOT 4HE RESULT WILL BE USED FOR SELECTION &IGURE %ARLY DENTINE LESION IN ´ PREPARED AIMING AT REMOVING DISEASED
OF APPROPRIATE PREVENTION STRATEGIES YEAR
OLDS SHOW ANNUAL PROGRESSION IN DENTAL TISSUE ONLY 4HE FLUORIDE
RELEASING
!SSESSING CARIES RISK IS A COMPLEX TASK AND ONE OUT OF THREE PROGRESSES )F MATERIALS MAY CONTRIBUTE SLIGHTLY TO LESS
THE THEME OF RISK ASSESSMENT PROMPTS THE RESTORATIVE DECISION IS BASED ON THE SECONDARY CARIES
EXTENSIVE ELABORATION BEYOND THE FOCUS OF RADIOGRAPHS ONLY CARIES IN THE DENTINE 3EVERAL NEW PREPARATION
THIS CHAPTER !MONG THOSE RISK
PREDICTION ONE WOULD END UP WITH UNNECESSARY TECHNIQUES HAVE EMERGED AS A CONSEQUENCE
RESTORATIONS IN TWO OUT OF THREE CASES GIVEN OF THE KNOWLEDGE OF CARIES PROGRESSION
*ANUARY&EBRUARY $ENTAL5PDATE
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#ARIOLOGY2ESTORATIVE$ENTISTRY
TO CARIES LESIONS )T WOULD BE CONVENIENT IF
REIMBURSEMENT COULD GO HAND IN HAND WITH
-)$ AND THE MAINTENANCE OF HEALTH
4HE CONCLUSION
4HE MAIN REASONS FOR RESTORATION
REPLACEMENT ARE SECONDARY CARIES AND
RESTORATION FRACTURES 3ECONDARY CARIES IS
THE SAME DISEASE AS PRIMARY CARIES BUT
LOCATED IN THE TOOTH STRUCTURE ADJACENT TO
THE RESTORATION 4O INCREASE THE SURVIVAL RATE
OF RESTORATIONS THE MAIN FOCUS SHOULD BE TO
ADDRESS THE CONDITIONS THAT CAUSED CARIES
IN THE FIRST PLACE AND THE SECOND TO MAKE
FILLINGS LESS PRONE TO FRACTURE
7ITHIN CARIOLOGY -)$ HAS LATELY
&IGURE )NTERPROXIMAL PREPARATION PROTECTION DEVICE BASED ON A STEEL BAND ATTACHED TO A WEDGE 4HIS EVOLVED FASTER SINCE WE NOW UNDERSTAND
MAKES APPLICATION SIMPLER AND THE WEDGE RETAINS THE DEVICE EVEN AFTER THE INTERPROXIMAL CONTACT IS LOST THE DISEASE BETTER AND THE EVIDENCE
DURING PREPARATION &ENDER7EDGE $IRECTA !" WWWTRYCARECOUK BASE ON THE SHORT SURVIVAL OF RESTORATIONS
PROMPTS ACTION 7E CAN INTERCEPT DISEASE
DEVELOPMENT AND HAVE THE TECHNICAL
POSSIBILITIES TO REMOVE A MINIMAL AMOUNT OF
RATES SURVIVAL OF FILLINGS AND NEW ADHESIVE DECREASE IATROGENIC DAMAGES HEALTHY TOOTH SUBSTANCE AND MAKE SMALLER
MATERIALS ! LESION ORIENTATION IN PREPARATION ! TRULY -)$ PROCEDURE ADHESIVE FILLINGS 4HERE HAS BEEN A CHANGE
PROCEDURES IS PROMOTED WHICH MEANS MINIMIZING IATROGENIC EFFECTS IS THE FROM @CARIES LESIONS ARE TREATED OPERATIVELY
FIRST TO ACCESS THE DENTINE CARIES TO REMOVE STEP
WISE EXCAVATION APPROACH 4HE TOWARDS @CARIES LESIONS ARE TREATED BY
OR MODIFY THE INFECTED DENTINE LEAVING PROCEDURE IS BASED ON CONSIDERATIONS OF ADDRESSING THEIR CAUSES AS WELL AS USING
THE AFFECTED DENTINE THEN TO MODIFY THE CARIES PATHOLOGY TO CHANGE THE CARIOGENIC A MORE TISSUE
PRESERVING APPROACH WHEN
CAVITY AS LITTLE AS POSSIBLE TO RECEIVE THE ENVIRONMENT AND NOT TO REMOVE CARIOUS RESTORING TEETH
FILLING MATERIAL AS PERTINENTLY DESCRIBED BY DENTINE CLOSE TO THE PULP BECAUSE THIS RISKS %VEN THOUGH WE DO NOT HAVE
%RICSON ET AL 3EVERAL REVIEWS ON OPERATIVE AN IATROGENIC PULP EXPOSURE !FTER A SEALING SUFFICIENT EVIDENCE THAT PREVENTION IS ALWAYS
TECHNIQUES HAVE ALSO BEEN DESCRIBED PERIOD LESIONS ARREST AND THE VITAL DENTINE EFFECTIVE WE HAVE AN ENORMOUS EVIDENCE
ELSEWHERE 4HIS IS CONCEPTUALLY DIFFERENT RESPONDS BY REMINERALIZATION AND FORMATION BASE INDICATING WITHOUT DOUBT THAT FILLINGS
FROM @FITTING THE FILLING IN THE TOOTH ´ OF PULPAL DENTINE !T RE
ENTRY THE EXCAVATION ARE FUTILE TO TREAT THE DISEASE 3UCH THERAPY
AN APPROACH USING CLASSICAL AMALGAM IS CONTINUED AS FAR AS HARD DENTINE REDUCING IS DIRECTED TOWARDS THE SYMPTOMS ´ THE
PREPARATION RULES 4HE LESION ORIENTATION IS THE RISK FOR UNNECESSARY EXPOSURE ROOT
CAVITIES AND AT ITS BEST IT BUYS SOME TIME
ALSO APPLIED IN REPAIR OR REFURBISHING OF A CANAL TREATMENT AND WEAKENING OF THE AS STATED BY "LACK IN 7HEN IT COMES
RESTORATION TOOTH TO -)$ PHILOSOPHY ADDRESSING @CARIES AS A
WHOLE n ) DARE SAY @"LACK TO THE FUTURE
(IGH RISK FOR IATROGENIC EFFECTS 4HE CONFLICT
)T HAS BEEN DEMONSTRATED 7E HAVE THE MEANS MOTIVES 2EFERENCES
THAT IN ´ OF PROXIMAL PREPARATIONS AND OPPORTUNITIES FOR -)$ BUT THERE 3IMONSEN 2* 4HE PREVENTIVE RESIN
THE ADJACENT TOOTH IS DAMAGED AND WILL MAY BE A LACK OF ECONOMICAL INCENTIVES RESTORATION A MINIMALLY INVASIVE
THUS DEVELOP CARIES MORE FREQUENTLY AS (ABITUALLY PATIENTS AND THIRD PARTIES NONMETALLIC RESTORATION #OMPENDIUM
COMPARED TO AN UNDAMAGED SURFACE ARE CONVINCED THAT THE ONLY THINGS THAT ´
4HIS FACT IS VERY SELDOM CONSIDERED WHEN COUNT ARE OPERATIVE PROCEDURES THAT IS 4YAS -* !NUSAVICE +* &RENCKEN *%
DISCUSSING LONGEVITY OF RESTORATION AND ONE IT IS ALRIGHT TO PAY FOR A FILLING BUT NOT FOR -OUNT '* -INIMAL INTERVENTION
SHOULD CERTAINLY ADD THE ASPECT OF LONGEVITY DIAGNOSTICS RISK ASSESSMENT OR PROCEDURES DENTISTRY ´ A REVIEW #OMMISSION
OF THE UNRESTORED ADJACENT SURFACE &IGURE THAT CAN HELP AVOID HAVING A RESTORATION 0ROJECT
)NT $ENT * ´
4HE DRIFT IN RESTORATIVE THRESHOLDS LEADS TO 4HIS IS THE BOTTOM LINE AND MANY 7IDDOP &4 #ARING FOR THE DENTATE
LESS IATROGENIC EFFECTS AND MIGHT ALSO HAVE REIMBURSEMENT SYSTEMS DO NOT RECOGNIZE ELDERLY )NT $ENT * ´
INFLUENCED THE CARIES DECLINE 4HE INCREASE NON
OPERATIVE PROCEDURES TO THE EXTENT 0ETERS -# -C,EAN -% -INIMALLY
IN CAVITY SIZE BY WASTE OF HEALTHY TISSUE THAT THE CARE PROVIDER CAN SURVIVE 4HERE INVASIVE OPERATIVE CARE ) -INIMAL
AT EACH RE
RESTORATION IS ALSO IATROGENIC IS A REIMBURSEMENT THRESHOLD TO EVERY INTERVENTION AND CONCEPTS FOR
2EPAIR OR REFURBISHING OF A RESTORATION MAY ENTERPRISE AS WELL AS A RESTORATIVE THRESHOLD MINIMALLY INVASIVE CAVITY PREPARATIONS
$ENTAL5PDATE *ANUARY&EBRUARY
© MA Healthcare Ltd. Downloaded from magonlinelibrary.com by 131.172.036.029 on October 16, 2017.
Use for licensed purposes only. No other uses without permission. All rights reserved.
#ARIOLOGY2ESTORATIVE$ENTISTRY