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Introduction History Definitions Aim and Objectives Principles and motives for MID Diagnosis tools Prevention Minimal interventions techniques

Path of MI in a nut shell

1900 Extension for prevention golden future of dentistry based on
prevention philosophy 1912-Hyatt:- Prophylactic Odontomy: The stepping stone to MI Philosophy

1951 - Dr J Tim Rainey: - Air Abrasion: A new way towards microdentistry

1954 Buonocore Acid etching: The turning point of MID. 1964 - Bowen introduced Resin: MID's best pal was born

1980s- Frenckon Joe came up with Atraumatic Restorative Treatment - MI

Philosophy in rural and community based set up with bare minimum tecq transfer 1980- Caridex:- Caries was looked beyond the cavity

 1998- Carisolv: A new package for caries excavation 1999- Dr.Hugo U & Mosele introduce caries excavation by Sonoabrasion: innovation in caries excavation. 2000 - Baysan & Lynch introduced Ozone Therapy for arresting dental caries: bidding final farewell to drill, fill and bill 2004 onwards I), Lawrence proposes genetically modified organisms to prevent caries: A new bug against dental caries Today's vision tomorrows reality!!!

DEFINITIONS
MINIMAL INTERVENTION DENTISTRY INTEGRATES PREVENTION ,REMINERALIZATION AND MINIMAL INTERVENTION FOR THE PLACEMENT AND REPLACEMENT OF RESTORATIONS

G.J.MOUNT 1998
TISSUE PRESERVATION BY PREVENTING DISEASE FROM OCCURRING AND INTERCEPTING DISEASE PROGRESSION AS WELL AS REMOVING AND REPLACING DISEASED TISSUE WITH AS LITTLE TISSUE LOSS AS POSSIBLE

MARTIN J TYAS 2000

Diagnostic Tools

Traditional Methods

New methods

Mirror & probe

Digital fiber optic Transillumination

Elective tooth separation

Fluorescence

Radiographs

UV illumination

Dyes

Electronic caries monitor

Ultrasonic imaging

Endoscope\ videoscope

Chewing Gums & Additives:

Alpha- tricalcium- phosphate Deposit of a Calciuim/ Phosphate reservior into dental plaque Increase resistance against cariogenic challenges Casein phospho peptide - Amorphous calcium phosphate (CPP-ACP) Remineralization of enamel subsurface lesions Chlorhexidine

Reduction of plaque and gingivitis

Funoran/ Eucalyptus Inhibition of plaque formation Potassium chloride (KCl)

Reduction of dental hypersenstivity after 3 weeks

Pycnogenol Reduction of gingival bleeding and plaque accumulation

Chewing Gums & Additives Sodium bicarbonate 5% (Baking Soda)

Reduction of plaque and gingivitis Increased period of use direct related to increased plaque reduction After meals, reduction of caries incidence .

Sorbitol Xylitol
Significant plaque reduction

MIT Classification
Technique Manual caries excavation Rotary Sonic oscillation Chemo mechanical caries removal Kinetic Hydrokinetic Ozone technology Example Atraumatic restorative treatment High/low speed burs Sonic micro abrasion Carisolv and enzymes Air abrasion Lasers ozone gas

Atraumatic Restorative Treatment

Elementary technique of caries removal using hand instruments only ,combined with the use of modern restorative material with adhesive characteristics

Pioneers:- Frencken Joe, Makoni F. in Tanzania 1980

ART- Principle

Controlled selective rotary excavation

Polymer burs
Smart prep, SS white Principle: Selective caries removal due to difference in hardness between healthy and caries dentin Disadvantages: Polymer burs are very sensitive Ruined by hard dentin

SONIC OSCILLATION (SONOABRASION)

SONO abrasion
Removal of carious dentin using high frequency ,sonic air scaler with modified abrasive tips Sonic micro unit deigned by Dr.Hugo U and Mosele Mechanism:Elliptical motion Transverse 0.08 - 0.15mm Longitudinal - 0.055 -0.135mm Diamond Coated 40 micro meter grit diamond Water irrigant 20-30ml/min Air pressure 3.5 bar Torque applied 2N More pressure dampens the oscillations

First design:

CHEMOMECHANICAL CARIES REMOVALCMCR

Chemical softening of carious dentin followed by its removal by gentle excavation
Chemomechanical agent

NaOCl + Aminoacids

Selectively degrade demineralized collagen

 CMCR first used by Goldman and Kronman

NaOCl + Sorensons buffer (glycine NaOH, NaCl) N mono Chloro Glycine (GK1019)

Glycine replaced by Amino Butyric acid

N mono Chloroamino butryic acid (NMAB)- GK101E

CMCR
Mechanism of action: Chlorination of partially degraded collagen Hydroxy proline --- pyrrole-2carboxylic acid Oxidation of Glycine residues Disruption of collagen more friable collagen

Advantages: More gentle than hand excavation -Root caries close to inflamed, bleeding gums -Deep cavities close to the pulp It is less strenuous on operator in case of high patient load Disadvantages: Slight unpleasant taste More expensive than hand instrument Restricted view of working area in cavity

Caridex - Carisolv
Caridex (1980,USA) solution
1%Naocl 0.1 M Aminobutyric acid glycine 0.1 M NaOCl, ), 0.1 M NaOH

Carisolv (sweden 1998)

0.5%Naocl 0.1 M Glutamic acid, leucine, lysine, NaoH, Nacl Erythrocin (GEL) 11 0.2-1ml 10-15 min 20min Specially designed

dye pH Volume time Stable Instruments

11

---100-500ml 10-15 min 1 hr Applicator tips

Enzymes for removal caries

Studies proven that caries might able to remove by

using enzymes
In 1989 Goldsberg and Keil successfully removed soft caries dentin using bacterial Achromobacter collagenase ( does not effect sound dentin layer) Enzyme Pronase:- non specifically proteolytic enzymes originating from Streptomyces griseus successfully to removes caries dentin

AIR ABRASION
Kinetic Cavity Preparation)

Air Abrasion
Concept :- directing high speed particles (aluminium oxide) through compressed air/gas onto tooth surface generating Abrasion Father of air abrasive microdentistry- Dr J. Tim Rainey, 1951 White technology Airdent-n first commercially available unit Abrasive particles: Aluminum oxide Alumina particles- alpha alumina, pure biocompatable used in food and medicine prime ingredient in tooth paste

Air Abrasion
Applications : Cavity preparations Internal cleaning of tunnel preparation Removal of temporary cement Stain removal Repair of acrylic , composite and porcelain Advantages: No traumatic treatment No chipping, no micro fracturing Decreased thermal build up Smooth margins Less invasive procedure No anesthesia, less discomfort

 Laser is acronym of Light Amplication by stimulated Emission of Radiation Applications: Selective Carious Dentin Removal Destroy S.Mutans Sealing of Fissures Cut Dental Hard Tissue Adjunctive treatment in caries prophylaxis Modify structures of dentin and enamel

Laser Therapy
Removes caries safely Minimal damage to surrounding tissue Minimal thermal damage Addition with topical fluorides application increases resistance against dental caries (Argon,CO2, Er:YAG, Nd:YAG) Desensitize of hypersensitive dentin (Er:YAG) C02 laser caries inhibition up to 82.7% Nd:YAG laser with Duraphat caries inhibition Pit and fissure 43% Smooth surface 80%

Ozone Therapy

THE MOST BEAUTIFUL THINGS ON EARTH ARE ALSO THE MOST SIMPLEST AND MOST NATURAL !!!!!

How does ozone come to our rescue?

Completely eliminates acidophilic bacteria ,fungi and viruses create a sterile environment 10 secs of 2200 ppm ozone eliminates 99 % of the carious micro flora It is strong oxidizer to cell walls and cytoplasmic membrane of bacteria Ozone treatment leads to oxidative decarboxylation of plaque pyruvate It oxidizes volatile sulfur compounds- prevents maladour

Indication of Ozone Therapy

Primary root caries lesions

Early carious lesions

Pit and fissure caries Caries around crowns and bridges

10 commandments of Minimally Invasive Dentistry Burnhal- Grigereit in 1995

1)Always follow the philosophy of minimally invasive dentistry. 2) Perform the least amount of dentistry needed in any situation. 3) Never remove more tooth structure than is absolutely required to restore teeth to their normal condition. 4) Always use dental materials that conserve maximal tooth structure over time. 5) Use only dental materials that have been researched by leading dental schools and research institutions and that are recommended by leading practicing dentists. 6) Use only the strongest and longest lasting materials to reduce the need for future repair and replacement. 7) Keep dental appointments as short as possible to ensure conservative treatment. 8) Use dental procedures that minimize the number of necessary appointments. 9) Select dental laboratories that use minimal invasive materials for the restoration of teeth 10) Use only restorative materials that do not wear opposing teeth more than enamel.

Conclusion
prevention of extension ConstriCtion with ConviCtion

repair rather replaCe

REFRENCES
Minimal invasive dentistry - JADA 2003, 134; 87-95

Minimal intervention dentistry- IDJ 2000

Ozone therapy for dental caries; a revolutionary treatment. 2003; 74-145 Art and science of operative dentistry- Sturdevant G J Mount. Glass Ionomer Restorations Contemporary practice in conservative dentistry.