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13-Minimum Intervention (Part 1)
13-Minimum Intervention (Part 1)
13-Minimum Intervention (Part 1)
in restorative dentistry
(Minimum Intervention)
part 1
For most of the 20th century, carious lesions were treated following
Black’s principles where diseased portions of the tooth were
surgically removed and the cavities were extended to areas which
were presumed to be caries-resistant.
The reasons for this approach were:
1. Operator.
2. Tools used.
1. Magnification.
• Loupes:
• Microscopes:
But, it was proved that by the time a good solid stick is achieved
with the sharp explorer, the lesion is already unnecessarily large.
Moreover, probing may disrupt the tooth surface and predispose to
cavitation or may lead to misdiagnosis due to stickiness of deep
non-carious fissures.
2.2. Advanced diagnostic tools
a. Intra-oral camera.
b. Digital radiography.
c. Laser-based devices.
Its technology is based on the fact that carious enamel has lower
index of light transmission than sound enamel. A high intensity
light is shone through the tooth and the transilluminated image of
the tooth is captured by an intraoral camera connected through a
computer software to display the image on a computer screen to be
diagnosed.
1. Painless.
2. Ease of use.
3. Ability to discriminate and remove diseased tissues only.
4. Silent.
5. Does not generate heat.
6. Affordable.
7. Easy to maintain.
All this led to the appearance of several tools that tried to fulfill
these requirements.
2.3. Non-invasive cutting tools
c. Ultrasonic cutting.
d. Laser cutting.
e. Enzymes.
f. Ozone treatment.
2.3.a. Air abrasion technology
Not considered a new technology but it’s use was limited in the
past due to the absence of restorative materials that would comply
with it.
The gel is applied over the diseased tissue for several minutes
where it selectively reacts by disrupting the denatured collagen in
demineralized areas. Then, a specially designed instrument is used
to remove the unsupported softened tooth structure.
It is effective only with carious dentin but does not affect enamel.
Therefore it can not be used alone.It is indicated in root caries and
in deep caries approaching the pulp.
2.3.c. Ultrasonic cutting
Early generations were large in size and could not preserve tooth
structure, however, later on smaller sizes were incorporated and
were useful.
Several types of lasers are used for cutting tooth structures such as
CO2 laser and Nd:YAG laser.