Minimal Invasive (MI) Dentistry

Minimal Invasive Dentistry is “the

management of caries with a biological/Medical
approach,
rather than surgical approach”

:MI Dentistry can be organized into

Recognize with patient caries risk -1
Remineralize -2
Minimal surgical approach for cavitated lesions -3
Biomimetic Restoration-4
Repair ,not replace the defective restorations -5
Recognize -1
• Caries history and early lesions

Past caries experience is useful predictor of tooth caries risk,

clinical examination should include plaque rerentive area:
“deep pits & fissure , crowded teeth , exposed root surface , rest seats
of partial denture”

•Biofilm assessment

PH anaysis : the critical PH is 5.0-5.5

Bacteria Testing : levels of strep.mutans indicate caries initiation
, levels of lactobacilli indicate progression
Primary Caries Risk Factors •
1- Diet
frequency of carbohydrate, amount, consistency

2- Fluoride
fluoridated water(1000ppm), fluoride toothpaste, supplements

3- Saliva :
-ph , at rest & stimulated
-flow rate
-viscosity
-buffering capacity

4- Medications and Disease

Advanced Diagnositic Tools for initial caries detection •

Magnification :
a) loupes
b) microscope

Intraoral Camera :
improve visual access to the cavity , lighting ,magnification

Digital Radiograph :
for proximal caries and classified into E1, E2, D1, D2 and D3

NOTE : minimal intervention approach

is not indicated otherwise D2
DIAGNOdent (quantitative)
for occlusal caries
measure the level of cariogenic bacterial activity
in numerical value

Flourescence of visible light

demineralization, auto-fluorescence

Digital Imaging Fiber Optic Trans-illumination

(DIFOTI)
detect occlusal caries, facial and lingual surface
and fractures

Electrical Caries monitor (ECM)

for occlusal caries
Remineralize .2
A. Methods to inc salivary flow and quantity
i.e; xylitol chewing gum, mouthwash( biotene & colgate hydris), toothpaste

B. Chemical Methods
1-substance interfering with bacterial growth
- chlorohexidine (twice daily for 2 weeks )
- iodine
-Triclosen ( cariostatic and antibacterial , in colgate products ) - antibiotic and enzymes
C. Pits and Fissure sealant

D. Infilteration method ( ICON)

used with incipient caries (white spots )

3-Minimal Surgical approach

According to conservatism :
a- caries define the outline , rather than include all pits and fissure in G.V black design

b- shallow fissure ( ½ or less enamel thickness ) , enamloplasty “ slantng bur technique”

c- the retention and resistance form is micromichanical, not macrmechanical as in G.V black
d- Partial caries removal
depend on : the difference between Infected dentin&
Affected dentin

: Can be defined through

smart prep burs -
caries detector dye -
fluoroscence aided cariess-
excavation
e. Minimal or Non-invasive cutting tools :

1- Air-abrasion technology

-large cavities can’t be obtained with air abrasion

-dis : loss of tactile sensation , messy particles
require rubber dam and high suction

NOTES: nowadays, bondodontics restoration enhance the re-emergence of this technology

2- Chemico-mechanical removal of tooth structure

-used with phobic , hand capping patients

-does not affect healthy dentin nor enamel
-can’t be used solely
laser cutting -3

- the most commonly used types are excimers , co4 ,

YAG lasers
- inefficient in large cavities

4- Enzymes

5- Ozone treatment

- ability to inactivate microoraganisms

- known as Heal Ozone
f. Modified conservative cavity designs:

1-Preventive resin restoration

for fissure caries( limited to enamel ) and its restortion is resin composite

2- Simple box preparation

for small proximal lesion without occlusal surface

3-Slot preparation
- for old patients with gingival recession
- often cavities on proximal exposed cementum , gingival to contact area

4- Tunnel prep
The Restorative materials -4

Bondodontics
- depend on adhesive densistry (Micro-mechanical )
rather than Bonding (Macro-mechanical )
-chemical adhesion provide gap-free interfacial
contact
-require proper isolation , as the adhesion absences
in oral cavity fluids