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Introduction History Definitions Aim and Objectives Principles and motives for MID Diagnosis tools Prevention Minimal interventions techniques
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
Diagnostic Tools
Traditional Methods
New methods
Fluorescence
Radiographs
UV illumination
Dyes
Ultrasonic imaging
Endoscope\ videoscope
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
ART- Principle
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
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:
NaOCl + Aminoacids
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
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 !!!!!
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
REFRENCES
Minimal invasive dentistry - JADA 2003, 134; 87-95