(Head of the Department)

1
 Content:
● Introduction
● Principles
● The Minimal intervention approach Caries
removal & restoration
● Recent advances in caries removal techniques
● Cavity designs for Minimal intervention
● Restorative materials used in MID
● Conclusion
● Reference

2
What is minimally invasive dentistry and how is it different from regular
dentistry?
● The goal of minimally invasive dentistry, or micro dentistry, is to conserve
healthy tooth structure. It focuses on prevention, remineralization, and
minimal dentist intervention.
● In minimally invasive dentistry, dentists use long lasting dental materials that
conserve the maximum tooth structure so the need for future repairs is
reduced

PRINCIPLES
■ Control the disease through reduction of cariogenic flora:
■ Remineralize early lesions:
■ Perform minimal intervention surgical procedures as required
■ Repair rather than replace

CARIES REMOVAL AND RESTORATION

• Rotary instruments used for the treatment of carious lesion have often resulted in
a considerable removal of tooth structure
• Newer technique for removal of carious dentin have been developed to minimize
this excessive tissue loss

Pit and fissure sealant

A material that is introduced into the occlusal pits and fissures of caries susceptible teeth,
thus forming a micromechanically bonded, protective layer cutting access of caries-
producing bacteria from their source of nutrients

Indications

• Deep, retentive pits and fissures which may cause wedging of an explorer
• Stained pits and fissures with minimum appearance of decalcification
• No radiographic or clinical evidence of proximal caries
• Possibility of adequate isolation
• Questionable enamel caries in pit and fissures
• Carries free pit and fissures

3
Contraindications
o Well-coalesced,self-cleansing pits and fissures
o Radiographic or clinical evidence of interproximal caries tooth not fully erupted
o Isolation not possible
o Life expectancy of tooth is limited
o Dentinal caries
o Lack of preventive practices

Preventive resin restoration

■ PRR is indicated in teeth with minimal teeth and fissures decay.
■ In this minimal cavity preparation is required to prevent unnecessary
removal of healthy tooth structures for retention.
■ Tooth preparation is done by removing the caries from enamel
■ After etching, rinsing and drying the cavity & is condensed with a normal
composite or GIC.

■ TYPES OF PRR Based on the extent and depth of the carious lesions:
■ Type A - Suspicious pits and fissures where caries removal is limited to enamel.
■ Type B - Incipient lesion in dentin that is small and confined.
■ Type C - Characterized by the need for greater exploratory preparation in dentin

Atraumatic restorative treatment

The atraumatic restorative treatment (ART) is a procedure based on removing carious

tooth tissues using hand instruments alone and restoring the cavity with an adhesive
restorative material

4
5
ADVANTAGES
▪ Easily available inexpensive hand instruments are used rather than the expensive
electrically driven dental equipment.
▪ As it is almost a painless procedure, the need for local anesthesia is eliminated or
minimized.
▪ RT involves the removal of only decalcified tooth tissues, which results in relatively
small cavities and conserves sound tooth tissue as much as possible.
▪ A practice of straightforward and simple infection control is used without the need to
use autoclaved hand pieces.
▪ The leaching of fluoride from glass ionomer probably remineralizes sterile
demineralized dentin and prevents development of secondary caries.
▪ The combined preventive and curative treatment can be done in one appointment. It
is less expensive and less time consuming as in one sitting several fillings can be
done.
▪ it enables to oral health workers to reach people who otherwise never would have
received any oral health service.

6
 Disadvantages
o ART restorations are not long lasting. The average life is 2 years depending upon the
rate of caries activity of the individual oral cavity
o As fundamental principles of cavity preparation are not followed all oral health
workers may not accept it
o Because of the low wear resistance and low strength of the existing glass ionomer
materials their use is limited to small and medium sized one surface cavity only
o The continuous use of hand instruments over long period of time may result in hand
fatigue
o A relatively unstandardized mix of glass ionomer may be produced due to hand
mixing.

Chemo - mechanical caries removal

According to Banerjee et al ,The chemo - mechanical method is an effective alternative
for caries removal, because it brings together atraumatic characteristics and
bactericide/bacteriostatic action.
The method was created so as that an active ingredient would soften the predegraded
collagen of the lesion without pain or undesirable effects to adjacent healthy tissues .
Caridex
The solution was claimed to cause disruption of collagen in carious dentin, thus
facilitating its removal.

Disadvantages
- Expensive
- Large quality required
- Solution has to be heated
- Short shelf-life.
Carisolv
It consists of Amino acids and 0.5% Sodium hypochlorite and is applied to dentin

Advantages
▪ Three amino acids are incorporated instead of one
▪ The solution does not need to be heated, or applied through a pump
mechanism
▪ The increased viscosity of Carisolv enhances precision placement
▪ The overall stability is increased, giving an improved shelf-life.

7
 Papain Gel
It is basically comprised of papain, chloramines, toluidine blue, salts, thickening vehicle,
which together are responsible for the Papacarie’s bactericidal, bacteriostatic, and anti-
inflammatory characteristics.
Papain is indicated in all phases of the cicatricial process and it promotes—
(1) chemical debridement,
(2) granulation and epithelialization,
(3) stimulation of the tensile strength of the scars

8
Air abrasion

It is described as a pseudo mechanical, non rotary method of cutting and removing

dental hard tissue. The terms “micro air-abrasion” and “kinetic cavity preparation” have
been used synonymously to describe air abrasion.

Principle

• Air abrasion for restoration preparation removes tooth

structure using a stream of aluminum oxide particles
generated from compressed air or bottled carbon dioxide
or nitrogen gas. The abrasive particles strike the tooth
with high velocity and remove small amounts of tooth
structure.
• Efficiency of removal is relative to the hardness of the
tissue or material being removed and the operating
parameters of the air abrasion device.

Advantages
™ It is painless
™ Local anesthesia is rarely needed
™ It works quickly and the tooth with a small lesion is ready to restore in seconds
™ It work quietly without the whine of the all too familiar dental headpiece
™ There is no vibration or pressure to cause micro fractures that weaken tooth
™ There is no production of heat to damage the dental pulp
™ Lesser sound tooth structure is removed

9
Disadvantages
● Depth of preparation cannot be controlled easily.
● Must be used in caution when used adjacent to soft tissues as it may lead to
surface injuries.
● The preparation does not render a well-finished surface.
Air abrasion can cause subcutaneous emphysema

LASERS

(light amplification by stimulated emission of radiation)

It operates at a wavelength of 2.94 um and is used for the caries removal, cavity
preparation in both enamel and dentine and for the preparation of root canals.
• Laser treatment is appreciated by patients as they are more comfortable than drilling

10
CARIES DETECTOR DYES
■ In caries removal during cavity preparation, only the soft, heavily infected
outer dentin must be removed, whereas the demineralized, uninfected inner
dentin should be left.
■ Caries-detecting dyes (e.g.1.0% acid red in propylene glycol) have been
developed in distinguishing between the two types of caries.

OZONE APPLICATION
● Ozone is part of a natural gas mix that surrounds the earth at high altitude and
protects world's population from excessive UV radiations.
● This technique utilize O3 gas which is applied to the tooth surface in a controlled
manner
This 03 gas eliminates decay causing bacteria. Once the bacteria are eliminated
the treated surface can be restored or left to re-mineralize

CAVITY DESIGN MODIFICATION FOR MINIMAL INTERVENTION

TUNNEL CAVITY PREPARATION

• This is indicated if the cavity is small and if placed 2–2.5mm below the marginal ridge
• The aim is to develop an access via the occlusal aspect so as to preserve the strength
of marginal ridge and also to prevent formation of proximal cavity
• Access to the lesion through the occlusal surface should be limited to the extent
required to achieve visibility and should be undertaken from an area that is not
under direct occlusal load
• Fossa immediately next to medial marginal ridge is the most suitable position for
entry
• Glass ionomer is best suited for such cavities as it readily flows into a small cavity
and has the ability to re-mineralize the enamel margins and any dentin on axial wall

11
SLOT CAVITY PREPARATION
■ It is creation of a small slot on the proximal aspect of posterior teeth
■ Indicated if there is a small lesion involving the area of or below the
marginal ridge only in deciduous teeth
■ Cavity preparation is done only on the proximal aspect after establishing
entry over marginal ridge, and the extent of cavity is defined by the extent of
the lesion with the intention to preserve as much tooth as possible
■ The material of choice is glass ionomer, but resin composite may be a
useful material because on many occasions, there will be an enamel margin
around the full circumference.

PROXIMAL APPROACH
■ This is a very conservative approach used when the proximal surface of a
tooth becomes accessible at the time of cavity preparation in an adjacent
tooth. The lesion may have been revealed through radiographs, or it may be
noted only during cavity preparation

12
CONCLUSION

It is time for changes in the principles of operative dentistry. The disease should be
treated first; the surgical approach should be undertaken only as a last resort and efforts
should be made to preserve a maximum amount of sound tooth structure.
Although further research is needed, it can so far be concluded that minimum
intervention has the potential to apply a more conservative approach to caries
treatment and health orientated treatment option

13
 REFERENCE
th
● Textbook of pediatric dentistry – Nikhil Marwah (4 Edition)
rd
Textbook of pediatric dentistry – Shoba Tandon (3 Edition

14
 THANK YOU

15