FRANK OSEI-BONSU UGDS/KBTH

FRANK OSEI-BONSU UGDS/KBTH

Definition Introduction G. V. Black s concept of Restoration New classification of Caries Principles & Concept of MID Conclusion

An approach to the management of dental caries with the aim of minimizing the loss of natural tooth structure either by disease or iatrogenic intervention

Strep mutans; only 2 microns tall It is widely acknowledged that caries is a bacterial disease & therefore must be treated as Notorious bacteria in the caries process such (others bacteria include Lactobacillus, S. sobrinus

Minimally invasive dentistry adopts a philosophy that integrates -prevention, -remineralization -minimal intervention for the placement and re-placement of restorations

Preventing development of caries Preventing unnecessary tooth tissue destruction in cases of already established lesions Preventing advance and most of the time expensive dental treatment or care.

Caries will progress to the cavitation stage if steps such as: -improved oral hygiene -use of fluoride containing dentrifices -flossing etc are not taken to reverse the process in the early stages

Remove decay and Restore with an appropriate biocompatible material Restore function & aesthetics

CLASS II AMALGAM FILLING CLASS II AMALGAM CAVITY

Known as one of the founders of modern dentistry He classified caries into five classes originally (class VI was later added) The popular mantra Extension for Prevention is attributed to Black s advocacy to extend cavity designs/restorations to include caries free areas for self cleansing in an attempt to prevent further decay

Green Vardiman Black 1836-1915

CLASS IV CLASS III CLASS III

CUSPAL TIPS CLASS VI INCISAL EDGE

Self cleansing outline form Resistance form Retention form Convenience form Removal of caries Finishing margins on enamel

MINIMAL INTERVENTION CONCEPT: A NEW PARADIGM FOR OPERATIVE DENTISTRY Meerkats band

NEW CLASSIFICATION SYSTEM By Mount & Hume

Enhanced understanding of caries process Recognition of the role of fluoride and other ions in caries prevention Availability of adhesive restorative materials Advance techniques in diagnosing early caries lesions

1. Individualized assessment of caries risk 2. Appropriate preventive strategies 3. Remineralization /arrest of noncavitated lesions

PRINCIPLES OF MI 4. Minimum surgical intervention Restore only if cavitated required for plaque control or aesthetics Removal of caries : only infected dentine Restoration with adhesive materials 5. Appropriate maintenance of existing restorations (if possible Repair, Don t Replace)

The plaque hypothesis - Non-Specific, Specific, Extended etc Theories- Acidogenic, Proteolytic, Proteolysis- Chelation Multifactorial nature of causes-keye s ring Dynamic Nature of Caries -Demineralization vs Remineralization

Multi-factorial aetiology nature of caries KEYE S RING Dr Paul H Keye

Mineral content Dynamic Nature of Caries Demineralization vs Remineralization RED GREEN breakfast coffee break lunch Net loss brushing snack dinner snack brushing

Total oral bacteria population Anatomy & surface morphology of teeth Saliva-secretion rate, properties etc. Diet intake of fermentable CHOfrequency etc. Mobility of tongue & lips Eruption stage of teeth Use of fluoride, chemical plaque control Individual OH habits etc

THE BALANCE BETWEEN DEMINERALIZATION & REMINERALIZATION

EARLY CARIES DETECTION Quantitative Light-induced Fluorescence (QLF) OCT (Optical Coherence Tomography) imaging Fibre-Optics-Based Confocal Imaging System Electrical Resistance Imaging Techniques Polarization-Sensitive Optical coherence Tomography (PSOCT) System Frequency Domain Photothermal Radiometry (FD- PTR or PTR

Device uses blue light to illuminate the tooth. Causes the teeth to fluoresce in green (so-called autofluorescence). The resulting QLF images show a higher contrast between sound and demineralized tooth tissue.

QLF

Optical coherence tomography high-resolution transverse microradiograph (TMR)

Plain Radiographs vs OCT, QLF Plain radiograph inaccurate in detecting early lesions confined to enamel Review article by Marina George Kudiyirickal, Romana Ivančaková- Sept 2008 Charles University in Prague, Faculty of Medicine and University Hospital Hradec Králové, Czech Republic: Department of Dentistry

MURAKAMI et al. using the micro ph Sensor on 20 extracted carious teeth were able to differentiate between Active & Arrested caries Dental Materials Journal 25(3:423-429, 2006

1. Inhibition of bacterial metabolism 2. Inhibition of demineralization 3. Increases resistance of enamel to acid attack & increases remineralization by formation of fluoroapatite crystals F - alone vs Ca 2+, PO 4 - & F - combination.

Effect of fluoride on caries prevention is now believed to be more of a topical than systemic

Caries reduction observed in the following Studies of adult patients (different RISK Groups) 1,100 ppm vs. non-fluoridated toothpaste 5,000 ppm vs. 1,100 ppm toothpaste 5,000 ppm or 12,300 ppm toothpastes or gels vs. sodium fluoride (NaF) 0.5% rinses Fure et al A comparison of four home-care fluoride programs on the caries incidence in the elderly. Gerodontology 1998; 15(2):51 608.

White spot lesion-reversibl Identification of Lesions rather than Cavities should be the key

Restoration of only cavitated lesions Minimal preparations -remove only infected dentine -type of burs -cavity design: tunnelling etc. Deep pits & fissures Use of fissure sealants-deciduous, permanent Use of preventive resins- Composite+fissure sealants

ADHESIVE DENTISTRY & MID Materials include: Glass-ionomer cement (GIC) Resin Modified GIC (RMGIC) -fluoride releasing effect Composite, Compomers etc.

POWER OF ADHESIVE DENTISTRY PRE-OP POST-OP

PRE-OP POST-OP

Air abrasion Using a stream of Al 2 O 3 particles generated from compressed air or bottled carbon dioxide or nitrogen gas

D. Jawa et al showed how Papacarie( a papain based chemical) helps with reduction in bacteria numbers during caries removal JOURNAL OF INDIA SOCIETY OF PAEDIATRIC & CONSERVATIVE DENTISTRY (2010 Volume : 28 Issue : 2 Page : 73-77) Carisol to dissolve caries

COMPLETE vs ULTRACONSERVATIVE removal of decayed tissue in unfilled teeth DNJ Ricketts, EAM Kidd, N Innes, J Clarkson No difference in incidence of damage or disease of the nerve of the tooth (pulp) irrespective of whether the removal of decay had been minimal (ultraconservative) or complete Australian Dental Journal 2007;52:3.

Partial caries removal is therefore preferable to complete caries removal in the deep lesion, in order to reduce the risk of carious exposure. Insufficient evidence to know whether it is necessary to re-enter and excavate further but studies that have not re-entered do not report adverse consequences.? Stepwise excavation

Remove soft, completely demineralized tooth tissue by using hand instruments. Restore with Glass ionomer filling material Accepted by -WHO in 1994 -FDI in 2002 Being use extensively in deprived areas

Fluoride containing dentrifices Twice brushing esp. night brushing Flossing Mouthrinses with antibacterial effect Avoiding frequent snacking in between meals esp. sticky foods Limit excessive sugar(sucrose) intake Routine dental check ups etc

In view of A better understanding of the caries process The tooth s potential for remineralization, Development of new dental restorative materials & advances in adhesive dentistry, Management of caries has evolved from G.V. Black s Extension for Prevention to Minimally Invasive or Preventing Extension

Twentieth Century EXTENSION FOR PREVENTION (G. V. Black) Twenty-first Century EXTENSION PREVENTION or PREVENTION OF EXTENSION

The goal is preservation of natural tooth structure So unless it is absolutely necessary -Do not cut (Education, fluoride therapy, monitoring etc.) -Do not Extend

PROF E. A. NYAKO DR P. C. AMPOFO DR S HEWLETT