• The original approach to the treatment of caries developed by G. V. Black (1899) was purely surgical. • He thought that the only effective method of eliminating the disease was to completely remove all of the demineralized areas to tooth structure and rebuild it with an inert restoration. A number of problems arise from this approach: • First, it fails to recognize that cavitation is essentially a symptom of a bacterial disease. • Second, it denies the ability of the. tooth structure to remineralize and heal.
PRINCIPLES OF MINIMAL INTERVENTIONAL DENTISTRY – Control the disease through reduction of cariogenic flora. – Remineralize early lesions. – Perform minimal intervention surgical procedures as required (ART, Air abrasion). – Repair rather than replace. EARLY DETECTION – Laser fluorescence (Diagnodent) – Ultraviolet-induced fluorescence – Caries detecting dyes – xeroradiography REMINERALIZATION It is possible to arrest and even reverse the mineral loss associated with the caries at an early stage, before cavitation takes place.
Enamel anddentin demineralization is not a continuous, irreversible process. Though a series of demineralization and re-mineralization cycles, the tooth alternatively loses and gains calcium and phosphate ions, depending on the microenvironment. ADVANCES IN CAVITY PREPRATION • Air abrasion • Lasers • Chemo mechanical Cavity preparation • Sonic oscillating system • Tunnel restorations MODIFYING THE MICROFLORA • A significant correlation between the prevalence of Streptococci mutans in saliva increment of new caries lesions was obtained.
• Lactobacilli along with Streptococci mutans are also related to root surface caries. • Using 0. 2% chlorhexidene as a water-based gel or an alcohol-based mouthwash twice a day for two weeks will offer a significant reduction in streptococcus mutans and lactobaccilus and provide the patient with an increased opportunity to overcome infection. BIOMIMETIC MATERIALS Biomimetic means “imitation of nature”. In other words these material reproduce one or more natural phenomena with in a bio-logical situation.
Adhesive dental materials make it possible to conserve tooth structure using minimally invasive cavity preparations, because adhesive materials do not require the incorporation of mechanical retention features. There are several materials that can be used: 1. glass ionomer cements,2. resin based composites or GIC resin based BIBLIOGRAPHY • The silent revolutions in dentistry ROULET & DEGRANGE • Advances in Operative dentistry WILSON, ROULET & FUZZI • Operative dentistry modern theory & practice MARZONK, SIMONTON, GROSS • Principles & practice of operative dentistry CHARBENEAU • Textbook of operative dentistry VIMAL K. SIKRI.