Conservative approach and minimal intervention 1
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The document discusses the conservative approach in operative dentistry, emphasizing minimally invasive techniques for restoring hard tooth structures while preventing further damage and decay. It covers key principles such as controlling causative factors, early remineralization, and utilizing advanced diagnostic and cutting tools to enhance dental treatment outcomes. The need for collaboration among various factors, including the operator's skill and the socioeconomic context of patients, is also highlighted to achieve effective conservative dentistry.
Conservative approach and minimal intervention 1
- 1. ALPINE SKI HOUSE Dr. Inas Ayoub Elalem inas.alalem@gmail.com 00970599448344 1 Operative Dentistry V
- 3. What do you think about conservative dentistry concept, do you support it or not ?
- 4. For most of the twentieth century, the profession has followed re-taughtable approach of Black’s principles. What were Black’s principles of extension for prevention ? What were his reasons behind this approach?
- 5. What were the consequences of Black’s principles of extension for prevention?
- 6. Conservative approach in restoration of hard tooth structure defects: ◦ It focuses on a minimally invasive dentistry or preservative dentistry, which allows a shift from the traditional surgical approach to a control of defects without cutting or if cutting is to be done, it has to be restricted as much as possible.
- 7. Conservative approach in restoration of hard tooth structure defects: ◦ The adoption of the medical model of treatment would thus save money, effort and time by: ◦ Preventing the development of defects or new cavities. ◦ Preventing periodontal problems. ◦ Stopping the progress of existing lesions and decay spots. ◦ Stopping the progress of existing lesions and decay spots. ◦ Maintaining existing old restorations.
- 8. This concept encompasses the following principles: ◦ Control of causative factor or carcinogenicity to eliminate further demineralization. ◦ Re-minerlization of early lesions. ◦ Minimal Surgical intervention for cavitated lesions. ◦ Repair rather than replace for defective restorations.
- 9. Essentials to allow conservation: ◦ To achieve this conservative equation, several contributing factors are to be shared in order to allow the realization of this required target. ◦ These could be dependent on the operator, the tool used, the restorative materials employed, the oral environment conditions and the socioeconomic conditions of the patient receiving the treatment.
- 10. The Operator ◦ Two main issues are to be focused upon: ◦ First is the elimination of microorganism to suppress demineralization ◦ Second is the saturation of saliva with fluorides, calcium and phosphate to drive them inside the tooth thus enhancing remineralization.
- 11. The tools used: ◦ Micro dentistry replaced macro dentistry to allow microscopic removal of diseased tissue. Therefore, maintenance of as much healthy tissue and structural integrity of the tooth as possible, while still allowing feasible visualization and access, is becoming a main requirement. ◦ To practice minimal invasive and micro dentistry, it was found essential for this ultraconservative approach to utilize magnification, precise diagnostic equipment and non-invasive cutting tools.
- 12. Magnification: ◦ Visual acuity helped accuracy of incipient caries diagnosis and minimization of healthy tooth destruction cutting. ◦ 1. Loupes
- 13. 2. Microscopes ( video)
- 14. Advanced diagnostic tools to detect incipient lesions: ◦ Up to date, no diagnostic tool could make caries detection full proof. The earliest possible lesion detection will provide the facility of condition reversal. It could also provide for a minimum tooth structure removal and consequently a much conservative restoration. This would provide a cliché to be maintained that dictates “ smaller is better”. ◦ It thus allows dentistry to be diagnostically-oriented.
- 15. The traditional methods of detection of dental caries ◦ The lesion is already unnecessary large. ◦ Probing may disrupt the tooth surface and predispose to cavitation or may erroneously result in misdiagnosis because stickiness may be due to fissure morphology or probe pressure.
- 16. ◦ This raises the question: “ which tool to use best and what tools combination could perform a better job? ◦ Is there a single tool to use to detect smooth surface or occlusal carious lesions ?
- 17. This led to the development of several techniques that help the operator to reach an accurate diagnosis.
- 21. Laser based device (DIAGNOdent):
- 22. Quantitative light induced fluorescence ( fluorescence of visible light) : ◦ The high resolution transillumination: Digital Imaging Fiber Optic Transillumination tool ( DIFOTI):
- 23. Electrical Caries Monitor (ECM):
- 24. Minimal or Non-invasive cutting tools ( video) : ◦Air-abrasion technology:
- 25. Chemico-mechanical removal of tooth tissues:
- 26. Ultra-sonic cutting Chemical vapor deposition (CVD bur)
- 28. Laser cutting
- 29. Enzymes ◦ Pronase does not attack sound dentin but solubilizes more than 90% of the nitrogen present in carious dentin. ◦ It has no ability to remove sound or carious enamel.
- 30. Ozone treatment:
- 32. The oral environment conditions ◦Salivary flow and PH
- 33. The socioeconomic conditions of the patients
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