Minimal Invasive Dentistry

current approach in dentistry in Covid state

Amidst the pandemic state with the high transmissibility of the disease through air & droplets and considering that routine dental procedures usually generate aerosols; alterations to dental treatment is of prime concern to maintain a healthy environment for patient & dental team.Here is where the approach of performing minimally invasive dental treatment becomes crucial.

Risks of infection – Human-to-human transmission

What is minimal intervention dentistry?

Minimal intervention dentistry( MID) is a conservative philosophy of professional care concerned with first occurrence,early detection & earliest possible cure of caries at a micro level ; followed by minimally invasive and patient friendly treatment to repair irreversible damage caused by dental caries.

Goals & Principles:

.Early diagnosis of dental caries

.Assessment of individual caries risk

.Disease control by remineralisation of incipient carious lesions.

.Repair rather than replacement of defective restorations

.Minimal invasive treatment

.Periodic follow up.

Caries diagnosis:

Includes early diagnosis & caries risk assessment

Early diagnostic aids
Factors relevant in caries risk assessment

Procedures:

Non invasive procedures: Biological approach

Remineralising agents

Minimal invasive treatments:

1)Air abrasion

Indications-

.for abrading the surface of old composites prior to new restoration ; minimal class I & class II preparations for composites ; for abrading ceramic or cast restorations for bonding ; for widening pits & fissures for sealants.

2) Sono Abrasion

Indications-

.opening pits & fissures for sealant restorations ; minimal preparation of incipient class II cavities

3) Chemicomechanical Caries Removal (CMC)

Carisolv – 2 syringe system ,one containing NaOCl & other with 3 amino acids (glutamic acid,leucine ,lysine); carboxymethylcellulose gel;NaCl,NaOH;Erythrosine.The contents are mixed together to form a pink gel which is applied onto carious dentin and left in place for 30 seconds to allow it to soften & degrade the infected dentin.

Advantages – relatively painless, removes only carious dentin, no vibrations,better substrate for adhesive bonding

Disadvantages- expensive, time consuming

4)Enzymes

5)Laser

2 commonly developed lasers-

.Er:Cr:YSGG(2780 nm)- Erbium,Chromium,Yttrium,Scandium,Gallium,Garnet laser – works by agonizing water droplets as they travel towards the target tissue.

.Er:YAG(2940nm)-Erbium,Yttrium,Scadium,Aluminum,Garnet laser – uses pulses of light energy to micro vaporize water within the target tissues.

6)Ozone

Caries treatment with ozone – based on Niche environment theory .Ozone kit consists of portable apparatus & disposable silicon cups. Follow up 3-6 months.

Disadvantages – can cause porosities or abrade tooth surface ,in case of heavy exposure.

Other techniques (in brief):

7)Atraumatic restorative treatment (ART)

8)Rotary instruments

Cavity designs for minimal tooth preparation:

According to the new classification based on site,size & severity of lesion,following are the designs –

Pit & fissure sealants;Preventive Resin Restorations (PRR)
Tunnel preparations
Slot preparations

Restorative materials used in minimal invasive dentistry :

Conclusion:

Minimal intervention techniques cause less tooth destruction than conventional techniques,thus increasing the long term survival of teeth ,also cause less discomfort to the patient and ensure healing of the disease not only the symptoms. With a reduction in chair side time and simplified techniques there is lesser chances of exposure of the dentist to aerosol contamination,thus maintaining which is the need of the hour.

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