Minmal Invasive Dentistry Pedo

•MINIMALLY
INVASIVE
DENTISTRY
www.FourthMolar.com 1
AIM
•Minimum number
of interventions
with maximum
reduction in
disease activity.
OBJECTIVES
1)Remineralisation of early lesion
2)Alterning the cariogenic
envoirment of mouth
3)Minimal surgical intervention of
cavitated lesions
4)Repair rather than replacement
of fractured restoration
acApproaching Procedyre
pproaching MINIMALLY INVASIVE
MINIMALLY INVASIVE
rocedures hing MINIMALLY INVASIVE Pro
•MI CARIES
PREVENTION &
CONTROL
XYLITOL REFRESING CHEWING GUMS
Effective in plaque control.
Removal of plaque on lingual and occlusal surface of
posterior teeth.
Remove stain & whiten the teeth.
COMPOSITION OF XYLITOL CHEWING GUMS AND ADDITIVES:-


Alpha tri calcium phosphate
Amorphous calcium phosphate
Eucalyptus
Chlorhexidine + Xylitol.
Kcl.
Pycogenol
Sodium bi-carbonate
PITS AND FISSURE SEALANTS
These are the resin based fluid material
which when applied fill up all the
pits,grooves& fissures and render the
passage of food particles in these areas
impossible.
Age range of sealant applicaton:-

3-4 Yr Primary Molars
6-7 Yr 1sstt Permanent molar
11-13 Yr 2nndd Permanent molar & Premolars
Cleaning
Washing And drying
Etching
Washing And Drying

Aplication of Material
Curing
CHLORHEXIDINE
Anti-bacterial(Broad
Anti-bacterial(Broad spectrum,full
spectrum,full
mouth
mouth disinfectant)
disinfectant)
Decrease
Decrease bacterial
bacterial growth
growth to
to zero
zero
after
after 21
21 days(Decrease
days(Decrease S.Mutans
S.Mutans
count)
count)
Efficient in plaque control
Action of CHX

•REMINERALIZATI
ON
CPP-ACP CONCEPT
CPP
CPP == Casein-phospho-peptide
Casein-phospho-peptide
ACP
ACP == Amorphous
Amorphous calcium
calcium phosphate
phosphate
Supplement
Supplement (e.g.
(e.g. for
for chewing
chewing gum,
gum, mouth
mouth wash,
wash,
tooth
tooth paste)
paste) to
to replenish
replenish mineral
mineral loss,
loss, due
due to
to
acidic
acidic environments
environments (plaque,
(plaque, bacteria:
bacteria: S.mutans)
S.mutans) ==
REMINERALIZATION
REMINERALIZATION
Remineralization
Remineralization effect
effect of
of 0.5
0.5 -- 1.0%
1.0% CPP-ACP
CPP-ACP solution,
solution,
equivalent
equivalent to
to 500
500 ppm
ppm of
of Fluoride
Fluoride
FLOURIDE AS
REMINERALIZING AGENT
APPLIED
APPLIED IN
IN THE
THE FORM
FORM OF
OF::
Wall
Wall Fluoridation
Fluoridation
Dietary
Dietary Supplement
Supplement
Topical
Topical Fluoride
Fluoride
Fluoride
Fluoride dentrifices,
dentrifices,
Mouth
Mouth rinses
rinses &
& Home
Home fluoride
fluoride gel
gel
FF AS
AS ANTI-PLAQUE
ANTI-PLAQUE AGENT:
AGENT: Stannous
Stannous FF destroys
destroys the
the MS
MS
group
group of
of bacteria
bacteria
DIFFERENT
DIFFERENT TYPES
TYPES OF
OF
FLUORIDE
FLUORIDE SALTS:
SALTS:
Stannous
Stannous FF
NaF
NaF
Acidulated
Acidulated phosphate
phosphate fluoride
fluoride
THERAPEUTIC FILLING
MATERIAL
GLASS
GLASS IONOMER
IONOMER CEMENT
CEMENT
Restrict
Restrict substrate
substrate supply
supply toto bacteria
bacteria by
by forming
forming chemical
chemical
bonds
bonds with
with cavity
cavity walls
walls
Forms
Forms aa hypermineralized
hypermineralized layer
layer
Increase
Increase the
the pH
pH acidic
acidic environment
environment caused
caused by
by lactic
lactic acid
acid
Resin
Resin modified
modified GIC
GIC less
less retention
retention of
of microorganisms
microorganisms
Continous
Continous release
release of
of FF -Anti-cariogenic
-Anti-cariogenic effect
effect
MI CARIES
DETECTION
CARIES DETECTING DYES
Acid red
Basic fuchsin
Carbolan green
Coomassie blue
Lissamin blue
Providone iodine
Caries detector dye (1% acid red in
propylene glycol), stain 'infected' tissue red
QUANTITATIVE LIGHT INDUCED
FLUORESCENCE
LASER FLUORESCENCE
INDICATIONS
Early carious lesion without visible cavitation (Size
0) class 0 size lesions.
Use for detection of early hypomineralised,
non-cavitated lesions.
ADVANTAGES
High reproducibility of measurements on occlusal
and buccal tooth surfaces
High rate of disease detection
DIAGNOdent
DIAGNOdent detects areas of
bacteria that cause decay, and
gives us an idea of how much
decay is present.
Use mainly in cases of O3

Exposure
Diagnostic Exposure Time
value
0-19 20-40 sec.
20-24 20-40 sec.
25-29 30-40 sec.
>40 >60 sec. +trad.

Dental care
MAGNIFICATION:
Correct and appropriate magnification
will enhanced quality and comfort.
To be used during MI diagnosis &
treatment using hand instruments.
Assist in maintaining correct working
distance
Binocular Telescope
Binocular Loopes
MINIMALLY INVASIVE
TREATMENT
AIR ABRASION TECHNIQUE
Concept:-Direct high speed
particles of Aluminium oxide through
compressed air or gas on to tooth
surface,generating abrasion
•
Clinical indications:-
Togain cavity access in situations were hand
instruments are not appropriate (preferable to drilling)
For marginal repair of Glass Ionomer or Composite
restorations, as well as for minimal invasive stain removal on
teeth.
AIR ABRASION UNIT
AIR ABRASION
EXPOSURE
Advantages
Less removal of sound tooth
tissue
Resulting cavities small, suitable
for adhesive restorations
More patient friendly: Less
pressure, heat, vibration, sound
Less need for local anaestethic
injections
Less adverse patient reaction
observed
Powder: free from viable micro-
ATRAUMATIC RESTORATION
TECHNIQUE
• BASED
BASED ON
ON THREE
THREE PRINCIPLE
PRINCIPLE
SLELECTIVE CARIES REMOVAL

THERAPEUTIC RESTORATIVE MATERIAL
SEALED RESTORATION
ADVANTAGES
less iatrogen damage.
less risk of removing sound tooth tissue
It is less time intensive Save tooth
structure and increased longevity of the
restoration at a low cost.
TUNNEL RESTORATION
To excavate proximal caries.

Marginal ridge left intact.
SLOT
SLOT PREPARATION
PREPARATION
(MINIBOX RESTORATION) ((SITE2,SIZE1
(MINIBOX RESTORATION) SITE2,SIZE1 )
When the lesion is <2.5mm below
the crest of marginal ridge.
Removing only that tooth structure
that has broken down beyond the
possibility of remineralisation.
Contact with adjacent tooth should
not be lost.
PRE-OPERATIVE
POST-OPERATIVE
LASER TREATMENT
-
UV LASERS-
Efficient drilling
No generation of heat
KEY HOLE
ADVANTAGES
ADVANTAGES
remove caries safely and effectively
minimal damage to surrounding tissue
minimal thermal changes to dental
hard tissue
SELECTIVE
SELECTIVE CARIES
CARIES REMOVEL
REMOVEL
MECHANICAL CHEMO-MECHANICAL
Use of spoon excavator Chemical

softening followed
Followed by filling with by mechanical
therapeutic filling material removel
Chemical used:-
SODIUM
HYPOCHLORITE
ACTION
ACTION OF
OF SODIUM
SODIUM
HYPO-
HYPO- CHLORITE
CHLORITE
DIAMMINE SILVER
• FLOURIDE SYSTEM
(Ag(NH3)2F)
DIAMMINE SILVER FLOURIDE
SYSTEM (Ag(NH3)2F)
Ag+ causes coagulation of bacterial
enzymes(collegenase,trypsinase)-denaturation
of collegen is prevented
Ag+ +PROTEIN =Ag+protein(coagulation
product)
F- (Fluoride) assists in the remineralisation of

affected dentine
– Advantages
Killing of caries causing bacteria

bacteria in cavity
Instant caries arrest
No need forfor drilling or injections, especially
especially suitable
suitable
for
for deciduous
deciduous teeth, treatment of children and adult
patients
patients with
with dental fears
Good patient compliance
• Clinical effects/indication
Prevention of pit and fissure caries
Desensitization of hypersensitive dentine
Caries arrest
OZONE THERAPY
CLOSED SYSTEM UNIT
Portable Chair
Unit
Air Pump
Ozone
Generator(615cc/
min)
Hand Piece
with silicon Cups
OZONE EXPOSURE
Silicon Cusp Air tied fit over the tooth
surface
Generation of Ozone(2200ppm)
Application of ozone
Recall patient after 3months -Sealing or

restoring cavity if required for cosmetic
reasons
Ozone Exposure
CSI CLASS 1 Caries lesion Size 2,3,4 40 sec ozone
cavitation into exposure
dentin
CSI CLASS 2 Cavitated Size 1,2 30 sec
caries lesion
and dention
involvement
CSI CLASS 3 Caries lession Size 0 20 sec

with no
cavitation
CSI CLASS 4 Arrested 10 sec
lesions www.FourthMolar.com 58
Disrupts intregity Toxic to
Of bacterial cell cariogenic
Oxidize wall microflora
Plaque in
arteries
WBC
Reduce MODE OF ACTION producti
nutrien
on
t
availabi
lity
O2 & Hb
dissociation
Inhibit tumour Denatured acid
metabolism metabolites of
bacteria
Reduction of colony Forming Units
Reduction of furthur Demeneralization
Caries Arrest & promotion of rapid

remineralization
THINK
THINK TWICE
TWICE BEFORE
BEFORE YOU
YOU
LIFT
LIFT YOUR
YOUR HANDPIECE,
HANDPIECE,
CUTTING
CUTTING EDGE
EDGE IS
IS NOT
NOT AA
DENTAL
DENTAL BUR
BUR!!

Minmal Invasive Dentistry Pedo

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•MINIMALLY

COMPOSITION OF XYLITOL CHEWING GUMS AND ADDITIVES:-

Age range of sealant applicaton:-

Washing And drying

Washing And Drying

Use mainly in cases of O3

20-24 20-40 sec.

25-29 30-40 sec.

>40 >60 sec. +trad.

SLELECTIVE CARIES REMOVAL

To excavate proximal caries.

Use of spoon excavator Chemical

F- (Fluoride) assists in the remineralisation of

Killing of caries causing bacteria

Recall patient after 3months -Sealing or

CSI CLASS 3 Caries lession Size 0 20 sec

Reduction of furthur Demeneralization

Caries Arrest & promotion of rapid

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