IAJPS 2019, 06 (01), 1422-1428 Mohammad M Fairaq et al ISSN 2349-7750

CODEN [USA]: IAJPBB ISSN: 2349-7750

INDO AMERICAN JOURNAL OF

PHARMACEUTICAL SCIENCES
http://doi.org/10.5281/zenodo.2545634

Available online at: http://www.iajps.com Review Article

MINIMALLY INVASIVE DENTISTRY

1Mohammad M Fairaq, 2Khadija M Naghi, 3Ehab N Alshouibi
1
Ministry of Health
Abstract:
Introduction: Dental profession recognizes that artificial restoration is of less biological value than the original
healthy tissue. This theory proposes the need for minimally invasive dentistry. It acts on the principle of tissue
preservation, preventing the disease from occurring at early stages and intercepting its progress by removing only
affected diseased tissue and normal healthy tissue as minimal as possible. Introduction of adhesive technologies has
led to a giant leap in minimally adhesive dentistry.
The aim of work: The review aims to understand the concept of the minimal intervention of dental disease and other
oral health related problems such as dental caries, diagnosis, risk assessment, prevention, and control.
Methodology: The review is comprehensive research of PUBMED from the year 1951 to 2013.
Conclusion: The practice of managing dental disease most efficiently has evolved in the recent era. The traditional
practices taught in dental school have all developed and changed. Minimally invasive dentistry is an requires
certain skill set of the clinician to be appreciated by patients as their attitude have also changed regarding modern
dental care and desired outcome of dental treatment. Hence it must be understood that traditional techniques and
process of preparing and filling cavity shapes does not cure dental caries and another dental disease rather the cure
is control of origin of caries and prevention in long-term.
Keywords: Minimum intervention, minimally invasive dentistry (MID), caries, risk assessment, prevention, tooth
preservation.
Corresponding author:
Mohammad M Fairaq, QR code
Ministry of Health.

Please cite this article in press Mohammad M Fairaq et al., Minimally Invasive Dentistry ., Indo Am. J. P. Sci,
2019; 06(01).

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 IAJPS 2019, 06 (01), 1422-1428 Mohammad M Fairaq et al ISSN 2349-7750

INTRODUCTION: progression and introduction of newer adhesive

HISTORY: materials. Non-cavitated and demineralized enamel
The concept of minimally invasive treatment in and dentin, which was earlier treated with surgical
dentistry was pioneered in the early 1970s with the method along with ‘extension for prevention’
application of silver fluoride followed by preventive proposed by Black are no more followed. [7]
resin restoration (PRR) in 1978, atraumatic
restorative treatment (ART) in 1980s and chemo- GOALS OF MINIMAL INTERVENTION
mechanics method of caries removal in 1990s.[1-5] DENTISTRY:

Martin et al. coined the term ‘minimally invasive,’ 1. Caries prevention.

‘minimal intervention’ or ‘preservative dentistry’ 2. Cariogenic bacteria reduction.
which was earlier termed as ‘prophylactic odontomy’ 3. Minimal surgical intervention of cavitated
in 2000. MID can be defined as “a philosophy of lesion.
professional care concerned with first occurrence, 4. Remineralization of early lesions.
earliest possible cure of disease on micro (molecular) 5. Repair rather than replacement of defective
levels, followed by minimally invasive & patient- restoration.
friendly treatment to repair irreversible damage
caused by such disease” [6] The ultraconservative treatment concept in MID is
applied to preserve the tooth structure as much as
This new concept of MID evolved as a result of possible and offer more patient-friendly treatment to
increased understanding of carious process fearful patients. The goal is ‘prevention of extension’
prevention regarding the occurrence, inhibition of its rather than ‘extension for prevention.’ The
ultraconservative treatment includes.

• Minimum Intervention Dentistry

• Prevention and control

• Minimally Invasive treatment (ART,LASERS)

• Sono abrasion ( Chemo-mechanical agents)
• Air Abrasion

DISEASE RISK ASSESSMENT, EARLY to infrared laser fluorescence, and light-induced

CARIES DIAGNOSIS, AND PREVENTION: fluorescence devices which are not significantly
reliable for assessing carious lesion in pits and
The goal of minimal intervention is stopped disease fissures of occlusal surfaces. [13]
first and restore the lost. Caries risk assessment is
defined as the ‘probability of future caries disease The goal of a caries prevention program is to reduce
development.’ It includes both the new and the cariogenic bacteria. The first step to prevention is
progressive carious lesion. The assessment can be consideration of overall resistance of patients to
best done by visual appearance, tactile sensation, infection by cariogenic bacteria. Although other
location, and gingival health. [8-10] Caries risk factors such as fluoride exposure, the function of the
prediction is still a work-in-progress. One of the most immune system and salivary glands may have a
common tools used worldwide by clinicians is certain impact on risk, the patient has little control
‘Cariogram.’ It demonstrates the chance to avoid new over these factors.[14] In contrast, the patient is
carious lesion development shortly and what various capable of controlling factors such as diet, oral
factors will affect this chance. [11] hygiene, use of antimicrobial agents and dental care
— preventive treatment limits tooth demineralization
The oldest method of diagnosis of a carious lesion is caused by cariogenic bacteria, hence preventing
probing and radiographs. In recent times Fiber-Optic cavitated lesions.
Trans-Illumination (FOTI) has become a reliable
device for detecting approximal caries [12] compare

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These mainly include: This approach was pioneered in Tanzania in the

1980s as part of the primary oral health program.
• Limiting pathogen growth and metabolism The technique of caries removal using hand
• Increasing the resistance of tooth surface to instruments only with combined use of modern
demineralization restorative material with adhesive characteristics.
Recently GIC with fluoride release that reduces
The enamel and dentin demineralization is not a the onset of secondary caries is used.
dynamic, irreversible process. But in series of
demineralization and remineralization cycles, the • Rotary – High/low-speed bur
tooth loses and gains calcium and phosphate ions
alternately, depending on the microenvironment. • Sonic oscillation –SONICSYS micro [15]
Fluoride uptake enhances the calcium and phosphate Sono-Abrasion is the use of high-frequency
ions and forms fluoroapatite which demineralizes at sonic air scalers with modified abrasive tips
pH less than 4.5, making it more resistant to which describe elliptical motion with the
demineralization. In a noncavitated lesion, the transverse distance between 0.08 and 0.15mm
approach to remineralization includes: and longitudinal movement between 0.055 to
0.135mm. 40 μm grit diamond is coated on one
• Decreasing the frequency of intake of side and uses water irrigant at a flow of 20-
refined carbohydrates 30ml/min as a coolant.
• Ensuring optimum plaque control
• Ensuring optimum salivary flow 2. Chemomechanical (Carisolv) [17]
• Conducting patient education. The chemomechanical methods involve
softening of dentin by chemical agent application
Chlorhexidine and topical fluorides can be applied to which further can be excavated gently using
encourage remineralization. Chlorhexidine acts by spoon excavator. N-Monochloraminoacids are
reducing the number of cariogenic bacteria while formed when amino acids are mixed with NaOCl
topical fluorides increase the availability of fluoride which selectively degrade demineralized
ion for remineralization and the formation of collagen in carious dentine. The approximate
fluoroapatite. [6] time for this 10-15min later restored with
composite resin or GIC. The technique is
MINIMALLY INVASIVE PREPARATION advantageous for dental phobics, medically
TECHNIQUES: compromised patients and children.
A wide variety of clinical application is shown by
3. Kinetic ( Air abrasion)[18]
different preparation technologies, but each technique
This technique involves the use of alumina
has significant potential and is used in the now recent
particles in a high-velocity stream of air to
era of dentistry. [15] Following techniques are used :
remove tooth structure as conservative as
1. Mechanical possible and is mostly restored with bonded resin
• Atraumatic restorative treatment – ART[16] materials.

Figure (1) showing minimal pit and fissure caries (2) Conservative cavity preparation using air abrasion (3)
Prepared Cavity.[19]

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4. Hydrokinetic (Laser- CO2, Er: YAG, Nd: • Erbium: Yttrium-aluminum-garnet (YAG) and
YAG, etc.) [20] neodymium: YAG – Mid-infrared (IR) to IR
LASERS are new technology produce emission
beams of coherent and very intensity light. • CO2 laser – IR emission
LASERS have been used in various • Excimer lasers (ArF [Argon: Freon] and XeCl
treatment soft and hard tissue in dentistry. [Xenon: Chlorine]) UV emission
Factors LASERS efficiency depends on • Holmium lasers
various factors such as wavelength, pulse • Dye-enhanced laser ablation – exogenous dye,
energy, optical properties of incident tissue. indocyanine green in conjunction with a diode
Most commonly used hard tissue ablation laser.
includes

Figure showing portion of electromagnetic spectrum showing dental laser wavelengths being used for treatment.[21]

• Removal of infected tooth structure,

incapable of regeneration.
5. Ozone Technology (O3) [22] • Gaining access to the body of the lesion
Ozone therapy uses energized form of without being destructive
oxygen and is new treatment modality being • Avoiding exposure to sound unaffected
introduced as an alternative to local dentine
anesthesia and management of dental caries. • Reducing restoration perimeter
Ozone is one of the most powerful oxidants,
• Retaining and reinforcing sound, but
able to kill bacteria, spores, and viruses.
undermined enamel
Primary lesion, when exposed to ozone,
• Keeping restoration margin away from the
becomes sterile and remineralize after some
gingiva
time. Thus, it is a radical approach to
• Reducing occlusal stress on final restoration
remove acidophilic microorganisms in
dental caries. The Designs for cavity preparation are as follow:
1. Tunnel preparation
2. Microchip cavity preparation
Cavity Designs for Minimal Intervention [23]:
3. Minibox cavity preparation
Basic cavity design principles are as follow:
4. Full box cavity preparation

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(A) (B) (C)

Figure (A) showing Microchip and Minibox cavity design (B) Tunnel Preparation (C)Full box cavity. [23]

Treatment Plan of MID [24]:

IDENTIFY

Oral Examination Visual caries detection Investigatory x-ray bite wing

Aetiology factors for

Anamnesis susceptibility

Diagnosis: Establish patient susceptibility

PREVENT

Treatment Plan

Irreversible/cavitated Reversible/non-caviated No lesion

lesion lesion

Susceptibility- high or low

Preventive active care Preventive active

Preventive active care
care/standard
care/maintenance

RESTORE

MI- invasive treatment MI- non invasive treatment

RECALL

Recall

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CONCLUSION: epidemiology, 26(6), 361-371.

The philosophy of minimum intervention of oral
healthcare is not only dependant on 10. Harris R, Nicoll A D, Adair P M, & Pine C M
materials/techniques used but on effective patient- (2004). Risk factors for dental caries in young
centered disease prevention and tooth preservation as children: a systematic review of the literature.
well. Thus an astute dentist must apply the concept of Community dental health, 21(1), 71-85.
MID for conservative management of dental caries
and offer patients a friendlier and health-oriented 11. Bratthal D, Petersson G H, & Stjernswärd J
treatment option. R (2004). Cariogram manual internet version.

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