Minimally Invasive Dentistry

Question 1

Restorative Renovation - The 5 R’s

Answer 1

1. Review.
2. Refurbish.
3. Re-seal.
4. Repair.
5. Replace.

Question 2

Review

Answer 2

• Monitor the tooth and review it later on.

- Can be monitored with radiographs and photographs.

Question 3

Refurbish

Answer 3

• Removal of excess.
• Reshaping.
• Polishing.

Question 4

Re-seal

Answer 4

The application of a sealant in a non-carious marginal gap.

Question 5

Repair

Answer 5

• Removal of part of the restoration.
• Removal of the localised defect.
• Restoration of the defect.

Question 6

Replace

Answer 6

• Removal of the entire restoration.

- Restoration of the tooth.

Question 7

Detection definition

Answer 7

Determining whether or not disease is present.

Question 8

How to diagnose

Answer 8

• Visual examination - very important for monitoring occlusal surfaces and early diagnosis.
• Pain or sensitivity to hot/cold/sweet often occurs later once the lesion has cavitated, because insulation has been lost.

Question 9

Clinicians role

Answer 9

• Assess patients caries risk.
• Employ non-operative preventative care protocols.
• Master early detection and diagnostic methods.
• Choose a minimally invasive adhesive restoration carefully.

Question 10

Pits and fissures anatomy

Answer 10

• Lined with aprismatic or amorphous enamel.
• Enamel prisms.
• Difficult to clean so promotes the adherence of bacterial plaque biofilm.
• Penetration and adhesion of sealant materials difficult.

Question 11

Pathology of occlusal carious lesions

Answer 11

• Pits and fissures acquire a pellicle, which is formed by the absorption of salivary proteins.
• This creates a base substrate for further bacterial attachment and the formation of plaque biofilm.
• Remains undisturbed by toothbrushing in pits and fissures.
• Unrefined carbohydrates infuse for bacterial nutrition.
• Demineralisation occurs on base or walls of fissure.
• Clinically undetectable from visual examination alone.
• May be arrested by biochemical remineralisation.
• If lesion progresses into dentine, it spreads laterally, underneath the EDJ and towards the pulp.

Question 12

Visible changes

Answer 12

• White spot lesion detectable when air drying.

- Matte.

Question 13

Fluoride and occlusal caries

Answer 13

• Reduces the rate of demineralisation on tooth surfaces, but is least effective in pits and fissures.
• Strong, well-fluoridated enamel is more resistant to fractures.
• This can allow lesions to extend into dentine and towards the pulp without symptoms (hidden caries).

Question 14

Risk assessment

Answer 14

• Verbal history.
• Examination.
• High medium or low.
• Patients must be informed of their risk and their need for co-operation.

Question 15

Risk assessment factors

Answer 15

• Social history.
• Medical history.
• Caries history.
• Restorative history.
• Dietary habits.
• Plaque control.
• Saliva (flow rate, buffering capacity, composition).
• Detection of existing carious lesions,

Question 16

ICDAS visual assessment protocol

Answer 16

• Remove appliances.
• Remove plaque.
• Remove stain with prophylaxis.
• Isolate with cotton wool rolls.
• Remove excess saliva.
• Examine visually.
• Air dry for 5 seconds.
• Examine visually again.

Question 17

High risk category

Answer 17

• New lesions or progression of an existing one will put the patient in the high-risk category.

Question 18

What should be noted before removal?

Answer 18

• Plaque biofilm.

- Because it is the primary risk factor for the development and progression of carious lesions.

Question 19

Radiography for detection

Answer 19

• Important for the early detection of class ll carious lesions.
• Occlusal caries rarely visible until there is significant dentine demineralisation.
• Lesions that are visible, but undetectable on a radiograph are better treated with MI techniques.
• Radiographically obvious dentine lesions are considered to be active.

Question 20

Routine bitewings

Answer 20

• 2 yearly, or determined for individual patient risk.

- Reduces the risk of undiagnosed active dentine lesions.