Invasive Dentistry Research Articles

Visual examination for caries detection

Minimally invasive dentistry (MID) starts with the accurate clinical diagnosis of carious lesions. This enables the practitioner to intervene in the caries process when required and not unnecessarily condemn a tooth to the chronic restorative cycle. The use of the merged-ICDAS system is part of the CariesCare International guide, which consists of a 4D caries management system that is being adapted internationally as part of the MID delivery framework.

Mesoscale structural gradients in human tooth enamel

The outstanding mechanical and chemical properties of dental enamel emerge from its complex hierarchical architecture. An accurate, detailed multiscale model of the structure and composition of enamel is important for understanding lesion formation in tooth decay (dental caries), enamel development (amelogenesis) and associated pathologies (e.g., amelogenesis imperfecta or molar hypomineralization), and minimally invasive dentistry. Although features at length scales smaller than 100 nm (individual crystallites) and greater than 50 µm (multiple rods) are well understood, competing field of view and sampling considerations have hindered exploration of mesoscale features, i.e., at the level of single enamel rods and the interrod enamel (1 to 10 µm). Here, we combine synchrotron X-ray diffraction at submicrometer resolution, analysis of crystallite orientation distribution, and unsupervised machine learning to show that crystallographic parameters differ between rod head and rod tail/interrod enamel. This variation strongly suggests that crystallites in different microarchitectural domains also differ in their composition. Thus, we use a dilute linear model to predict the concentrations of minority ions in hydroxylapatite (Mg2+ and CO32-/Na+) that plausibly explain the observed lattice parameter variations. While differences within samples are highly significant and of similar magnitude, absolute values and the sign of the effect for some crystallographic parameters show interindividual variation that warrants further investigation. By revealing additional complexity at the rod/interrod level of human enamel and leaving open the possibility of modulation across larger length scales, these results inform future investigations into mechanisms governing amelogenesis and introduce another feature to consider when modeling the mechanical and chemical performance of enamel.

Approach to clinical laser application in pediatric dentistry

The modern concept of pediatric dentistry today is based on minimally invasive dentistry. Light amplification by the stimulated emission of radiation or Laser is one of the newest technologies available and is used for dental and oral care. This technology causes patient compliance with treatment to be maximized because the discomfort caused is very minimal. Lasers are an exci-ting technology and make pediatric dental care more optimal without causing many of the fear factors found in conventional dental care. This protocol has been developed long ago so that laser treatment can continue to evolve and is a safe and effective part of treatment. Although it has some disadvantages regarding cost and training, its use in pediatric dental procedures is well received by patients and their parents. Because of this, the use of lasers, especially in pediatric dentistry, is increasingly import-ant and needs to be developed. The American Academy of Pediatric Dentistry (AAPD) states that the use of laser as an alterna-tive method in the treatment of hard and soft tissues in the oral cavity for infants, children, adolescents, and patients with special health care needs, but dentists need additional training to apply it to pediatric dental care.

An Insight into Enamel Resin Infiltrants with Experimental Compositions.

Resin infiltration is a conservative treatment of initial enamel carious lesions. Only one infiltrant material is available on the market (Icon, DMG), and research is now investigating new chemical compositions so as to further exploit the benefits of the resin infiltration technique. A literature search of the articles testing the effects of different formulations on mechanical properties, resin penetration ability, remineralizing, and antibacterial activities was conducted. Of 238 articles, 29 resulted in being eligible for the literature review. The formulations investigated were all different and consisted in the inclusion of hydrophobic monomers (i.e., BisEMA, UDMA), solvents (ethanol, HEMA), alternative etchants (PAM) or molecules with antibacterial or bioactivity features (i.e., AgNP, YbF3, MTZ, chitosan, DMAMM, HAp, MC-IL, NACP, PUA, CHX) and microfilled resins. Information on the long-term performances of the tested experimental materials were scarce. The combination of TEGDMA with hydrophobic monomers and the inclusion of a solvent alternative to ethanol reinforced mechanical properties of the materials. Hybrid-glass materials demonstrated an enhanced remineralization capacity. Techniques such as tunnelization increased the penetration depth and preserved the recourse to less-conservative treatments. Combining the min-invasive infiltrant approach with remineralizing and bacteriostatic properties would be beneficial for therapeutic and economical aspects, according to the principles of minimally invasive dentistry.

EVIDENCE BASED PRACTICE OF MINIMAL INVASIVE DENTISTRY AMONG DENTISTS


 
 
 This study aimed to explore the evidence based practice of minimally invasive dentistry among the dentists in Lahore. This quantitative research study was a cross-sectional survey research conducted on general dentists working in posh areas of Lahore using convenient sampling. 70 dentists were recruited in the study. Majority of the participants (42.90%) reported that caries assessment should be carried out for all patients whereas 15.70% dentists disagree with the statement. 47.10% participants reported that fluoride is an effective way of preventing dental caries. 30% of the dentists always repair defective restorations instead of replacement. In conclusion, the dentists are quite familiar with the evidence based practice of minimal invasive dentistry in Lahore city.
 
 

Successful outcome of surgical reintervention for implant placement in borderline aesthetic area related to agenesis: a case report

The aim of this study is to illustrate and discuss the fundamentals of a well-succeeded and minimally invasive technique of surgical reintervention for installing implant in the reduced area of the alveolus, affected by agenesis, and traumatized by an unsuccessful intervention. Materials and methods: A 27-year-old patient sought dental care and her main cause was the great dissatisfaction with the aesthetic sequelae in the region of the right upper lateral incisor, in addition to the uncertainty regarding the predictability of a new unitary implant. Imaging exams showed trauma in the middle and apical region of the canine root surface. The dimensions of the edentulous area varied between 4.6 and 5.52 mm. A small diameter implant (BLT 2.9mm SC, Loxim SLActive® 12 mm, TiZr - Straumann Dental Implant System) was planned and installed, in addition to a subepithelial connective graft. Results: The results achieved allowed to restore the desired function and aesthetics, with excellence, low morbidity, in addition to a predictability favored by the benefits related to small diameter implants. Conclusions: The concept of minimally invasive dentistry is becoming an effective surgical approach and, although these implants present a higher risk for fracture than do large-diameter implants, implant fractures are rarely observed.

Renewal MI Dental Composite Etch and Seal Properties.

This study’s aim was to assess whether the Renewal MI composite can self-etch enamel, seal sound cavities, and stabilize demineralized dentine. Etching was assessed using scanning electron microscopy (SEM). Cavity sealing was quantified using the ISO-11405 dye microleakage test. Demineralized dentine stabilization was evaluated by visualizing resin tag formation, enzyme activity and mineral precipitation at the adhesion interface. Renewal MI provided a mild etching of sound enamel in comparison with 37% phosphoric acid. It provided a comparable seal of sound cavities to Z250/Scotchbond Universal adhesive and a superior seal to Activa, Fuji IX and Fuji II LC. With demineralized dentine, Renewal MI formed 300–400 µm resin tags covering 63% of the adhesion interface compared with 55 and 39% for Z250/Scotchbond and Activa. Fuji IX and Fuji II LC formed no resin tags. A higher tag percentage correlated with lower surface enzyme activity. Unlike Activa and Fuji II LC, Renewal MI promoted mineral precipitation from simulated body fluid, occluding adjacent dentinal tubules within 6 months. These novel etching and sealing properties may facilitate Renewal MI’s application in minimally invasive dentistry.

Minimally Invasive Dentistry: Step by Step of an Anterior Adhesive Bridge

Fixed Partial Dentures (PPF/FPD) bonded with resin cement are viable alternatives based on the fundamentals of Minimally Invasive Dentistry (MIO). The conservative concept of preserving healthy dental tissue allows planning a minimally invasive restorative approach. Nowadays, remain uncertain how to replace teeth in patients with edentulous spaces that are not suitable for implant placement or with limited economic factors. The current ceramic systems provide greater bond strength to the substrate while offering an optimal aesthetic result. Clinical and laboratory investigations demonstrate the adequate long-term clinical performance of fixed partial dentures bonded with resin cement. The present clinical case will be approached in an even more conservative way, without the unnecessary removal of healthy dental tissue, replacing a tooth with a unitary fixed partial prosthesis in a patient not suitable for the placement of endosseous implants.

Effect of casein phosphopeptide amorphous calcium fluoride phosphate and calcium glycerophosphate on incisors with molar-incisor hypomineralization: Across-over, randomized clinical trial.

Within the scope of minimally invasive dentistry, the use of different biocompatible remineralization agents on incisors affected by molar-incisor hypomineralization (MIH) gains importance. To evaluate the effect of casein phosphopeptide amorphous calcium fluoride phosphate (CPP-ACFP) and calcium glycerophosphate (CaGP) in mineral density (MD) of white/creamy and yellow/brown demarcated opacities on incisors affected by MIH by means laser fluorescence (LF). As a cross-over, randomized trial, twenty-two children with 167 incisors affected by MIH were recruited and randomly assigned to one of the two different agents and crossed over to other agents with two weeks washout in between. Incisors were examined by using LF at all before and after three months periods. The results of the paired t-tests for determining the period effect between the baseline findings showed significant difference in white/creamy and yellow/brown demarcated opacities of LF values for both groups (p <0.05). The difference between both groups according to after categorization of 20% increasing in MD in the percent of change before and after application on LF values; was not found statistically significant in white/creamy (p =0.970) and yellow/brown (p =0.948) opacities. The primary outcome was CPP-ACFP and CaGP had a positive effect in decreasing hypomineralization on MIH-affected enamel for three months period.

The antibacterial effect of nanosilver fluoride in relation to caries activity in primary teeth: a protocol for a randomized controlled clinical trial

BackgroundMinimally invasive dentistry is a highly convenient and efficient method of managing caries in pediatric patients. Silver diamine fluoride (SDF) is commonly used to arrest active caries lesions. However, the associated black stain, possibility of soft tissue injury, and unpleasant taste often limit its use. Recently, nanosilver fluoride (NSF) emerged as a promising topical fluoride agent with potent cariostatic and antibacterial potentials. This novel anticaries agent has gained attention as an alternative to overcome the drawbacks of SDF in caries arrest.ObjectivesTo assess the antibacterial effect of NSF in relation to caries activity in dentin caries lesions, as well as to investigate the change in saliva bacterial levels in primary teeth in comparison to SDF after 1 and 3 months.Materials and methodsFifty children aged 4 to 6 years old with active dentin caries lesions (score 5 according to International Detection and Assessment System (ICDAS II) criteria) will be enrolled in the study. They will be equally and randomly allocated into 2 groups: a group receiving NSF and a control group receiving SDF treatment. Microbiological samples will be collected from the carious lesions and from unstimulated saliva at the baseline and at the 1 and 3 months’ follow-up appointments. Bacterial counts will be assessed using Mitis Salivarius agar (selective culture media for S. mutans) and Rogosa agar (selective culture media for lactobacilli), and the results will be expressed in colony-forming units. Data regarding the children’s oral health will be collected and their dmf index will be scored. The arrest of active carious lesions will be measured at the follow-up appointments according to ICDAS II criteria.ResultsThe relation between bacterial colony counts and lesion activity for both groups will be assessed, as well as the change in salivary bacterial counts. The collected data will be statistically evaluated and tabulated. This clinical trial has been registered on ClinicalTrials.gov in January 2022 (original version) with ID: NCT05221749.

Management of intrinsic discoloration in maxillary incisors with the walking bleach: A case report

In the age of minimally invasive dentistry and increasing aesthetic demands, walking bleach is the most effective and conservative method. Hydrogen peroxide is one of the commonly used bleaching agent. This case report illustrates the walking bleach technique in maxillary incisors with hydrogen peroxide.A 35 years old female reported with discoloured endodontically treated maxillary incisors. Retreatment of maxillary incisors followed by walking bleach was planned. Glass ionomer cement was used as a barrier material. 35% hydrogen peroxide was placed in the pulp chamber with intermediate restorative material. The procedure was repeated after 5 days to achieve the desired results.35% hydrogen peroxide can successfully bleach discolored endodontically treated teeth.Walking bleach technique is an incredibly effective approach for discolored intact non -vital teeth. It is rapid and easy to obtain desired results as well as economical to patients as compared to crowns and veneers.

Resin infiltrant as a treatment of common changes in dental enamel: narrative literature review

Minimally invasive dentistry has been considered the most suitable method of choice in order to prevent and treat changes in the tooth surface, such as the initial caries lesions, characterized as white spot. This type of conduction aims to maintain the tooth structure, as long as there is no sign of cavitation on the surface. Thus, in 2009 a material was created based on monomers and additives denominated resinous infiltrant, which has the function of paralyzing this white spot lesion acting through diffusion, where the material fills the microporosities. The only material commercially available is Icon®, which, despite having numerous benefits, has some limitations. Some studies with experimental material have been developed in order to try to minimize the limitations of commercial material. Therefore, this literature review aims to address the characteristics, function, application and indications of the material, as well as its limitations.

Minimal invasive dentistry

The ideal definition of "Minimal Invasive (MI) Dentistry" is the use of a biological method rather than a typical (surgical) operational dentistry strategy to treat dental caries. When operational dentistry is necessary, it is now done in the most conservative way possible, with the least amount of tooth structure being harmed. This novel method of caries cares shifts the focus from detecting carious lesions as cavities (and a recurring cycle of restorations) to diagnosing the oral ecological imbalance and affecting biological changes in the biofilm. After stopping the disease process, MI aims to restore lost tooth structure and function, while optimizing the tooth's healing capacity. “Caries treatment has evolved from G.V. Black's extension for prevention to minimally intrusive owing to advancements in dental adhesives and restorative materials, increased knowledge of the caries process and remineralization, and changes in the incidence of caries. A decrease in cariogenic bacteria, new classifications of caries based on the location and size of lesion remineralization, and procedures and materials for minimally invasive cavity preparation are some of the topics covered in this book.”

Coronal restoration of endodontically treated posterior teeth

There is still no consensus on the restoration of endodontically treated posterior teeth in the most appropriate way. With the development of adhesive materials with improved properties and a shift in approach towards minimally invasive dentistry, there is a paradigm change in the restorative modalities of root-filled teeth. Conventionally endodontically treated teeth were restored with post and core followed by a crown, but conservative restorative options have gained popularity with the advancements in adhesive techniques. Many studies have been done, but there is a need to re-explore the scholarly literature with the changing trend. This review article provides a brief overview of the literature on the survival of endodontically treated posterior teeth in relation to the type of post endodontic restoration. A literature search of papers related to the survival of endodontically treated teeth and type of post endodontic restorations published till July 2021 was undertaken in PubMed, MEDLINE, SCOPUS, Web of Science and Science direct. A few of the keywords searched were: post endodontic restorations, survival, clinical performance, root canal treated teeth, endodontically treated teeth, success, resin composite, crown, cuspal coverage restoration.

Awareness about minimally invasive dentistry among dental under graduates &amp; Interns: A cross-sectional study

Minimally Invasive Dentistry (MID) is a modern concept that attempt to keep teeth functional for life. It is the management of caries with biological approach rather than traditional surgical approach. It is to leave the traditional GV Black concept of ‘Extension for Prevention’ behind. Now, the present-day principle is ‘Constriction with Conservation’. This has been noticed that the concept of MID is still very unclear to the practicing dentists &amp; even to the undergraduates. To understand the knowledge and awareness of undergraduates about MID a survey is important. The aim of this study is –Firstly, to assess the knowledge about MID technique among the undergraduate students and interns from my dental institution. Secondly, to also investigate whether the knowledge acquired by the students reflects in the form of a positive attitude towards practice of MID principles. A cross-sectional survey involving 50 dental students and interns of my dental institution. The questioner is close ended. The questions are to assess the respondent levels of agreement regarding diagnostic, preventive and minimally invasive restorative techniques. In this study it was found that interns had greater knowledge of MID than final years as they had greater clinical exposure. There is a need to introduce evidence-based dentistry in the dental curriculum as well as establish guidelines for caries detection, diagnosis, treatment discussion &amp; treatment performance.

Comparison of Procedures Performed and Costs between an Outsourced Dental Health Plan with Fee-For-Service Payment and an Evidence-Based, In-House Dental Health Service with Salaried Professionals

Aim: Evaluate the change in terms of levels and mixes of services rendered and costs resulting from the change from an outsourced dental health plan with fee-for-service payment to an in-house health service provided by salaried dentists. Method: We evaluated dental care services provided to almost 4,000 users (employees and their families) of a big company (Moinhos de Vento Hospital, Brazil). The analysis was divided into two periods of time: from January 2000 to December 2002, during which time the dental care provided to employees (and families) was outsourced to a dental plan which operates with an accredited network, and from March 2003 to June 2005, when the dental care was provided by an in-house dental care service with preventive and evidence-based dentistry guidelines. Economic data were collected, as well as the type and number of procedures performed. Results: There was a significant increase in the number of preventive and oral environment adequacy procedures performed by the in-house service in relation to the outsourced dental plan. There also was a significant decrease in the number of restorative procedures with the implementation of the in-house service. Expenses were reduced by 36%, while the number of procedures increased by 30% and customer satisfaction did not decrease with the adoption of the in-house service. Conclusion: An in-house service with evidence-based clinical protocols, as compared with an accredited network, decreased costs and also increased the number of procedures done, changed the profile of care for a less invasive dentistry and one more geared toward the causes of diseases, while still preserving the customers’ satisfaction.

Successful rehabilitation of a child patient with ankyloglossia using the diode laser of wavelength 808 nm and speech therapy

Abstract Ankyloglossia is an abnormal congenital condition of the tongue characterized by abnormal attachment of lingual frenum or shorter lingual frenulum. Although various conventional surgical modalities and lasers for frenectomy has been described in literature, only few articles have been reported in the existing literature regarding the diode laser of 808 nm wavelength for frenectomy procedure in pediatric patient. Hence, the current article describes the clinical case report of successful and effective treatment of ankyloglossia using soft-tissue diode laser of 808 nm wavelength with minimally invasive dentistry approach in a 10-year-old male pediatric patient. In addition, the tongue-tie was clinically evaluated using the Hazelbaker Assessment Tool for Lingual Frenulum Function. Diode lasers can be used as a safe alternative surgical tool for managing tongue-tie with minimally invasive dentistry approach and also for alleviating the dental anxiety in pediatric patients.

MINIMALLY INVASIVE SOLUTIONS FOR THE TREATMENT OF WHITE SPOTTS BY FLUOROSE

Objectives: The proposal of this clinical case report was to show the solutions that generate minimal tooth structure wear on treatment of white spots by dental fluorosis, showing the benefits and limitations by suggesting a minimally invasive dentistry. Case report: Patient 28 year old, women, attended in Integrated Dentistry Clinic of the University Center UNIEURO complaining about the aesthetics of her smile, noticed the presence of uniform white spots in the incisal region of the anterior teeth with notorious opacity. The treatment with Dental Whitening started with home bleaching technique for 1 month, then the Icon® system (DMG, Hamburg, Germany) as recommended by the manufacturer. Conclusion: The results were satisfactory, the techniques were excellent for the resolution of the case, there was an improvement in the aesthetics of the smile, also directly enhancing the self-esteem and self-confidence of the patient in their social life, when smiling and talking.

Diagnosis of Early Dental Caries by Traditional, Contemporary and Developing Imaging Methods

Dental caries is an important problem for human health which is frequently seen under clinical conditions and also progresses slowly, causes severe pain and even tooth loss, and affects the quality of life. Especially in pediatric patients, with the early detection of caries, treatment procedures can be performed with uncomplicated methods. In today's dentistry; preventive applications and minimally invasive approaches are gaining importance, and early diagnosis of initial caries lesions is very important for minimally invasive dentistry. With the development of technology, many new methods are being introduced to ensure the early diagnosis of dental caries. In this review, conventional, contemporary, and developing approaches used in the detection of dental caries will be presented.

Do non-clinical subjective factors influence the treatment decisionmaking of Brazilian dentists?

The literature contains little information on several non-clinical factors such as the association between graduate residency programs and the application of minimally invasive dentistry, or on dentists' clinical decision-making processes for replacing restorations for esthetic reasons. This study evaluated whether non-clinical subjective factors influence the treatment decisions made by Brazilian dentists regarding technical and esthetic matters. Dentists were invited to participate in a cross-sectional survey by answering an electronic questionnaire containing clinical cases, regarding what treatment they would select for: T1 - a molar tooth with significant crown destruction and spontaneous pain, and T2 - premolar teeth with extensive amalgam restorations and no carious lesion or associated complaint. The survey also included questions about subjective variants (sociodemographic and professional). Chi Square test and Fischer's Exact test were used toanalyzetheanswers to T1, and one-factor analysis of variance and post-hoc Tamhane were applied to T2. The significance level was set at 5% for all analyses. A total 302 professionals participated in the study. For T1, it was found that clinical decision-making was influenced by the Brazilian region of clinical practice (p=0.005). For T2, a significant association was found between increased loss of patient tooth tissues and whether the professional had completed a residency program in Operative Dentistry (p=0.035), worked in a private practice (p=0.033), or if most of his/her patients belonged to a high estimated socioeconomic level (household income above $4350) (p=0.002). In conclusion, the clinical decision-making of Brazilian dentists varies according to professional profile, mainly with relation to the replacement of restorations due to esthetic concerns.