Minimally Invasive Dentistry

The Editors Aylin Baysan, BDS MSc PhD MFDS RCSEd SFHEA MEndo RCSEd FDTFEd FDS RCSEng, is a Clinical Reader in Cariology in relation to Minimally Invasive Dentistry at Queen Mary University of London, UK. Paul Anderson, BSc, PhD, is Professor of Oral Biology at Queen Mary University of London, UK.

• List of Contributors ixForeword xiPreface xiiiAbout the Companion Website xiv1 Introduction to Minimally Invasive Dentistry: History of Minimally Invasive Dentistry and Key Concepts 1Aylin Baysan and Kenneth EatonKey Topics 1Learning Objectives 1Introduction 1The Epidemiology of Dental Caries Worldwide 2The Epidemiology of Periodontitis Worldwide 4The Epidemiology of Tooth Wear 5The Epidemiology of Tooth Loss 5The Concept of Minimally Invasive Dentistry (MID) 7Principles of Minimally Invasive Dentistry (MID) with Advantages and Disadvantages 7The History of Minimally Invasive Dentistry (MID) 82 Where Are We with the Evidence for Minimally Invasive Dentistry? 11Derek Richards and Valeria MarinhoKey Topics 11Learning Objectives 11Introduction 11Clinical Experiences and Patient Values 12Evidence 12Clinical Experience 13Patients Values 13The Evidence-based Approach 13Asking Answerable Questions 14Searching for the Best Evidence 14Evidence-based Computerised Decision Support Systems 15Evidence-based Guidelines 15Systematic Reviews 15Individual Studies 16Critical Appraisal 16Applying the Evidence 17Evaluating the Outcome 17High Quality Evidence in Relation to MID 17Cochrane Reviews on the Effects of Minimal Intervention Approaches in Caries Management 18The Main Findings/Conclusions from Each Review Were 19Cochrane Reviews on the Effects of Other MID Approaches (Consequences of Dental Caries) 213 Molecular Dentistry: Role of Salivary Proteins in Dental Hard Tissue Protection 25Paul AndersonKey Topics 25Learning Objectives 25Introduction 25Protein Control of Enamel Formation 26The Inorganic Chemistry of Dental Hard Tissue Mineral Loss 27The Role of the Organic Proteins of Saliva in Enamel Mineral Preservation 30Biomineralisation and Bio-demineralisation/remineralisation 31The Potential Roles of Protein Engineered Salivas in Minimally Invasive Dentistry 32Overall Conclusion 334 Dental Caries Risk Assessment and Early Caries Detection 35Bennett T. AmaechiKey Topics 35Learning Objectives 35Introduction 35What Is Caries Risk Assessment and Its Benefits? 37The Components and Uses of Caries Risk Assessment Tools 38The Caries Risk Likelihood Matrix 45Identification of Factors Predictive of Risk 46Caries Detection, Activity Assessment, Staging, and Diagnosis in Caries Risk Assessment 47Visual Caries Detection 47Detecting Early Lesions on Buccal, Lingual and Root Surfaces 49Detecting Early Caries in Pits and Fissures on Tooth Surface 51Detecting Lesions on Tooth Proximal Surfaces 52Detecting Early Caries around Restorations 53Assessing Caries Lesion Activity 53Staging of the Caries Process 54Radiographic Detection of Early Caries 56Diagnosis of Dental Caries 57Clinical Application of Caries Risk Assessment 575 Management of Dental Caries: Minimally Invasive Dentistry vs. Conventional Strategies 65John FeatherstoneKey Topics 65Learning Objectives 65Introduction 65Clinical Challenges to Manage Dental Caries 66Caries Risk Assessment and the Process 67Disease Indicators 68Biological and Environmental Risk Factors 70Protective Factors 70Determining the Caries Risk as Low, Moderate, High, or Extreme 71Levels of Chemical Therapy Needed According to the Caries Risk Assessment 71Low Caries Risk Chemical Therapy 72Moderate Caries Risk Chemical Therapy 72High Caries Risk Chemical Therapy 72Extreme Caries Risk Chemical Therapy 73Anticaries Agents and Delivery Systems 73Bioactive Materials and the Future 74When to Consider Conventional Treatment in High Risk Patients? 746 Intraoral Vaccine and Their Potential Clinical Use 77Lesley Ann BergmeierKey Topics 77Learning Objectives 77Introduction 77A Brief History of Vaccination 78Principals of Vaccination 78Types of Vaccine Preparations 80Immunisation 83The Structure and Function of the Oral Cavity 84Immune Responses in the Oral Cavity 85Inflammation and the Immune Response: Defending the Barricades 85Inductive and Effector Sites in the Oral Cavity 88Mucosal Immunisation and Oral Tolerance 89Oral Diseases and Vaccination 89Dental Caries 90Periodontal Disease 91Behçet’s Disease (BD) 92Sublingual and Buccal Vaccine Delivery 92'Biologics'-passive Immunotherapy with Monoclonal Antibodies 93Cancer 957 Can Minimally Invasive Strategies Be Applicable in Restorative Dentistry? 101Sevil Gurgan, Zeynep Bilge Kutuk, and Aylin BaysanKey Topics 101Learning Objectives 101Introduction 101Evolution of Minimally Invasive (MI) Strategies in Restorative Dentistry 102mi Operative Management Strategies in Anterior and Posterior Dentition 103mi Management of Early Carious Lesions 103Fissure Sealants 103Preventive Resin Restoration (PRR) 104Resin Infiltration Technique 104mi Restorations in Non-Carious Cervical Lesions 105mi Management for Deep Carious Lesions 105Remineralisation of Demineralised Dentine 105Cavity Design and Principles for MID 106Appropriate Excavation Methods 106mi Restorations in Posterior Teeth 107mi Restorations in The “Aesthetic Zone” 107"No-Prep" Adhesive Restorations: Another Way to Deal with Problems Related to Aesthetics 108Management of Tooth Discoloration with MI Approach 108Tooth Whitening/Bleaching 108Management of Tooth Wear with MI Approaches 111Tooth Loss and MI Restorative Approaches 113An Alternative Replacement Approach to Tooth Loss: Resin Bonded Bridges 113Repair of Defective Restorations 1158 Dental Materials and Their Clinical Implications in Minimally Invasive Dentistry 123Saroash Shahid and Robert HillKey Topics 123Learning Objectives 123Introduction 123Glass Ionomer Cements and the Atraumatic Restorative Treatment (ART) 124Bioactive Dental Composites 126Cention N 126Activa Bioactive 127Bioactive Glass as Remineralizing Agent 127Original Studies by Hench and Spilman on Incorporating Fluoride 129New Fluoride- Containing Bioactive Glasses 129Sol=Gel Fluoride- Containing Bioactive Glasses 130Chloride- Containing Bioactive Glasses 131Incorporating Bioactive Glasses into Resin Matrices 1319 Where Are We with a Minimally Invasive Approach in Periodontology? 141David Gillam, Nik Pandya, and Wendy TurnerKey Topics 141Learning Objectives 141Introduction 141Changing Concepts: Dynamic Paradigm Shifts in Dentistry and in Periodontology 142Non-surgical and Surgical Procedures in Periodontology 143Non-surgical Procedures 144Surgical Procedures in Minimally Invasive Periodontal Surgery (mips/mist) 146Advantages of Minimally Invasive Periodontal Surgery 146Disadvantages of Minimally Invasive Periodontal Surgery 147Example of Applying the Principles of Minimal Invasive Periodontal Surgery in a Periodontal Practice 148Relevant Medical and Dental History 148Clinical Examination 148Main Complaint 149Surgical Procedure 149Post-operative Instructions 150Patient Outcomes 151Post Script 152Concluding Remarks 15210 Pulp and Endodonic Regeneration 158Alastair J. SloanKey Topics 158Learning Objectives 158Introduction 158The Dentin-Pulp Complex 159Dental Pulp Stem Cells and Regeneration of the Dentine-Pulp Complex 161Vital Pulp Therapy 163Regenerative Endodontics 16511 Minimally Invasive Dentistry in Paediatric Dentistry 173Paul Ashley and Ferranti WongKey Topics 173Learning Objectives 173Introduction 173Differences between Primary and Permanent Teeth and How This Will Influence the MI Approach 174Eruption and Exfoliation 174Thinner Enamel and Dentine 175Pulp Chamber and Canals 175Dental Materials for Primary Teeth 176Differences between Treating Children and Adults and How This Will Influence the MI Approach 177Managing Behaviour 177Health Promotion for Children 177mi Therapies for Children 178Silver Diamine Fluoride 178Sealing in Caries 178Atraumatic Restorative Technique 18012 Minimally Invasive Dentistry in Orthodontics 182Tarek EL-BialyKey Topics 182Learning Objectives 182Introduction 182New Technologies in Orthodontics (Diagnosis and Treatment Options) 183How New Technologies in Orthodontics Help Achieving Minimally Invasive Orthodontics 185Anchorage 186Dentofacial Orthopedics 186Accelerated Tooth Movement 187Summary 187References 188Index 190