콘스아시아 학술대회 : 치과 예방치료관련 강연 : MI 최소침습치료

David Manton Professor
Faculty of Medicine, Dentistry & Health Sciences
The University of Melbourne
Australia

Dental Caries – The New Paradigms

Dental caries, a behaviourally and genetically influenced bacterial disease moderated by individual characteristics, is one of the world’s most prevalent primarily preventable conditions. In many communities worldwide, a large proportion of children are still severely affected by dental caries. In the past 50 years, the prevention of dental caries has concentrated on the delivery of fluoride, whether it be via reticulated water, toothpaste or professionally applied products such as varnishes. Despite still being the ‘gold standard’ for prevention, the action of fluoride is limited somewhat by the concentration of bioavailable calcium and phosphate. Several products containing or having the ability to stabilize calcium and phosphate are now available commercially. Surprisingly, the primary cause of dental caries – a cariogenic diet, has often been ignored or barely mentioned, as modifying the diet involves behaviour modification, a difficult proposition in many people. In some individuals, modification of the risk factors is unlikely or not possible, so other methods, such as low viscosity resin infiltration of early carious lesions, become the most appropriate intervention.

 

Niek Opdam Professor
Dentistry
Radboud University Medical Centre
Netherlands

Severe Tooth Wear, When and How to Restore?

Rehabilitation of patients with severe tooth wear presents problems for the dentist, as restorative protocols are complicated and extensive, including raising the bite in increased vertical dimension of occlusion. Especially for this ‘high risk’ group of patients, showing bruxism and erosion, prognosis of these rehabilitations is likely to be limited due to recurrent wear and fracture of the restorations.
Therefore, for these patients with reduced dental tissues, a minimally invasive approach is mandatory in order to enable future retreatments. At the Radboud University in Nijmegen, the Netherlands, there is a special care centre for severe tooth wear running several clinical studies. In this lecture, the Radboud Philosophy on treatment of severe tooth wear and results of Minimally invasive strategies will be discussed: from monitoring severe cases to total rehabilitations with minimally invasive techniques, either using direct composites or indirect composite and CADCAM restorations. Many examples of clinical cases will show failure and success in treatments of this difficult patient group

 

Sebastian Paris Scientific Director, Center for Dental and Craniofacial Sciences
Department of Operative and Preventive Dentistry
Charité Berlin
Germany

Micro-Invasive Dentistry: From “Drill and Fill” to “Heal and Seal”

Restorative Dentistry is changing nowadays. Due to widespread fluoridation and other preventive measures caries is progressing slower and the disease burden shifts more and more from children and adolescents towards older people. A new caries paradigm describes caries as a lifestyle - disease rather than an infectious disease. Due to these changes, besides the classic approach of caries treatment by excavation of diseased tissue and restoration of the defect, new treatment options emerged. These new methods aim to “heal” caries lesions without excavation either by addressing etiological factors or by micro-invasive measures such as sealing and infiltration of caries lesions. The lecture will and present new non- and micro-invasive treatments as well as the evidence regarding their clinical efficacy.

 

Anthony Tsai National Taiwan University Hospital
Taipei Veterans General Hospital and Taipei Wanfang Hospital
Taiwan

An Appraisal of the Start of a Caries Lesion

The fundamental understanding of how a caries lesion may start will affect many aspects in managing the caries disease. The presentation will focus on the sequence of conditions to start a caries lesion. There are limitations of current practice of caries risk assessment. Silver diamine fluoride may have a role in these areas.

 

Juhea Chang Special Care Clinic
Seoul National University
Dental Hospital
Korea

How to Approach to Treatment of Root Surface Caries in Elderly Patients with Special Needs

An increased severity and activity of caries lesions in the root surface are often found in elderly patients. Exposure of the root surface by gingival recession and a decreased salivary flow by multiple medication induce a high risk of caries development. Moreover, many elderly patients with special needs poorly manage their oral hygiene due to a lack of motivation and impaired physical dexterity. Consequently, they often exhibit quick development of rampant root surface caries, resulting in multiple loss of the involved teeth unavoidable. In this lecture we will discuss about the considerations posed for caries-prone elderly patients. And, clinical cases of root caries will be reviewed according to the severity of the caries evelopment in the mild, moderate and severe phases. The sequence of the restorative intervention needs to be applied with meticulous operative techniques and adequate material selection. Non-invasive and preventive treatment regimens are also essential to enhance the caries-resistance of elderly patients. Active collaboration between patients’ caregivers and dental healthcare personnel needs to be also implemented. Comprehensive clinical protocols of caries management will be beneficial to elderly patients who are at extremely high risk of developing root caries.

 

Liang Lin Seow School of Dentistry
International Medical University
Malaysia

Management of Caries- from Classroom to Real World

The International Caries Detection and Assessment System (ICDAS) is a clinical scoring system designed for use in dental education, clinical practice, research, and epidemiology. Together with other parameters eg. caries risk assessment, this provides a holistic approach in diagnosis and clinical management of caries. In Malaysia, all dental schools adopt ICDAS scoring system in the undergraduate dental programme. This presentation will provide insight into teaching cariology and caries management in the dental curriculum and relate it to clinical circumstances, including emphasis on personalized treatment plan to improve oral wellness of patients.

 

Mikako Hyashi Osaka University Graduate School of Dentistry
Japan

Japan’s Pioneering Guideline for Treating Caries Based on MI Policy

Japan has set the laudable goal of 80-20 meaning that at the age of 80, people would have at least 20 of their natural teeth. But to achieve this, dentistry needs to undergo a paradigm shift. Everyone involved, government and dentists particularly must enhance the concept of Minimal Intervention (MI). Experts from the Japanese Society of Conservative Dentistry in 2009 published a Guideline for evidence-based treatments of caries based on MI policy. This was followed in 2015 by an expanded version incorporating recommendations for remineralizing incipient enamel and root caries. The aim was to make drilling of healthy tooth a thing of the past. This will make it easier to keep healthy teeth longer as well as taking a lot of the pain out of dental treatments. This presentation will explain the latest scientific evidence, the best modern materials, the advanced clinical techniques that are combining with MI to make dentistry a key partner in helping patients lead longer healthier lives.

 

Paul Brunton Univ. of Otago
New Zealand

Caries Risk Assessment

As part of clinical care its important to consider a caries risk assessment, the factors that inform such an assessment and how it should affect future treatment planning decisions. This presentation will consider this subject in some detail using clinical examples to support the protocols being advocated.

 

Usha Sathyanarayanan Sri Balaji Vidyapeeth University
India

Dental Caries – A global phenomenon in Indian Context

Dental caries disease has been a global burden since pre-historic times. Though a dramatic decline has been witnessed in the recent decades, it is still prevalent in certain countries. The philosophy of ‘eradicating the disease’, has been replaced by ‘life-time control’. This change is due to the current understanding of aetiopathogenesis and the strong role of socio-economic factors that influences the process and progress of the disease. Thus, despite being a global phenomenon, dental caries might be widely varying in the psycho-social, socio-cultural and socio-economic contexts, at the national/regional level. Though international guidelines have been proposed for cares management at population level, patient level, and lesion level, they must be extensively adapted to the uniqueness of the regional contexts. India being a country of diversity in all aspects and caries being a life-style disease, significant variations are inevitable in the disease presentation and perception of prevention. This presentation attempts to project the Indian challenges and variations, in terms of prevalence, education, patient service and clinical research in dental caries.

 

박정길 (Jeong-Kil Park)부산대학교
Professor
Pusan National University

Clinical Assessment and Treatment of Non Carious Cervical Lesions

Noncarious cervical lesions (NCCLs) are characterized as structural defects found on the tooth surface of the cemento-enamel junction. Loss of tooth structure through noncarious mechanisms may vary in etiology. Previously, clinicians believed this to be caused solely by toothbrush abrasion, but presently many clinicians now classify this as tooth failure due to occlusal loading but the etiology and diagnosis of NCCLs remain controversial. Clinically, these lesions have sharp, angular, wedge-shaped defects principally found on the buccal aspects of the teeth. Loss of tooth structure in the cervical area of a NCCL may cause esthetic problems and discomfort due to dentinal hypersensitivity. NCCLs occur in a variety of forms depending on the type and severity of the etiological factor, but not all lesions require restorations. When clinically assessing NCCLs, dental practitioners must consider if the cervical defect requires a restoration and if so, which restorative material will provide the best outcome. Additionally, the clinician must consider a elastic modulus of restorative material and biomechanical stress factor of NCCL. This session will present and discuss the varieties of etiology, shape, clinical assessment and management of NCCLs.

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