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When clinicians will be able to practice dentistry safely and fully again, infection control inside and outside the patients’ mouth will be the main focus. A great deal of time and effort will go into reconnecting with our patients and restarting preventative and therapeutic plans, including extra care and cleaning for periodontal and implant cases.
Minimally-invasive dentistry (MID), as defined by Prof Kaidonis and colleagues from the University of Adelaide, has two fundamental components: “a maximum preventive approach and a minimum operative intervention”. MID traditionally revolves around cariology. Yet the philosophy can apply more widely; to endodontics when keeping the access cavity small and shaping canals with Ni-Ti rotary instruments, or to prosthodontics when choosing resin-bonded veneers over conventional crowns.
What about periodontology?
Curettes are among the oldest instruments introduced in dentistry, the invention of ultrasonic scalers dates back to the 1950s, and standard non-surgical methods have remained mostly unchanged. Although suffering from a slow start, periodontology seems to be finally catching up with the MID revolution.
The term minimally-invasive non-surgical techniques (MINST) first appeared in periodontology to indicate a new way to manage intra-bony defects with residual periodontal pockets without any surgery. Positive clinical outcomes were obtained, along with minimal tissue trauma, less discomfort, and lower costs for patients.
What makes the difference in MINST is the type of instruments being used, and the different aim the operator has in mind. Biofilm has been established as the principal cause of periodontal disease, and the necessity to perform root planning was demystified many years ago. Therefore, we now want to remove biofilm and the calculus harbouring it without damaging healthy or potentially healing tissue.
According to the protocol designed by the research group of Prof Luigi Nibali, senior lecturer at the King’s College of London, thorough debridement of the root can be obtained with specific thin and delicate tips on piezoelectric devices, complemented by mini-curettes. More recently, Italian periodontist Carlo Ghezzi has published the clinical results of more than a hundred periodontal patients he treated with MINST. His protocol goes even further: it involves the use of air-polishing and piezoelectric debridement, and achieved an overall pocket closure rate of 72%, versus the 57% reported in the literature for traditional SRP. Air-polishing with low abrasiveness Erythritol powder (EMS Dental PLUS Powder) can remove biofilm efficiently whilst being gentle on tissues, and the ultrasonic instrument (EMS Dental PS Instrument) can target mineralised deposits precisely, in a strategic application of the most current technology.
Treatment of oral diseases without addressing the related risk factors does not take care of the issue at its source. Many useful tools are available to help keep track of the several factors influencing periodontal health, such as the Periodontal Risk Assessment (PRA) by Lang, Suvan & Tonetti for natural teeth and the novel IDRA tool for implants by Professor Liza Heitz-Mayfield, Dr Fritz Heitz and Prof Lang. However, present circumstances might require clinicians to go a bit further. Patients might be under emotional, physical and financial difficulties. Stress is detrimental for general health, and higher salivary cortisol levels are linked to worsening of periodontal conditions. Clinicians must be ready to assist.
Guided Biofilm Therapy (GBT) was developed in collaboration with universities and dental practices around the globe and launched in July 2016. The goal of GBT it to provide a minimally invasive approach to preventive and periodontal maintenance treatment. It focuses on biofilm removal with the least abrasive methods, giving particular consideration to the accessibility of removing biofilm from deep periodontal pockets.
About the Author
Dr Annamaria Sordillo is an Italian-qualified dentist, with a strong passion for research and preventative dentistry.
Barbato L, Selvaggi F, Kalemaj Z, Buti J, Bendinelli E, Marca M, Cairo F. Clinical efficacy of minimally invasive surgical (MIS) and non-surgical (MINST) treatments of periodontal intra-bony defect. A systematic review and network meta-analysis of RCT’s. Ghezzi, C., Ferrantino, L., Donghi, C., Vaghi, S., Viganò, V., Costa, D., Mandaglio, M., Pispero, A., Lodi, G. Clinical audit of minimally invasive nonsurgical techniques in active periodontal therapy. Accepted for publication on The Journal of Contemporary Dental Practice. Kaidonis JA, Skinner VJ, Lekkas D, Winning TA, Townsend GC. Reorientating dental curricula to reflect a minimally invasive dentistry approach for patient-centred management. Australian Dental Journal 2013; 58:(1 Suppl): 70–75 doi: 10.1111/adj.12052.Reorientating.Nibali L, Pometti D, Chen T-T, Tu Y-K. Minimally invasive non-surgical approach for the treatment of periodontal intrabony defects: a retrospective analysis. J Clin Periodontol 2015; 42: 853–859. doi: 10.1111/jcpe.12443