How to Repair Dental Caries Without Drilling? Non-invasive and Minimally Invasive Treatment of Cavities


Non-invasive and minimally invasive techniques that delay or obviate the need for traditional restorations have started gaining momentum:

- 5% fluoride varnish
- 38% silver diamine fluoride (SDF)
- resin sealants
- resin infiltration
- chemomechanical caries removal
- atraumatic restorative treatment

These interventions are especially effective in arresting the progress of early/incipient carious lesions. 

Minimum intervention for non-cavitated lesions

To arrest or reverse non-cavitated lesions in the primary or permanent teeth, the ADA recommends that dentists prioritize the use of sealants plus 5% sodium fluoride varnish for occlusal surfaces, or sealants alone over any other option alone.

- For approximal non-cavitated lesions, the recommendation is to prioritize 5% sodium fluoride varnish

- 5% sodium fluoride varnish or 1.23% acidulated fluorophosphate (APF) gel is recommended for facial or lingual non-cavitated lesions

- The use of 5,000 ppm fluoride is prioritized for non-cavitated root caries.

Colgate PreviDent® 5% Sodium Fluoride Varnish contains 22,600 ppm fluoride. When applied, it sets quickly to leave a thin film of protective fluoride over the teeth, promoting ultra-high, sustained fluoride uptake and the remineralization of lesioned enamel.

To arrest or reverse non-cavitated lesions on the root surfaces of permanent teeth, the ADA recommends prioritizing the use of high-level fluoride toothpaste or gel (1.1% sodium fluoride). Colgate PreviDent® 5000 Booster Plus is a prescription-strength toothpaste that contains 5,000 ppm fluoride, and has been shown to help reverse white-spot lesions and to improve remineralization in just ten days.  

Minimum intervention for cavitated lesions

A cavitated lesion would typically be treated with restoration or extraction, however minimally invasive interventions are possible. The ADA recommends the biannual application of a 38% silver diamine fluoride (SDF) solution for cavitated lesions on the coronal surfaces of primary and permanent teeth, and for this to be prioritized over 5% sodium fluoride varnish. To arrest cavitated root caries in the permanent teeth, the ADA recommends that clinicians prioritize the use of 5,000 ppm fluoride (1.1% NaF) toothpaste or gel at least once daily.

Prevention

For patients under six years of age, 5% sodium fluoride varnish is recommended.

Large/cavitated lesions extending into the dentin are less amenable to current techniques due to:

- differences in dentin composition and structure
- caries pathology that facilitates bacterial penetration, survival and the ability of the dentin to remineralize
- elimination of bacteria trapped within the deeper portions of large lesions without surgical intervention poses an additional challenge

Materials used in minimally invasive procedures are susceptible to hydrolytic and enzymatic degradation in the oral environment, resulting in a deterioration in their mechanical properties over time.

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8700643/

https://www.colgateprofessional.com/dentist-resources/caries/the-advantages-of-minimally-invasive-dentistry

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