Minimum Intervention Treatment Plan (MITP) - practical implementation in general dental practice

Abstract

The Minimum Intervention (MI) concept is well described in the literature and summarizes the clinical rationale for the preventive and cause-related approach in the management of dental caries. The GC “MI Advisory Board” which is a Pan-European group of clinical academics and general dental practitioners aims to present an evidence-based, patient-centred MI treatment approach for use in routine dental practice. This treatment methodology is based on four phases of treatment planning: MI Identify, MI Prevent, MI Recall and MI Restore. MI Identify: encompasses detection of dental caries and identifying factors affecting the susceptibility of the individual patient. A modified ICDAS detection scoring system is presented to relate the visual appearance of lesions with the histological process and is related to the clinical signs of caries and radiological investigation. In addition, assessment of plaque and saliva is discussed using commercially available chairside kits. All this information can then be evaluated to assess the patient’s susceptibility and the risk factors of the patient, preventive treatment regimes can be instituted. The “standard” approach includes oral hygiene instruction, dietary advice, patient motivation and maintenance. Those patients with high risk factors need “active” preventive care. This includes the measures to decrease the bacterial content of the oral cavity, placement of transitional restorations and use of remineralisation agents. Repeated diagnosis of the risk factors will be used to assess the need for the precise level of preventive measures and the amount of recall sessions individualized for each patient. MI Restore: MI Restore presents techniques for conservation of tooth structure when restorations have to be placed. Distinctions are made between on-invasive and invasive techniques.