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Case Study
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Minimally Invasive Restorative Dentistry: A Biomimetic Approach

A Case Presentation

Learning Objectives:

This study discusses the minimally invasive procedures for treating and restoring damaged teeth due to cavitated carious lesions. Upon reviewing this study, the reader should:

  • Become familiar with a variety of treatment options that are available and their varying levels of invasiveness.
  • Understand the importance of conserving as much natural tooth structure as possible and how this can benefit subsequent treatments.

 

It is widely accepted that prevention is the most conservative, least costly method of maintaining a patient’s teeth over the long term. Prevention has been the cornerstone of modern dentistry, but even with the encouragement and education provided by a trained staff, clinicians will encounter some patients who present with compliance issues. Many times, compliance with home care—especially during orthodontic treatment—is neglected, requiring invasive restorative procedures. 

The severity of the resulting damage can often be seen in the form of extrinsic stains (ie, white spot surface lesions) as well as cavitated carious lesions. These lesions, which are caused by the accumulation of plaque and bacteria, can be addressed through treatments of varying invasiveness. Depending on the severity of the lesion and its etiology, therapy may consist of prophylaxis, air abrasion, tooth whitening, resin bonding, prosthetic restoration, or some combination thereof.  

Minimally invasive treatments are procedures that restore form, function, and aesthetics with minimal removal of sound tooth structure. As a person ages, so do their restorations. Eventually, previously restored teeth will deteriorate and require replacement restorations. Fortunately, restorative materials and procedures are constantly evolving. If an initial restoration is created using minimally invasive procedures, sound tooth structure will often be available for a subsequent restoration.  

Preventive dental maintenance is the most cost-effective means of preserving dentition. Neglect can lead to a variety of problems, ranging from white spot surface lesions to fully engulfed carious lesions. Minimally invasive treatment should follow only dedicated preventive maintenance. The patient in this case underwent a minimally invasive procedure that preserved sound tooth structure. This preservation lends itself to better future treatment options as dental technology advances. 

 

*Private practice, St. Paul, MN 

  

Related Reading:

  1. Kressin NR, Boehmer U, Nunn ME, Spiro A 3rd. Increased preventive practices lead to greater tooth retention. J Dent Res 2003;82(3):223-227.
  2. Widstrom E. Prevention and dental health services. Oral Health Prev Dent 2004;2(Suppl1):255-258.
  3. Greenwell L. Bleaching techniques in restorative dentistry: An Illustrated Guide. London, UK: Martin Dunitz, 2001:1-23.
  4. Loesche WJ. Chemotherapy of dental plaque infections. Oral Sci Rev 1976;9:65-107.
  5. Steinberg S. A paradigm shift for caries diagnosis and treatment—Part I: Diagnosis. J Pract Hygiene 2004;13(2):27-30.
  6. Christensen GJ. The advantages of minimally invasive dentistry. J Am Dent Assoc 2005;136(11):1563-1565.
  7. White JM, Eakle WS. Rationale and treatment approach in minimally invasive dentistry. J Am Dent Assoc 2000;131(9):1250, 1252.
  8. Rainey JT. Understanding the applications of microdentistry. Compend Contin Educ Dent 2001;22(11A):1018-1025.
  9. Brantley CF, Bader JD, Shugars DA, Nesbit SP. Does the cycle of rerestoration lead to larger restorations? 1995;126(10):1407-1413.
  10. Lutz F, Krejci I, Besek M. Operative dentistry: the missing clinical standards. Pract Periodont Aesthet Dent 1997;9(5):541-548.
  11. Additional aids to the remineralization of tooth structure. In: Reynolds EC, Walsh LJ. Preservation and Restoration of Teeth. 2nd ed. 2005, p111-118.
  12. Manhart J, Mehl A, Schroeter R, et al. Bond strength of composite to dentin treated by air abrasion. Oper Dent 1999;24(4):223-232.
  13. Berry EA 3rd, Ward M. Bond strength of resin composite to air-abraded enamel. Quintessence Int 1995;26(8):559-562.
  14. Rosenberg SP. Air abrasion in the aesthetic restorative practice. Pract Periodontics Aesthet Dent 1999;11(7):843-844.
  15. Bryant CL. The role of air abrasion in preventing and treating early pit and fissure caries. J Can Dent Assoc 1999;65(10);566-569.
  16. Okuda WH. Achieving optimal aesthetics for direct and indirect restorations with microhybrid composite resins. Pract Proced Aesthet Dent 2005;17(3):177-184.
  17. Mitra SB, Wu D, Holmes BN. An application of nanotechnology in advanced dental materials. J Am Dent Assoc 2003;134(10):1382-1390.
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