Overview
Traditionally, dental caries has been treated by “drilling and filling”. Minimally invasive dentistry (MID) is an evidence-based approach that aims to arrest caries and preserve as much tooth structure as possible when managing early and moderate caries lesions. The intervention strategy employs detection of early caries lesions, a comprehensive caries risk assessment, clinical decision-making and a personalised care plan [1].
Use and Application
MID involves professionally conducted non-operative procedures and tooth-preserving operative care of early enamel lesions and lesions located in the outer parts of the dentin [2]. MID can be applied to both primary and permanent teeth. Examples are fissure sealants of early occlusal lesions, resin infiltration, grinding of proximal surfaces, atraumatic restorative treatment (ART) and stainless steel (Hall) crowns.
Effectiveness and Efficacy
Based on a recent meta-analysis [3], progression of proximal caries lesions was less likely to occur in permanent teeth treated with MID (resin infiltration) as compared to non-invasive methods after 3 years (OR=0.15). However, the quality of the evidence was rated as low. Use of sealants for occlusal caries in permanent molars has a 70% success rate after 7 years.
Safety
There are no adverse-effects associated with MID but all treatments must be carefully monitored and maintained at regular follow-ups.
Cost Effectiveness
MID techniques on the whole are highly likely to be cost-effective in the long-term, since more advanced treatments can be avoided. In a German study of primary molars over 2.5 years, Hall crowns performed significantly better at lower costs than conventional restorations [4].
Recommendations
MID techniques present a range of well-documented advantages over more tissue-destructive traditional restorations and should be considered as the first choice for fully informed practitioners and patients.
Key Further Reading
1- CariesCare Practice Guide: Consensus on Evidence into Practice.
Martignon S, Pitts N, Goffin G, Mazevet M, Douglas G, Twetman S, Deery C, Domejean S, Jablonski-Momeni A, Banerjee A, Kolker J, Ricketts D, Santamaria R. CariesCare Practice Guide: Consensus on Evidence into Practice. British Dent J 2019; accepted.
2- Minimally invasive direct restorations: a practical guide.
Mackenzie L, Banerjee A. Minimally invasive direct restorations: a practical guide. Br Dent J. 2017;223:163-171.
3- The effect of resin infiltration on proximal caries lesions in primary and permanent teeth. A systematic review and meta-analysis of clinical trials.
Chatzimarkou S, Koletsi D, Kavvadia K. The effect of resin infiltration on proximal caries lesions in primary and permanent teeth. A systematic review and meta-analysis of clinical trials. J Dent. 2018;77:8-17.
4- Cost-effectiveness of the Hall Technique in a Randomized Trial.
Schwendicke F, Krois J, Robertson M, Splieth C, Santamaria R, Innes N. Cost-effectiveness of the Hall Technique in a Randomized Trial. J Dent Res. 2019;98:61-67.
Guidance Document
ACFF Members can download the full reference document for Minimally Invasive Dentistry.