Minimal intervention prosthodontics can be considered a treatment option for a country's overall dental health care plan. Prosthodontics can cover a range of increasingly aggressive treatment interventions depending on the severity and progression of the disease. The 'shortened dental arch' concept is a minimal treatment intervention approach that has been advocated for a wide range of partially edentulous patients. This concept favors limited prosthodontic intervention to achieve patient-perceived acceptable function levels in the presence of multiple missing teeth. The implementation of minimal interventions should be balanced by considering risk-to-benefit ratios, as well as the consequences of nonintervention of low-level prosthodontic interventions. The 'nonintervention' approach and low-level prosthodontic interventions have inherent consequences and well-documented risks; professional ethics dictate that a practitioner present these risks as well as the known benefits of all treatment options. Developing countries are under significant pressure to effectively utilize limited resources, increase skilled human resources, provide advanced levels of care to very large numbers of patients and plan for the future dental health care of their society. Many developing countries are prime candidates for inadvertent abuse and misappropriation of prosthodontic materials, treatment modalities and human resources in trying to provide cost-effective prosthodontic care. A developing country can learn from the mistakes that developed countries have made in the past and use the evidence from these experiences to plan for a better future state of dental health for their society.

High-quality appropriate dental care should encompass the concepts of effectiveness and efficiency. Many dental procedures are ineffective, and some preventive measures are inefficient. Examples of criteria that are ethically essential to use before carrying out any clinical procedure are outlined based on the concepts included in 'informed consent'. Applying the criteria rigorously will lead to minimal intervention and a more equitable distribution of appropriate dental care. Unnecessary dental care will be reduced.

The term minimal intervention is relatively new in dentistry and has been introduced to suggest to the profession that it is time for change in the principles of operative dentistry. The disease should be treated first; the surgical approach should be undertaken only as a last resort and then with the removal of as little natural tooth structure as possible. This article discusses the advances in techniques and materials that have led to change and attempts to put them into perspective. Treatment should begin with identification and elimination of the disease. There will then be a need for limited restoration of actual cavitation arising from demineralization of the tooth crown. Restorations, per se, will not prevent or eliminate disease. Caries is a bacterial infection and, until the microflora is controlled, all restorations are at risk of further demineralization in remaining tooth structure. This leads to the continuum of replacement dentistry that keeps the profession occupied for much of its productive time. If this cycle is to be broken, the profession must first acknowledge the primacy of prevention.

The concept of minimal intervention dentistry has evolved as a consequence of our increased understanding of the caries process and the development of adhesive restorative materials. It is now recognised that demineralised but noncavitated enamel and dentine can be 'healed', and that the surgical approach to the treatment of a caries lesion along with 'extension for prevention' as proposed by G V Black is no longer tenable. This paper gives an overview of the concepts of minimal intervention dentistry, describes suggested techniques for a minimally invasive operative approach, and reviews clinical studies which have been carried out in this area.

The concepts of 'minimal intervention' or 'minimally invasive' restorative dentistry do not appear to be well understood or accepted. This paper attempts to clarify what is meant by these concepts, and to examine some of the difficulties preventing these concepts being fully implemented in general dental practice in Australia. Possible approaches to facilitating more widespread acceptance and adoption of these concepts are proposed.

SUMMARY: From the mainly reparative dentistry of the 20th century, contemporary dentistry shifts towards a minimal intervention (MI) approach encompassing up-to-date caries diagnosis and risk assessment before arriving at a treatment decision. An overview is provided of incorporating MI philosophy into the field of operative dentistry. The ultimate goal of MI is to extend the lifetime of restored teeth with as little intervention as possible. When operative care is indicated, it should be aimed at "prevention of extension." Black's principles for cavity design are considered and put in the perspective of minimally invasive operative care. Guiding principles for contemporary adhesive cavities are reviewed. CONCLUSION: Contemporary operative care should be based on a minimally invasive approach. Minimal intervention is not just a technique, it is a philosophy!

BACKGROUND: Current methods of detecting caries, especially fissure caries, are inaccurate, causing some caries to go undetected until it has reached more advanced stages. Minimally invasive dentistry is a philosophy in which the goal of intervention to conserve healthy tooth structure. The authors review the rationale and role of air abrasion in successful practice in the 21st century that includes the philosophy of minimal intervention. CLINICAL IMPLICATIONS: This objective encompasses a range of clinical procedures that includes assessment of caries risk to reinforce patient self-help, early detection of the disease before lesion cavitation to fortify the oral environment, restoration of fissure caries with maximum retention of sound tooth structure and sealant placement in unaffected areas. This conservative approach minimizes the restoration/re-restoration cycle, thus benefiting the patient over a lifetime.

Microdentistry is a science-based tool of operative dentistry, and is an alternative to traditional dentistry. The structures and substructures of teeth have been generally misunderstood. Once these structures are understood, the goal of the microdentist is to identify unsound tooth structure, which is a threat to the long-term stability of the tooth, and then neutralize or remove those structures with minimal disruption of the surrounding sound tooth structure. Minimal disruption of sound tooth structure provides the additional patient benefit of reducing or eliminating the pain associated with traditional dentistry. This article reviews some of the newly discovered structures in human teeth and discusses methods of microdentistry used to preserve these structures.

Practicing microdentistry is not for the weak-spined dentist. It takes guts to face the possible challenges and resistance described in this report. Those who truly believe microdentistry will become the standard of care remain its best advocates. They are better equipped to manage any resistance encountered from peers, boards, insurance companies and patients. But to avoid legal and board troubles, always obtain informed consent from patients of indications, costs, risks of providing and not providing treatment, and alternative treatments and their costs. The debate over whether microdentistry will become the standard of care, replacing traditional restorative dentistry, continues. Most of those who hold onto the tried and true methods of traditional diagnosis and treatment are probably trying to err on the side of caution. Most of those who embrace microdentistry are not unscrupulous opportunists but are probably trying to provide the care that represents the highest quality in their opinion. Best case scenario, traditionalists and microdentists can coexist and dialogue peacefully within their communities and through their dental organizations to navigate the future of optimal treatment. Worst case scenario, attorneys and insurance companies will profit more than ever while the division in dentistry over microdentistry widens. The shakeout will prove interesting.

Micro-dentistry offers a new standard of care to address and solve the current challenges facing the dental profession. Patients will be grateful for accurate diagnosis of the pit and fissure system with caries detection dye and magnification, followed with comfortable air abrasion debridement and preparation for restoration with an adhesive composite material.

UP