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ePaper created 2015-03-06, 09:14:48 | version 1.33.01
10 I I review _ minimally invasive dentistry practice _Extension: Invasive dentistry If we look carefully at the history of restorative dentistry, the word “extension” (or “invasive”) has always been a point of focus among clinicians.14 The concept of “extension for prevention and retention” was pronounced by Dr G.V. Black 100 years ago and itwasappropriateinrelationtotherestorativemateri- als available at that time. However, with the develop- ment of porcelain-fused-to-metal technology in the late 1950s, the concept of “extension for functional aesthetics”wasadvocated,whichisstillverypopularin clinical practice. In the early 1980s, the concept of the “Hollywood smile” was introduced, which established the concept of “extension for cosmetics” in dentistry. In 2002, the FDI World Dental Federation endorsed the approach of minimal intervention dentistry, which hasbasicallyfocusedontheconservativemanagement of carious lesions, applying the concept of “minimal extension for decay removal”. History clearly shows that,sinceDrG.V.Blackeratothepresentday,wehave beenapplyingtheconceptof“extensionindentistry”in the name of prevention, retention, function, aesthetic needandcosmeticdesire,andcariesremoval.Itisaclin- icalfactthatthisconceptwillremainthefocusbecause each clinical situation is different, as its treatment modalities are guided by multifactorial issues such as patient factors (mind, body, behaviour and surround- ings), operator factors (knowledge, skills, honesty and humanity), protocol factors (the truth, evidence, ex- perience and common sense), technology factors (health, reliability, affordability and simplicity). The use of science and technology requires consciousness in operators and awareness in patients; hence, the oper- ator must use his or her professional knowledge and skills with honesty and humanity to select the least invasive procedure, protocol and technology in treat- ment, so that extension in dentistry is always minimal, safeandhealthy. Theinvasivenessofproceduresselectedincosmetic dentistry depends on the level of smile defect, type of smile design, proposed treatment types and treatment complexity. MiCD uses the most conservative smile enhancementprocedurepossible.Thelevelofinvasive- ness in cosmetic dentistry can be classified into four types, namely non-invasive, micro-invasive, minimally invasive and invasive, and the treatment options, vari- ous treatment procedures and their biological cost for eacharepresentedinTable1.Thereisonlyoneprinciple in selecting treatment modalities in MiCD: always select the least invasive procedure as the choice of the treatment.2 Treatment procedures mentioned under non-invasive, micro-invasive and mini-invasive are usedselectivelyinMiCD. Table I_Treatment options, treatment procedures and biological cost in cosmetic dentistry. cosmeticdentistry 1_2015 Treatmentoptions Treatmentprocedures Biologicalcost Non-invasivetreatment: _Smileexercise None whenhardandsofttissueis _Remineralisationofwhitespots notpreparedduringsmile _Oralappliancesandbruxismguard enhancementprocedures _Denturesrequiringnotissuepreparation _Gingivalmask Micro-invasivetreatment: _Cosmeticchemicaltreatment,suchas Verylow whenhardandsofttissueis bleachingandmicro-abrasion preparedatamicro-levelduring _Cosmeticrestorationswithchemicaltooth smileenhancementprocedures preparation,suchasdirectbonding,ultra-thin veneers,adhesiveponticsandoverlays Minimallyinvasivetreatment: _Cosmeticcontouring(teethand/orgingivae) Low whenhardandsofttissueisprepared _Cosmeticrestorationswithminimaltooth atasuperficialorminimallevelduring preparation,suchasthinveneers,modified smileenhancementprocedures inlaysandonlays,partialcrowns, partialdentures,andinlaybridges _Non-extractionconventionaland MiCDorthodontictreatment _Minidentalimplants(smalldiameter) _Gingivaldepigmentation Invasivetreatment: _Toothpreparationforcrowns,bridgeabutments High whenhardandsofttissueis anddeepveneers preparedatadeeperlevelduring _Orthodontictreatmentwithtoothextraction enhancementprocedures _Dentalimplants _Aestheticsurgicalprocedures,suchas periodontal,orthognathicandfacialsurgeries Table I Fig. 14d Fig. 14fFig. 14e Fig. 14a Fig. 14cFig. 14b CDE0115_06-12_Koirala 26.02.15 10:27 Seite 5 CDE0115_06-12_Koirala 26.02.1510:27 Seite 5