Minimally invasive dentistry represents a philosophical shift from "extension for prevention" to maximum tooth structure preservation. Evidence supports less aggressive intervention for many carious lesions, particularly with modern materials and preventive protocols.

Caries Risk Assessment

Effective minimally invasive practice begins with individualized caries risk assessment. The CAMBRA (Caries Management by Risk Assessment) protocol categorizes patients as low, moderate, high, or extreme risk based on disease indicators, risk factors, and protective factors.

Disease indicators include active cavitated lesions, white spot lesions, and radiographic lesions. Risk factors include frequent sugar consumption, inadequate fluoride exposure, and xerostomia. Protective factors include adequate saliva flow, fluoride use, and effective oral hygiene.

Non-Operative Caries Management

Incipient lesions confined to enamel can be arrested through remineralization. High-concentration fluoride applications (22,600 ppm fluoride varnish quarterly or 5,000 ppm toothpaste daily) promote remineralization and inhibit demineralization.

Resin infiltration (ICON, DMG) treats proximal lesions extending into outer dentin without cavity preparation. The technique involves acid etching to remove the pseudo-intact surface layer, desiccation, and low-viscosity resin infiltration. Clinical studies show 3-year success rates of 70-85% for appropriate lesions.

Selective Caries Removal

Traditional complete caries removal risks pulp exposure in deep lesions. Selective removal to soft dentin in the pulpal wall while removing to firm dentin peripherally reduces pulp exposure risk while maintaining restoration longevity.

A 2023 Cochrane review found selective removal reduced pulp exposure risk by 77% compared to complete removal, with no difference in restoration failure rates at 5 years. This evidence supports selective removal as the standard of care for deep lesions.

Atraumatic Restorative Treatment

ART involves hand instrument caries removal and restoration with high-viscosity glass ionomer cement. While developed for resource-limited settings, ART principles apply to minimally invasive practice.

Glass ionomer materials release fluoride, chemically bond to tooth structure, and require minimal preparation. For small to moderate cavities in low-stress areas, glass ionomer restorations achieve 85-90% survival at 3 years—comparable to composite resins with less invasive preparation.

Adhesive Dentistry Integration

Modern adhesive systems enable conservative preparations. Bonded restorations do not require mechanical retention features like undercuts or dovetails, allowing smaller preparations.

Partial coverage restorations (onlays, overlays) preserve tooth structure compared to full crowns while providing adequate strength. CAD/CAM technology facilitates these restorations with predictable fit and esthetics.

Implementation Strategies

Transitioning to minimally invasive practice requires clinical training, patient education, and practice systems. Continuing education in caries risk assessment, resin infiltration, and selective removal techniques builds clinical skills.

Patient communication emphasizes prevention and tooth preservation. Explaining the rationale for non-operative management or conservative treatment improves acceptance and compliance with preventive protocols.

Documentation of caries risk assessment, preventive protocols, and treatment rationale supports minimally invasive decisions. Baseline and follow-up photographs demonstrate lesion arrest or progression, justifying treatment choices.