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Think 'minimally invasive’ Preparing for and using minimally invasive philosophy is easier if you equip your practice with the right tools.
This monthly column is co-sponsored by DPR and The World Congress of Minimally Invasive Dentistry. It is edited by Congress past-president Dr. Joseph Whitehouse.
For several years, the public has read about the continuing advances that minimally invasive procedures have brought to medicine. Some dental professionals, myself included, are on a mission to end the traditional invasive concepts in dentistry as well. Along with changes in procedure, new equipment and instruments have helped us keep up with these changes. The minimally invasive dentistry (MID) concept appeals to many patients. When MID principles and procedures are described to patients, they embrace the philosophy. However, clinicians must share these ideas for patients to appreciate the efforts.
Often, dental care is not a pleasant experience for patients. Most patients need a supportive, non-invasive communication style from the dental team, especially the doctor. Too often, patients let a past poor experience influence their view of current treatment. The MID approach allows patients to feel in control, because all proposed treatment is relevant to patients and how they desire their mouth to look. When the patient perceives that a practitioner has no “agenda” but only an interest in helping meet these desires, patients feel empowered—often a novel experience for them. Once patients have a positive perception of the treatment planned, acceptance follows. On the other hand, if they perceive that the practitioner has purely professional or profit interests in mind, they may delay any decision-making until trust is established. How can your dental team focus on being understanding, supportive, and empathetic toward all patients? What can you do to have every patient who visits leave wanting not only to return but also to refer others? Will minimally invasive communication be your “rock” from which you deliver MID?
At least 40 of the nearly 55 dental schools in the U.S. now teach Caries Management by Risk Assessment (CAMBRA). If not already, this soon will become the standard of care to manage caries disease. Beyond the basic information about decay and its cause, MID focuses on a medical model of disease diagnosis and provides the patient with a regimen to manage this biofilm problem. Without CAMBRA, dentistry merely is a surgical model. For too long patients have had their teeth restored, only to be diagnosed with recurrent decay. Continual restoration for some patients has been a lifetime affair. Using a MID approach and CAMBRA, the original restorations would be smaller but long-lasting. When MID and CAMBRA principles are applied correctly, few root canals, extractions, and crowns are necessary.
Dental equipment and instruments have improved over the years, and a core group of early MID adopters paved the way for the rest of the profession to accept new procedures for treating dental disease and conditions. MID has significantly improved the dental health of patients through orthodontics (especially Invisalign), root canals, periodontal therapy, implant placement, and MID fillings. The continued upgrading of instrumentation and techniques has and will lead to the increased practice of a MID approach/philosophy. What’s more, many advances in treatment have led to additional MID procedures. A dental office can continually upgrade its equipment/instrumentation until every procedure is practiced as minimally invasively as possible. In no particular order, I will present innovations that implement the MID philosophy. Of course, materials and procedures are as important as the instrumentation, so taking relevant courses to enhance skills also is paramount.
For those who want to impress patients with the MID approach, digital x-rays rank near the top of the equipment innovations list (Fig. 1). Noting the reduced radiation and allowing the patient to see their results immediately can enhance patient perceptions about an office’s “high tech” quotient. Furthermore, the information supplied by the digital x-ray results in an improved treatment plan. Using digital x-rays for endodontics is faster and more accurate, as more angles can be shot with minimal radiation and less measurement-taking. When planning for implant placement, adding a 5-mm steel ball to the sensor for measurement verification and placing a specifically sized virtual implant from a particular manufacturer leads to more accurate planning and placement (Fig. 2). During implant placement, the digital x-ray’s immediate results save time and keep the procedure moving forward. Archiving each patient’s x-rays in an online “chart” prevents lost or misplaced records, thereby eliminating retakes. For the office, digital x-rays result in less work when sending claims electronically—simply attach the x-rays or photos. Finally, no one misses cleaning a processor or paying for processing chemicals.
Patients dislike numb lips. They complain about an appointment’s tingly aftermath that sometimes can last up to hours afterward, and they dislike the pain associated with blocks. The solution? Inject anesthetic through the tissue into the medullary bone for profound, quick anesthesia. One product that enables the process to proceed smoothly is the IntraFlow anesthesia delivery system (Fig. 3). Used like a slowspeed handpiece, the attached hollow needle is advanced through the tissue between the roots. Once the needle reaches the proper depth, the anesthetic is delivered. The MID aspects involve avoiding numbing more than the specific area to be treated, along with offering profound immediate anesthesia. Treatment can begin immediately, eliminating patient anxiety about getting numb or the anticipation of yet another shot. The practitioner’s frustration level likewise is reduced. (continued on page 2)
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