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To hear longtime dentist Dr. Stewart Rosenberg explain that “minimally invasive” dentistry is much better than “maximally invasive” might sound a little silly at first. But there is nothing silly about the passion this Laurel, Md. general practitioner has when it comes to providing the best, most comfortable and least invasive care to his patients.

Dr. Rosenberg, who co-founded the World Congress of Microdentistry—which has since been renamed the World Congress of Minimally Invasive Dentistry (WCMID) (wcmid.com)—is both thrilled and proud to be a pioneer in minimally invasive dentistry (MID), yet struggles with the fact that not all dentists today are aware of its benefits and how to deliver this type of care to their patients.

One of the key protocols of MID is caries risk assessment, and its popularity is beginning to grow nationwide among dental schools, a trend that Dr. Rosenberg enthusiastically supports.

“This is the best thing to happen to dental education in all the years I’ve been in dental practice. Yet, it’s amazing how many dentists aren’t aware of this and don’t realize its importance,” he said.

CAMBRA (caries management by risk assessment) is one way the profession can play a more preventive role in oral health. It is characterized as a set of recommendations and guidelines for practical caries intervention and prevention, and it essentially involves a more detailed patient history form specifically geared to help determine a patient’s risk of caries, a test to measure the level of cariogenic bacteria in the patient’s mouth, and a set of recommendations for caries control and management.

But CAMBRA is just one of many aspects of MID and therefore only a portion of DPR’s latest exclusive survey. Our first-ever Minimally Invasive Survey report covers the early years of MID, product and technology advances that have helped deliver this less invasive care to patients, and steps and advice on how you and your staff can get more involved in delivering this approach to clinical care.

The entire MID way of thinking is gaining steam, as evidenced by the fact that 77% of survey respondents have either taken some classes and have implemented small steps of the protocol into their practice, or are interested in learning more.

Early days

Many dentists—not just the pioneers featured in this article—believed early on that there might just be a better way to treat teeth than to stick with the “wait and see” protocol and the “extension for prevention” methods taught more than a century ago by G.V. Black.

Dr. Rosenberg was ready to shift gears the moment adhesive dentistry enabled clinicians to depart from G.V. Black’s preparation designs by no longer making it necessary to cut a specific preparation to compensate for the physical properties of amalgam and gold.

“I really started thinking about minimally invasive dentistry even before air-abrasion,” Dr. Rosenberg said. “I recognized very early on in my career that what we were being taught with regard to restoring teeth and to diagnosing and restoring carious lesions just didn’t make logical sense. We were taking away way too much tooth structure than necessary to get rid of whatever pathology was there. And in doing so, we were weakening teeth and ultimately over time seeing the results of these weakened teeth— fractured cusps and broken teeth.” 

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Breakthroughs in bonding systems and materials more than two decades ago opened the door for the minimally invasive way of treating decay, and practitioners like Dr. Rosenberg eagerly ran with the opportunity to do away with amalgam. “As soon as composites came, that’s the year I stopped doing amalgams,” he said. “To do amalgam restorations, we had to remove more than just decay; we had to remove healthy tooth structure to support the amalgam. Whereas with the advent of adhesive dentistry, we could remove just the pathology and still restore a tooth properly. That’s where I started thinking minimally invasive dentistry.”

Using technology for MID

Air-abrasion enables the creation of small preparations when cavitated lesions are in their infancy. This technology is credited by many to have taken off thanks in large part to Texas dentist Dr. J. Tim Rainey. But Drs. Rosenberg and Kim Kutsch, a Past President of both the Academy of Laser Dentistry (laserdentistry.org) and the WCMID, each jumped on board with air-abrasion about 20 years ago, getting a big head start on MID.

Air-abrasion has since been replaced in many procedures by dental lasers, but it remains helpful when customizing the preparation for composite application and also enhances the bond. The technology is popular when placing sealants. With the advent of air-abrasion came the need for early diagnosis, now a critical element of care.

“When we first brought air-abrasion into that (MID thinking) it carried things to another level. That’s when we coined the word ‘microdentistry,’ which then became minimally invasive dentistry,” Dr. Rosenberg said. “Too many people thought we were talking about microscopes rather than minimally invasive dentistry, so we changed the semantics to better reflect the philosophy that we were trying to teach.”

Air-abrasion was adopted by many doctors, but many other clinicians shunned it because of the mess, said Dr. Rosenberg, who lectures internationally, often on behalf of Biolase Technologies (biolase.com), maker of the Waterlase MD all-tissue laser that he uses in his practice.

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