air/water abrasion, ozonotherapy etc. The minimally invasive restorative therapy
managed to combine the most recent notions regarding prevention,.
Editorial
MINIMALLY INVASIVE THERAPY: TEHNIQUE OR PHILOSOPHY?
Medical dentistry continuously develops, in harmony with the information torrent that “flows” from the fundamental and clinical sciences and that models all things related to the medical field: obsolete things are eliminated, things that can still be applied are updated and new and necessary things are implemented. Scientific research changed our perceptions, our way of thinking and the attitude towards today and tomorrow. Minimally invasive dentistry (MID) coincided with the era of molecular medicine, which supports the quality increase of medical care, inclusive the preclinical identification of the predisposition to illness, preventive interventions, new diagnosis and treatment techniques and new biomaterials for the repair and regeneration of oral and dental tissues and craniofacial structures. Minimally invasive dentistry is in favor of “systematic respect towards the original tissues”. This statement suggests that our profession admits that an artificial product has a smaller biological value than the healthy original tissue. This concept cancels the traditional rupture between prevention and operative techniques, aspect that medical dentistry really needs at present. Minimally invasive dentistry can be defined as a professional philosophy preoccupied by the initial cases, the early detection and the complete healing of the disease at a micro (molecular) level, followed by minimally invasive and unaggressive treatment in order to repair the lesions caused by the disease. MID strives to support the patients in their effort to participate to their dental destiny via information, competence (skill, qualification) and motivation. The philosophy of minimally invasive therapy in carious diseases has three support pillars: IDENTIFICATION: identification (detection) of the initial lesions and of the cariogenic risk of the patient, internal and external REMINERALIZATION: healing of non-cavity lesions and REGENERATION (REPARATION): control of the caries activity, restorative therapy via minimally invasive techniques and the repair of marginal defects. The identification of the etiological and risk factors, as well as the elaboration of the ecologic Journal of Romanian Medical Dentistry
theory of bacterial plaque enabled the development of the medical model for dental caries. Its main objective is the etiological, control and elimination treatment of all factors with clinical implication in relation to the induction of a dental environment that favors caries diseases. Restorative treatment does not represent the beginning or the end of the management strategy of caries diseases. From the perspective of minimally invasive treatment, its indications are increasingly limited and the appearance of biomimetic restoration materials and of adhesion phenomena led to the development of bioadhesive restorations. From a technical standpoint, the minimally invasive orientation introduced the principle of tissue economy, of removing only the irreversibly affected tissues, and this encouraged the elaboration of some very favorable strategies for hard dental tissues: air or air/water abrasion, ozonotherapy etc. The minimally invasive restorative therapy managed to combine the most recent notions regarding prevention, remineralization, ionic exchanges, tissue regeneration and repair, adhesion, for the purposes of reducing the negative effects of this disease as simply and as less invasively as possible. Thus, we can offer the patients a high degree of dental health, and this is an imperative objective for the medicine of the third millennium. The community of scientists and researchers in the field must increase its efforts of putting at the disposal of the clinicians, and even of the wide audience, the findings and conclusions of their work, so that we can replace intuition based dentistry with evidence-based dentistry. Those who finance the health system and who were reluctant when it came to paying the services provided via this strategy should try to reward physicians rather for the early detection of caries and the healing of the disease than for the treatment of late symptoms: cavity, death of the pulp and edentation. Such a change of paradigm is important because throughout the entire world the knowledge and manualized treatment requested by MID are provided via continuous medical education activities. Despite the fact that G.W. Black was the founder of 7
Editorial
restorative therapy, laying the foundations of a genuine base for restorative techniques, he also proved to be a genial visionary, foreseeing the future of cariology from 1910: “the day will come, of course, and maybe even during your lifetime, when the etiology and pathology of caries will be so well understood that we will be capable of fighting its destructive effects without genuinely
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restorative treatment”. This is why I consider that we can honor his memory, not by rejecting his initial concepts, but by getting to know and introducing in the didactic curriculum and in clinical practice the modern progress and trends that minimally invasive dentistry is part of. PhD Professor SORIN ANDRIAN
volume 13 • issue 2 April / June 2009
Editorial
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volume 13 • issue 2 April / June 2009
Editorial
Journal of Romanian Medical Dentistry
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