CONSERVATIVE DENTISTRY

1) NON-INVASIVE TREATMENT OF INITIAL CAVITIES:

Initial cavities are hidden caries lesions still at early stage without the collapse of the tooth enamel. These non-cavitated caries lesions could occure in the pits and fissures of teeth. In this case, we recommend a non-invasive approach using regular tooth cleaning, applying local flouride varnish  or sealing the pits and fissure with a sealant.  Currently, a non-invasive approach to the management of non-cavitated occlusal caries lesions appears to be the most ethical since no restoration can be considered permanent and will ultimately need to be replaced. The replacement of a restoration often involves additional tissue loss that in turn affects the long-term prognosis, the vitality and longevity of the tooth. 

Initial cavites could also occur in the proximal surfaces of teeth. In this case, we recommend a micro-invasive approach using Resin infiltration therapy. This ultraconservative treatment option is highly recommended by the German society of conservative dentistry to arrest and to camouflage non-cavitated proximal caries lesions that virtually bridges non-invasive and restorative treatment options.

2) MINIMALLY-INVASIVE CAVITY TREATMENT:

If a non-invasive approach  is no longer  recommended due to the progression of the caries lesion, one can always resort to a minimally invasive restorative approach. Invasive treatment should only be provided when the potential to halt the progression of the caries process has failed or when the residual tooth tissue is weak and at risk of fracture. Clinically, therefore, the threshold for restoration usually corresponds to a level of caries progression reaching the middle third of the dentine and/or the occurrence of definitive cavitation through the overlying enamel. 

3) MANAGEMENT OF DEEP CAVITIES:

Deep proximal cavities extending below the gum level are challenging to handle due to the limited access, the difficulty to isolate and the subsequent persistent saliva, cervical fluid and bleeding. The conventional approach includes orthodontic extrusion, surgical exposure of the cervical margin, or a combination of both techniques leading to an apical displacement of supporting tissues to access the subgingival margin. These techniques may cause further attachment loss and exposure of root concavities and furcations to the oral environment, dentin hypersensitivity, and unfavorable crown to root ratio as well as compromised esthetics. Additionally, this process may often delay the delivery of the final restoration.

As a conservative approach, we recommend deep margin elevation (DME). Deep margin elevation is a technique used to manage subgingival deep carious defects. The procedure involves raising the margins of the restoration by placing them more coronally. Proper isolation is maintained after caries removal, a compatible material is layered to create a relatively elevated margin. In this procedure, adequate magnification, illumination and proper isolation are the key to success.

4) MICRO-INVASIVE TREATMENT OF WHITE SPOTS:

Resin infiltration therapy is a micro-invasive approach to treating white spot lesions. It provides therapeutic and esthetic results, while minimizing the extent of invasive interventions such as veneers and crowns. This treatment technique is designed to be an ultraconservative alternative option to other esthetic treatments.