Conservative Dentistry: Are We There Yet?

Damon Adams, DDS


The buzz on minimally invasive (MI) dentistry continues to grow. In our cover-featured article, we are proud to share the outstanding work of Dr. Jose-Luis Ruiz, who is passionate about practicing and promoting MI dentistry. He leads by example in his lectures, hands-on courses, and in his own clinical work. I have observed that many other clinical leaders are teaching and practicing MI techniques, having left more aggressive preparation paradigms in the dustbin of their own dental history. However, how does the world of “clinical leaders” compare to the everyday world? Frankly, if one walks randomly into any number of US dental laboratories and looks in the case pans, a different sort of reality becomes apparent—the vast majority of “everyday work” consists of full-coverage crowns with subgingival margins. While one cannot determine how many of these cases could have been more minimally prepared (without a full dental history and findings), it is safe to assume that many of these designs could have been approached more conservatively. This reflects an ongoing challenge that was highlighted by Dr. Gordon Christensen in CLINICIANS REPORT (June 2013); surveys showed that full-coverage crowns are “the most popular lab-fabricated restorations in North America, accounting for 98% of all the indirect restorations placed. Only 2% of restorations are partial-coverage in design.”

Why is this still the case? Is there a lack of willingness to learn and to implement the latest MI techniques? Are many doctors imprisoned by an insurance business model or a corporate dentistry model that demands high production/profits? The profession needs to address this matter, because an honest assessment will show that, when it comes to widespread MI implementation, dentistry is not there yet!

Also this month, Dr. Tarun Agarwal showcases advancements in technology and materials for implant cases; Dr. Michael Koceja describes a high-tech approach to a common surgical procedure; Tom Limoli defines the “point of the transaction”; Dr. Ben Miraglia shares a multidisciplinary case approach; Dr. Craig Misch discusses management of vertical bone defects; Drs. Ali Nasseh and Dennis Brave talk about advances in endodontic instrumentation; Dr. Paresh Patel outlines the latest prosthetic approaches for edentulous arches; and Dr. Alan Weinstein compares 2 different classes of dental cements.

In our peer-reviewed CE selection, for 2 MAGD/FAGD CEUs, Anne Guignon, RDH, and Dr. Brian Nový discuss the management of dry mouth syndrome.

Please enjoy this issue of Dentistry Today!