Get Ready for Minimally Invasive Dentistry!

Minimally Invasive Dentistry, (MID), is an approach to conservatively treat your dental problem(s) while preserving your natural tooth structure. In many cases we can do these procedures without an injection. Also, to appreciate and benefit from Minimally Invasive Dentistry you don’t have to be from the high-rent district!

My Early Experiences with MID Treatment: My exposure to Minimally Invasive Dentistry began before entering dental school. In 1977, thanks to my father, Dr. Leonard L. Portnoy, I was fortunate to get an opportunity to be employed by one of the pioneer manufacturers of bonded dental fillings for Minimally Invasive Dentistry. The owner of that dental materials manufacturing company was Dr. Henry Lee, a former polymer chemist with NASA. After establishing his own polymer business, he produced one of the original bonded filling materials sold to dentists by “Johnson & Johnson” under the brand name “Adaptic”.

In my job, in the research and development department, I had an opportunity to operate a Scanning Electron Microscope, (SEM), which is used to study the wear and tear on dental restorations. Here are two examples of the amazing images we were able to capture with the SEM.

Scanning Electron Microscope images of (l) enamel, the outside of the tooth, ready for bonding; (r) dentin, the inside of the tooth.

In the past 30 years: We have seen several generations of state-of-the-art bonding materials come into use due to continued research & development. Today we have materials based on nano-molecular bonding that are designed to adhere to the outside enamel of a tooth as well as the dentin.

For those interested in more details of bonding technology, I refer you to an excellent history/state-of-the-art report.

Sample Case 1: Here is a patient who presented with a defective silver filling.

(l) old filling had open leaky margin causing decay.(r) tooth restored with minimally invasive bonded restoration.
NOTE: color match is not perfect compared to the full crowns on either side, but tooth structure is preserved.

Sometimes a slight gray area can be seen under the minimally invasive bonded fillings. This is usually from a previous silver filling that left a gray shadow in the healthy tooth structure; or from some other dark area within the tooth. Although we could eliminate those esthetic issues with full crowns, (as can be seen on the adjacent teeth), those teeth required a more extensive and costly preparation.

Sample Case 2: Here is a patient who wanted to improve his smile. We developed a minimally invasive treatment plan that conserved his natural tooth and came close to a perfect match with conservative treatment of the adjacent front teeth.

(l) tooth spaces & front crown with poor color match;
(r) crown replaced to match natural tooth & conservative veneers to close the spaces

Sample Case 3: Here is a patient who lost part of an old silver filling. Because the remainder of the silver filling was in acceptable condition, that good portion was left intact. The part where the filling was lost was replaced with a nano-technology white filling that bonds very effectively to the tooth structure. Minimally drilling was involved. The patient was told that she could always go with a full crown in the future if it becomes necessary.

Intra-oral, close up camera: Part of the ability to successfully perform minimally invasive dentistry is to have excellent, close-up visualization of the tooth. Over the past several years, I have developed an intra-oral dental camera to help in the diagnosis and treatment of your dental problems.

(l) sterilizable dental camera (developed by Dr. Portnoy); (r) example of the magnification achievable.

Conclusion: Bonding can produce effective restorations of the tooth while preserving tooth structure. In most cases, these restorations can be satisfying treatment option.