BIOMIMETIC DENTISTRY: Minimally Invasive Dentistry - Less is More
by Dr. Howard Golan and Dr. Alex Shvartsman

A growing trend across all disciplines of dentistry is Minimally Invasive Dentistry also known as Conservation Dentistry. Minimally invasive dentistry is one of the principles of Biomimetic Dentistry. New technologies like Advanced Magnification in the form of Prism Loupes and Surgical Microscopes combined with Air Abrasion, Tooth and Gum Lasers and Specially designed micro-drills allow Dr. Golan and Dr. Shvartsman to remove tooth decay and cracks in teeth with pinpoint accuracy. They make every effort to preserve the healthy parts of your teeth.

Advances in bonding technology over the past 30 years have allowed dentists to replace silver-mercury metal amalgam fillings with more tooth-conserving tooth colored resin-composite fillings. Traditionally, in order to place a metal filling, the decay is removed and in an effort to keep the filling from falling out, the base of the cavity is widened. Often grooves, undercuts, troughs and boxes are cut into healthy tooth structure. Another popular technique is to place pins in teeth by drilling deeper into the tooth in an effort to help to retain non-bonded fillings. These approaches may further weaken an already compromised tooth leading to fracture, or the need for root canal treatment. In contrast, when placing a bonded resin-composite filling, after all the decay is carefully removed, the filling is bonded into place without any additional damage to the tooth. Dr. Shvartsman and Dr. Golan are mercury-free dentists that do not use silver-mercury amalgam fillings and avoid tooth destructive auxiliary retention procedures.

A filling, even a bonded one needs a certain amount of tooth structure to be placed directly in the tooth. When the tooth is drastically weakened by tooth decay, trauma or fracture an indirect (made outside the mouth) restoration is needed to replace the missing part of the tooth. Originally cast gold was used. Cast gold restorations can be very tooth conservative and fit well into the minimally invasive dental philosophy. Unfortunately, due to its color many patients find gold teeth objectionable. When in the 1950's porcelain bonded to metal became available, the majority of dentists switched to porcelain bonded to metal crowns as their main indirect restoration of choice. This is unfortunate, because by design, the tooth has to be drilled down to a pointy nub in order to fit a crown. Esthetics won over tooth conservation. Even when healthy parts of the tooth remain, a crown preparation dictates that the entire top of the tooth is drilled off as well as 360 degrees all around. To make matters worse, many dentists place the rim of the crown under the gums, often creating chronic gum inflammation, which is very unhealthy. Fortunately, along with bonding, stronger porcelains have been developed. Today, dentists like Dr. Golan and Dr. Shvartsman, who embrace the minimally invasive dental philosophy, offer their patients conservative porcelain restorations that only replace the damaged or weakened part of the tooth. Their porcelain restorations fit like jigsaw puzzle pieces into the tooth and are bonded with dental adhesives.

Minimally invasive dentistry with tooth conservation as its core tenet means less drilling. Drs. Shvartsman and Golan have found a large decrease in the need for root canal therapy using this minimally invasive approach. In addition, when removing decay, both doctors use high magnification, a special decay indicating dye and in very deep areas a Laser to precisely remove only the decayed part of the tooth. In contrast, all dental students in every dental school are taught the "poke around" method in finding tooth decay. We call this "poke and pray." Tactile sense is subjective. It's basically an opinion. What feels sticky to one dentist may not feel sticky to another. And what if the dentist does poke in the right spot? We believe much decay can be left without decay disclosure. This is evidenced by us finding many teeth with decay left under the fillings. Proper decay removal, tooth disinfection and sealing the tooth against bacteria can also minimize the need for root canal treatment.

Unfortunately, when the nerve in the tooth dies, root canal treatment is indicated. Here too the minimally invasive approach is needed. Root canal treated teeth are more brittle and are more prone to fracture than live teeth. Think of it this way: a live branch bends, while a dead branch cracks. Teeth are similar in this way. That is why Dr. Shvartsman and Dr. Golan make every effort to preserve as much of the tooth's internal structure during root canal therapy. By using surgical dental microscopes, they are able to treat teeth more conservatively.

During a time when bonding technology did not exist, posts were needed to help rebuild weakened teeth. The primary purpose of a post is for mechanical retention of the synthetic core of a tooth, so that traditional porcelain fused to metal crown can be placed. The trouble is, posts add additional stress to the tooth increasing its fracture probability. In addition, sometimes posts that are placed incorrectly can perforate the root causing infection and loss of the tooth. Some dentists always place a post following root canal therapy whether it is needed or not. In the era of bonded dentistry, posts are the exception rather than the rule. Dr. Shvartsman and Dr. Golan rarely use posts for two reasons: 1. They bond the core filling to the tooth without making the post obsolete. 2. They simply do not restore teeth with traditional crowns unless the tooth had a crown to begin with.

Alex Shvartsman, DDS, FAGD is located at 260 E Main Street, Suite 109, Smithtown NY, 11787. Call Dr. Shvartsman at (631) 361-3577 or visit www.SmithtownSmiles.com. Howard Golan, DDS is located at 369 Old Courthouse Road New Hyde Park, NY 11040. Contact Dr. Golan at 516-627-1687 or visit www.golanfamilydentists.com