Rescuing Teeth with the Least Invasive Approach

Published Date 06/23/2020
 

Rescuing Teeth with the Least Invasive Approach

Minimally invasive dentistry, which I define as the biological approach of conserving healthy tooth structure in the restoration of a tooth, is the cornerstone of our practice in New York, NY. I believe it is important for dentists to take note of this approach for a very simple reason: Conserving a patient’s healthy tooth structure will not only extend the life of the tooth, it will prevent more expensive and invasive dental procedures in their future.

In other words, when a patient gets a sealant or a PRR (preventative resin restoration), that prevents them from needing a filling, which several years later could become an onlay or a root canal, post, core, and crown. That tooth, once root canaled, then has a poor prognosis, because it’s a weakened tooth. It may ultimately need an extraction and an implant. Simply put, this type of minimally invasive dentistry prevents multiple procedures being done in the future on that particular tooth.

We take direct restorative approaches whenever possible in our practice. Recently, I saw an 8-year-old boy who suffered a fractured upper front tooth in a sports injury. A bonding was done, as this was the most minimally invasive procedure as compared with the options of a veneer or crown. The parents and patient were advised of the postoperative care needed to preserve the restoration. They were also advised of the possible future need for a procedure such as a veneer, but first, a minimally invasive option was offered. This could last several years without needing another restoration for such a young patient.

The Coverage Hitch

One reason many clinicians do not follow through on more minimally invasive practices is the lack of third-party coverage for these procedures. For example, sealants are only covered up to a certain age, and PRRs are sometimes limited according to a patient’s plan. Also, some third parties may only cover crowns instead of inlays or onlays, and the patient may opt for the crown because it’s covered, even though it takes away good healthy tooth structure in its preparation. It’s often difficult to convey the importance of the treatment to the patient when something is not covered by their insurance. We must discuss going out of pocket for a procedure that is better for them.

Avoiding the Drill & Fill

On the bright side, advances in materials are helping us achieve our goals. For example, when patients with cavities interproximally are placed on a high-fluoride regimen, we have seen that it will remineralize their cavity within 3 to 6 months, when decay is approximately 1 to 1.5 mm into enamel. This is a huge benefit for these patients because it rescues them from having their teeth drilled and filled, followed by years of maintenance.

The CEREC technology that I’ve used for the last 10 years has also allowed me to practice minimally invasive dentistry by removing only diseased tooth structure. Patients benefit from a conservative onlay or inlay, as opposed to a 360 degree preparation for a crown. This preserves a great deal of tooth structure that would otherwise be prepped and lost for good. If we can save healthy tissue, we’re doing our jobs well.

 

Sharde Harvey, DDSSharde Harvey, DDS, is a general dentist with extensive training in full-mouth cosmetic rehabilitation. A 2004 graduate of the New York University College of Dentistry, she has been in practice for over 15 years. Her practice, Upper East Side Dental Innovations in New York, NY, provides a full range of cosmetic, restorative, and general dental services for patients of all ages in Manhattan.

 

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