Minimally invasive treatment forms: Treatment in changing times – Yesterday and today

When we look back on the 1960s and 1970s, the daily routine of our dental colleagues was overloaded with "drill and fill". Dental emergencies and acute pain were the predominant conditions treated in a dentally underserved population. These dynamics prevailed for years due to the lack of awareness and understanding of proper oral hygiene. Several education and prevention initiatives were launched by dental professionals to eliminate these conditions.

These measures began to take effect in the 1980s, when a significant decline in tooth decay among adolescents was reported. Periodontal therapy became the central focus of dental treatment. These initiatives resulted in significantly better oral health conditions and gave a growing number of dentists the time needed to replace restorations fabricated according to older techniques with higher-quality and longer-lasting restorations. The 1990s were also characterized by high-quality crown and bridge restorations, but more attention was placed on the fundamentals. The focus of research was on endodontics, augmentative periodontology and implant dentistry, and these areas were revolutionized by new treatment approaches and instruments. The improved treatment options and the shift from pain management to prevention and early intervention were accompanied by a rise in patient expectations. Dental treatment was transitioning from "need-based dentistry" to "want-based dentistry. Prevention, early diagnosis, minimally invasive therapy and aesthetic dentistry are the central focus of dental treatment concepts today.

The treatment field has become more demanding and more interesting. In former years, the cause of pain had to be filtered out of a whole host of pathologies in the same patient (e.g., multiple profound carious lesions with endodontic involvement and persistent periodontal disease) whereas today, early diagnosis is the primary goal of the diagnostician. Accordingly, the demands placed on our diagnostic tools and strategies have also changed. Whereas assessing the viability of diseased teeth used to be the main focus of initial radiological diagnosis, the quality of imaging techniques is now focused on primary lesions (D1 caries lesions). Lesions should be diagnosed before they become visually apparent. Caries diagnosis systems commonly used today are based on laser measurements (DIAGNOdent, KaVo), fluorescence luminescence in diagnostic microscopes (in experimental stages in vivo), and digital radiography with specific analytical software programs (Dürr, Gendex, Trophy).

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