Patient care Continued »
changed, but the balance that he spoke about is just as impor- tant today as it was back then. Similarly he listed the treat-
ment options that are available to us: • Reshape • Reposition • Restore • Reposition bone (surgery). At first glance, the above
treatments look just to be a list of options, but if considered in this order at the treatment planning phase, it will enable us to practise truly minimally invasive dentistry. The concept of minimally invasive dentistry has been around since the 1970s, but the emphasis of this was solely on the biological aspects of patient care. More recently there has been a move towards minimally invasive cosmetic procedures with a much greater emphasis on orthodontics (repositioning), tooth whitening and simple bonding procedures (align- ment, bleaching and bonding). Most dentists have always
accepted that if the teeth are a good shape but in the wrong position, it is much more appropriate to move the teeth to position rather than to restore them into position. However, many patients
would refuse orthodontics because of the time it would take and the appearance of “train track” braces. This has spurred the development of other ways of moving teeth which are much more accept- able to patients. Lingual orthodontics, ceramic brackets and clear aligners, such as Invisalign, have become very popular, as has the Inman aligner which is removable, offers quicker treatment times and is less expensive (Figs 7 and 8). These are just a few of a number of systems avail- able today. Again, it is important to
understand that each of these is just a tool to help us in providing a comprehensive and appro- priate result. Straight teeth that aren’t biologically sound or don’t function properly are not
a satisfactory result. Orthodon- tics can also be an extremely important prerestorative treat- ment correcting gingival levels and minimising or eradicating the need for tooth preparation. Many patients will require a combination of treatment options to produce an accept- able result.
Summary With the development of improved, more patient- friendly treatments and the fabulous array of materials we have available to us today, we have never been better placed to practice minimally invasive comprehensive dentistry to fulfil the needs and desires of even our most demanding patients. However, we must remember that to achieve a great solution for any patient, it is critical that we listen to them carefully so that we may understand what an appro- priate result may be for each individual. At the same time, we must
have our own clear and well- defined goals such that we deliver a treatment that is maintainably healthy, structur- ally sound, functionally correct and aesthetically pleasing to that patient. Perhaps most importantly, we should remember that it is under- standing the timeless principles and overall concepts that will allow us to use the tools avail- able today or developed in the future for the benefit of our patients, keeping them happy and healthy for a lifetime and not just the next few years.
ABOUT THE AUTHOR
Ian Buckle is the director of the Dawson Academy in Europe offering a structured hands- on curriculum at his practice and teaching facility on the Wirral, close to Liverpool and Manchester, and in London. For details of this curriculum or for details of his latest lectures ‘An introduction to Occlusion’ and ‘Minimally Invasive Compre- hensive Dentistry’ (available at various locations throughout the UK), visit
www.bdseminars.com
Ireland’s Dental magazine 39 Fig 5
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