Minimally Invasive Dentistry

Classical crowns rely on retention and resistance form: the tooth is shaped with a drill so the crown holds on mechanically. They work, and they still have their place. Bonded restorations are glued to the tooth instead, so far less needs to be removed, and sometimes nothing at all.

Minimally invasive dentistry is that second approach practised as a discipline: treat only what is damaged or diseased, bond the restoration to what is left, and leave healthy tooth alone. Your teeth are living structures, and every millimetre kept is a millimetre that never needs rebuilding later.

Biomimetic means to mimic biology. Each layer of a bonded restoration is matched to the tissue it replaces: composite where dentin was lost, ceramic where enamel was. The idea is borrowed from engineering. Cars have crumple zones: the part designed to fail protects the passengers. In a bonded tooth, the restoration is that part. Stronger is not always better, because a restoration far stiffer than the tooth passes the load into the root.

The key to a lasting bond is sealing the freshly cut dentin immediately, before impressions are taken, rather than weeks later when the final restoration is fitted. It protects the tooth in between and produces a much stronger, more durable bond.

It is the difference between a bond that lasts and one that does not, and it is why the sequence of a visit here is planned around it.

Front teeth. A broken incisor with very little tooth left under its old crown, rebuilt with immediate dentin sealing and a bonded porcelain restoration instead of a root canal, a post, a crown and crown lengthening surgery, still in place after more than twenty years. Teeth shortened by acid erosion, restored through a mock-up the patient approved first, with thin frontal-path veneers, twenty years on.

Back teeth. A molar with almost nothing above the gum, where the usual plan would be a post and crown or extraction and an implant, rebuilt with a bonded overlay: composite replacing the lost dentin, the overlay bonded with warmed composite vibrated into place. No post, no crown lengthening, functioning perfectly at five and a half years. Both are shown step by step in the guide to rebuilding damaged teeth.

Both are excellent, and both can break. What matters is how they break. In fatigue testing on root-treated molars with a 3 mm overlay and no post, failures stayed within the restoration and the dentin seal held. A broken overlay can be replaced; the tooth underneath survives.

Porcelain is stronger and more wear-resistant, keeps its colour and polish, and is Dr. Reshad's usual preference further back in the mouth; it is stiffer, so in extreme overload a fracture can take tooth with it. Composite acts as a shock absorber and protects the root, is kind to opposing teeth and easy to repair, and is useful nearer the front and for heavily compromised teeth; it wears and stains more over time.

If you have been told you need a crown, a root canal or an extraction, a bonded restoration may do the job with far less of your tooth removed. But bonding needs healthy dentin, a dry field and a manageable bite. Some teeth are too broken down, and for them a crown, a post or gold is the treatment that will actually save the tooth. Dr. Reshad practises both approaches every week, so the choice is made for your tooth, not for a technique.