Composites Versus Crowns – Recall @ 6 months

Minimally Invasive Dentistry - Is It a One-Stop Solution?

There seems to be a popular trend in dentistry these days – minimally invasive dentistry (MID)! This encompasses composite restorations, porcelain laminate veneers, no prep additive dentistry. There was a paradigm shift in how we viewed our cases – instead of crowns everywhere, we started becoming more conservative in our treatment plans. Now, along with this, there started another trend, which is a little disturbing – brutal criticism of anybody who decides on a treatment plan involving crowns! Frankly…I am a little stunned, because while I appreciate the trend towards MID , it is not necesarrily a one-stop solution for all cases!

The issue with minimally invasive dentistry is, its additive and in most cases, there is no consideration of functional occlusion. Yes, anterior teeth do play a very important role in functional occlusion, apart from speech and esthetics. Its not only the posterior occlusion that counts! Anterior teeth play an important role in mutually protected occlusion (MPO), which is, only the anterior teeth contact in protrusive movement, disoccluding the posteriors and in lateral movements, there is contact only between the upper and lower canine with disocclusion of the posteriors. This is very important as this is how the anteriors protect the posteriors in excursive movements, and the posteriors return the favour in maximum intercuspation position (MIP).

Occlusion in Esthetic Cases? Yes, Always!

Whenever we decide to do any esthetic dentistry, we must first evaluate the existing functional occlusion. In most cases, corrections are required, and we are obligated to do it for our patients, for esthetics without function has no value. When we offer our patients minimally invasive dentistry, are we really communicating our treatment plan in the right way? For e.g. if we haven’t evaluated the functional occlusion, are our patients making a conscious decision in accepting the smile makeover we are offering them (through minimally invasive dentistry) that has no functional value?

When we start looking at our esthetic cases through the lens of functional occlusion, we realize that not all cases qualify for minimally invasive dentistry! When we do veneers, we add to the existing labial surface of anterior teeth, and by doing so, we straighten out the teeth which are mismatched in alignment, form etc. But what about the arch form of such teeth? Without touching the palatal surface, the arch form cannot be changed, and without changing the arch form, we cannot achieve functional occlusion in anterior teeth. Arch form matters! Not to mention, the added bulk on the incisal edge may not be comfortable to all patients and affect MPO.