In my opinion, we do harm when we do not avail ourselves of the most up-to-date devices and methods, which aid in the earliest possible diagnosis and intervene with the least invasive treatment, preventive or otherwise.

This book begins with a review of preventive techniques and current best practices with fluoride. The earliest signs of tooth decay can be treated with penetrating resins, sealants, and fluoride preparations when utilized early in the disease process.

Earlier diagnosis presents us with an opportunity to provide a better service, but only when we have the tools necessary for objective measurement and/or monitoring of the decay process. Several chapters of this book explain, in practical detail, devices, which far exceed the accuracy of the oldest dental instruments – the explorer and the dental bitewing X-ray.

The latest microbiological findings about caries are published here for the first time – shattering traditional concepts, not only in the discovery of novel causative species but also questioning current concepts of the anti-caries value of restorative materials. The potential of regeneration of dental materials is discussed by world-class researchers and clinicians.

Where caries has extended into the dental tissue, new methods of caries excavation and cavity preparation are explained and demonstrated in great detail by leading edge clinicians, based on years of real-life experience. The advantages of air-abrasives and all-tissue laser devices have been shown over the decades to be far safer on human teeth than the high-speed drills, which have been in common usage for the past 70 or so years. The time has arrived when we should be retiring the GV Black concepts designed for metallic restorations.

So, I invite you to read and study this book on Microinvasive Dentistry and challenge you to become part of the New Age in Dentistry.

Of course, my family and wife, Karen made the greatest sacrifice of all-giving up family time with me, somehow we made it through, but many thanks to her and our children and grandchildren.

No work of this breadth could be produced by just one individual. Fortunately, my professional career has taken me both far and wide – far in the aspect of being invited all over the world to share my knowledge and experience in the practice of Laser Dentistry, and wide in the aspect of being in the frequent company of so many talented dentists and health professionals especially in these past 30 years.

I am eternally grateful to the many contributors to this book. Their contributions to better dentistry are awesome.

I also must inform you that many of the contributors are my fellow members of the Academy of Laser Dentistry. As a founding member and Past President, I am so grateful for the insight and foresight of so many members who not only inspired this text but contributed to the formation of many of its ideals and aspirations.

The dental explorer, mirror and high-speed handpiece remain as the standards of care. If so much change for the better in materials has taken place, why have most practitioners held onto outmoded techniques of diagnosis and treatment? Why is speed of delivery so important to the average practitioner? If less invasive techniques have been shown to produce less destruction to tooth structure, why haven't they been implemented?

Perhaps there is truth to the adage: dentists have been overly trained and poorly educated! Is it so difficult to change the way every dentist has been trained? If we subscribe to the Ethical standard of “DO NO HARM” why do we find it so hard to understand that tried and true methods may no longer be the right thing to do?

Over the past 25–30 years, there have been technological and clinical developments in dentistry, which have not become fully integrated on the delivery of routine restorative care.

Part of the cause of this is the reluctance of Dental Schools and General Practice Residency Programs to introduce many of these new technologies to their students. Rightly asked, “Why Not?”

In defense of these programs, it might be argued that the teaching staff has not been exposed to these technologies either and how could students be possibly taught by those who not yet learned themselves. Another reason is that many of these technologies are costly, and institutions are already under fire with budgetary constraints. But unfortunately, the idea of a “slower” diagnostic process, or slower treatment modalities have no obvious compelling economic benefit to the practitioner.

If we still subscribe ethically to the “do no harm” principle, then the information and evidence is there to support the idea of utilizing the most accurate techniques in diagnosis as well as treatment modalities.

In nearly 50 years of practicing dentistry, I long ago moved away from many of the principals and techniques taught in my undergraduate program. Many of those techniques and principles I questioned even then, and later came to realize that certain techniques were merely taught so as to have the entire class able to pass both required proficiencies and board exam requirements. Continuing education experiences (nearly 4,000 hours and 2 Masterships) over my career began to reshape my techniques and knowledge base. The plethora of new materials and technologies introduced during my professional career also has heavily increased my questioning of how and why. To date, there has been too little written concerning these developments. Many long-standing principles of practice have been challenged under the “medical model” scenario or the move to evidence-based care.

Beyond the cost and ethical dilemmas, what about serving the patient better? All dentists lament the fact that only about half of the population seek care on an annual basis. Why? Every dentist also has heard the two most frequent barriers to care: The “Shot” and the “Drill”. Would there be an increase of patients seeking care if both of the main objections to care were eliminated? (other than obvious economic barriers)

Most practicing dentists surveyed, indicate a lack of familiarization with the more accurate diagnostic and treatment options available to them. This seems so true despite the constant flow of device advertisements in the dental literature.

The purpose we hope to fulfill with the publishing of this textbook is to familiarize General Restorative Dentists with the updated information about these devices and how to practically incorporate them into practice. If adopted, as some dentists have already, that the incorporation of the devices in this book will increase their ability to make earlier diagnoses, make more evidence-based decisions and better educate their patients in their disease management. A bonus would be to do less iatrogenic damage to the dentition, with methods that are far more acceptable to the average patient. The net benefit to the population is earlier treatment, more scientific management and far more patients seeking this type of care. This can have a major impact on the “busy-ness” issue for many offices and clinics. There is little controversy that the smaller the restoration, the longer the tooth will most likely survive for a lifetime.

When should sealants be placed? What are the best practices for sealant preparation? Clear sealants versus opaque. Fluoride release materials versus plain unfilled resin? How do you accurately determine if a sealant is indicated or a restoration? What happens if caries is present and teeth are sealed over decay? Are they worth doing at all?

Is there a way to cause melting of the sides of a fissure and coalesce the walls as a “natural” sealant? Which device could be used for this technique? Within this text, you may find the answers.

Transillumination with white light has been utilized for many decades. This technique has inherent limitations due to the weakness of white light to transmit through tissue deeply.

New devices currently available utilize near-infrared light that is invisible to the naked eye. However, one property of near-infrared is potentially deeper penetration into both hard and soft tissue than white light. One such device transmits this infrared light through gingival and osseous tissue and then through the roots of teeth and into the crown. A miniature infrared camera (similar to a night vision device) records this phenomenon in real-time and display an X-ray like image on a computer monitor. Besides being much more sensitive than an X-ray, the images can be saved to the patient's record. One reason that it is more accurate is that the beam travels up the root and into the crown of the tooth contrary to the penetration of an X-ray. This change in angulation of the “beam” in conjunction with visualizing a bitewing X-ray will have an almost 3D appearance. Other advantages of this type system is being able to better visualize the extent of decay in both the enamel and the dentin; the exact location of the lesion in a buccolingual dimension is also easily determined; seeing cracks in both the restorations and the enamel; imaging decay under a composite restoration or lingual or buccal to an existing metallic restoration. This is usually completely blocked in an X-ray image.

No inference should be drawn that bitewing X-rays do have value in finding other types of pathology such as alveolar bone levels and calcification density.

There have been introduced a number of simple diagnostic devices which utilize various wavelengths of light. They have been demonstrated to more accurately pinpoint the extent of carious progression into both decay and dentin. More sophisticated devices can analyze lesions for decalcification. Others measure the column of bacteria in a pit or groove base utilizing the principle of laser fluorescence.

The digital age of miniaturization and high definition has enhanced what we can see in real time. Intraoral video cameras have come a long way since their first introduction in the 1980s. Not only is this methodology important to the diagnosing dentist but it is also a very essential element in the education of patients. While these cameras are justifiable in the hygienist's hands, it is also essential that the diagnosing dentist record and present these images to the patient for their understanding and treatment acceptance.

Other cameras utilize specific wavelengths of light to highlight bacterial concentrations, plaque accumulation, etc. One such camera system (SoproLife) allows for differentiation of normal structure from carious both pre- and intraoperatively. Use of this system could make the messy dyes commonly used for decay visualization unnecessary.

The operating microscope has gained favor with the endodontic and surgical specialties. How long will it take the average dentist to adapt to this higher standard of magnification?

A clearer understanding is needed foir practitioners for this disease to become eradicated or at least better treated.

More than 70 years ago, an air abrasive device was introduced to the profession. While reports at the time indicated general acceptance by both practitioners and patients, the technique did not facilitate retention of the restorative materials – amalgam and/or gold. Both of these materials require mechanical retention with undercuts.

The nature of air abrasives does not create mechanical undercuts sufficient to mechanically retain most materials. A re-introduction of the devices met with good acceptance in the 1990s for bonded restorations. The manufacturers failure to control the airborne particles has led to abandonment by most practicing restorative dentists. Newer techniques of particle management require another look by practitioners. The adherence of materials to an air abraded surface is significantly improved, and highly recommended.

Enamel, on the other hand is non-living structure. It is crystalline in structure, with protein sandwiched in between the crystal prisms. In attempting to re-create it, researchers have tried any number of techniques. Unfortunately, formative ameloblast cells are lost as teeth erupt into the oral environment. This has somewhat hampered research. Chemical, electrical means and lasers low-level have been used in the regeneration trials. More work is indicated in the quest to develop more natural restorations.

Could enamel be re-grown in situ? Is this the future of restorative dentistry? This has already been done in the laboratory, but can it be done intraorally? Please see the Chapter 19 to find out how stem cells stimulated by photobiomodulation may hold the key to completely replacing lost enamel.

Although beyond the scope of this text, there is ongoing work on the use of stem cells to re-populate the pulpal space with functioning tissue. This has the potential to markedly change endodontics.

This type of treatment is now known as Photobiomodulation.

Today's technological explosion has had a major impact on the practice of medicine. To a far less extent, this explosion has been much less on the practice of dentistry. Some of the reasoning is the isolated nature of dental practice, and some is the economic burden on the individual practitioner. Dentistry does not command the fee levels that medicine and hospital care command. Reduced fee programs have a negative effect on new equipment purchases.

Where the tried and true methods have proven less than adequate or prevent patients from accessing care, they should be replaced.

No one practitioner could or should employ every technology or methodology mentioned in this textbook. If every practice implemented just one of the technological changes in diagnosis or treatment, the impact on patient care could be demonstrably better.