Operative Dentistry in a Changing Dental Health Care Environment

The introduction of adhesive techniques has brought a major shift in the concepts of operative dentistry. Additionally, the possibilities of working in a minimally invasive fashion when restoring a tooth or even of utilizing noninvasive interventions can allow practitioners to overcome the disadvantages of traditional restorative dentistry, such as the high biological price that is paid for such restorations in terms of increased loss of tooth structure and, in turn, the higher risk of pulpal complications. Because the desire for placing lifelong, lasting restorations is a goal that is almost impossible to achieve with all of the different types of restorations (including implants), preserving tooth structure is a crucial issue. As most of the first restorations in a nonrestored tooth are placed as a result of caries, which is mainly a lifestyle problem, prevention should always be the first option. Since carious lesions can be active or inactive, nowadays it is recommended that the practitioner be much more conservative with operative interventions. As a result, operative intervention is recommended only in those cases where a caries lesion is clearly progressed into dentin and are cavitated, as these cannot be kept clean as a result of biofilm formation.1