CDE0211

06 I I MICD _ occlusal force management _The minimally invasive (MI) concept wasini- tially introduced in physical medicine and adopted into dental medicine in the early 1970s with the application of diamine silver fluoride to teeth.1 This was followed by the development of preventive resin restorations (sealants) in the 1980s2 and the atraumatic restorative treatment (ART) approach3 with Carisolv (MediTeam) in the 1990s.4 Since its inception, the focus of MI dentistry has been caries detection and treatment.5 It has not yet been comprehensively adopted in other fields of dental medicine; however, the comprehensive con- cept of minimally in- vasivecosmeticden- tistry (MICD) and its treatment protocol were introduced in 2009withthebasic aim of a clinician effecting optimum clinical therapeu- tic improvements in smile enhancement, while performing cor- rective procedures that requireaslittleclinicalinter- vention as possible.6 Additional guidelinesforMICDtreatmentare: _the adoption of the “Do No Harm” philosophy to maximise possible preservation of healthy oral tissues; _the proper selection of appropriate dental mate- rials; _the use of supportive procedure methodologies that offer clinicians an “evidence-based” treat- ment approach that will reliably improve treat- ment outcomes. With respect to smile design, the interven- tion level of a selected MICD treatment will depend on the types of smile defects present, combined with the subjective perception of the patient’s own pre-treatment smile condition (Figs. 1a & b). Some of the more common smile defects are: _presence of diastemas; _discoloured teeth; _worn and flattened incisal edge contours; _missing teeth; _rotated and misaligned teeth; _teeth internally stained by fluoride or through childhood disease; _gingival absence, leading to visible “black trian- gles”; _uneven crestal gingival heights; _maxillary and/or gingival excesses resulting from altered passive eruption; cosmeticdentistry 2_2011 Fig. 1a_A smile defect of discoloured teeth and presence of a diastema. Fig. 1b_Four anterior veneers placed to improve smile defects. Fig. 2_Smile Design Wheel that incorporates patient psychology, health, function and aesthetics. Healthy and harmonised function via computer-guided occlusal force management Author_ Dr Robert Kerstein, USA Fig. 1bFig. 1a Fig. 2