Dental Asia Nov/Dec 2018

Under the Spotlight DENTAL ASIA NOVEMBER / DECEMBER 2018 16 “I found my path. I found my passion. My passion was not about me but about others, helping others as much as my mentors have helped me by empowering them with knowledge and information. Now, having done this for 42 years, I value the relationships that I’ve built with manufacturers, being a peer reviewer for major articles and helping others find their way – that is my passion,” he surmised. In addition, Dr. Milnar does not consider himself solely as an Aesthetic or Cosmetic dentist but rather as a family dentist. His heart has always been with families because he likes to communicate and take time in building relationships with his patients and their families. “I want to know the children, parents and grandparents – the whole family. I do cosmetic work but I do family dentistry every day.” Principle of Minimally Invasive Dentistry Dr. Milnar encountered Minimally Invasive Dentistry (MID) not in school but on his journey of improvement as a clinical practitioner and educator. He revealed that during his time in school, MID was not practiced and they were doing the complete opposite. “I came from the old school dentistry track where we amputated everything. It was civil war dentistry; we didn’t care about tooth structure. We were authorised to reduce teeth and we were graded on it. If we did not remove enough tooth structure, we would fail,” he recounted. It was not until recently, while studying with scholars and reading articles, that he understood the concept of ‘less is more’ and ‘less is better.’ Applying MID into his practice gave him more options with procedures while preserving tooth structures. Further, he remarked that incorporating MID into a patient’s Smile Design is favourable; dentists have fewer smile components to recreate, making it more manageable and achievable. Strategies and techniques in MID According to Dr. Milnar, MID begins with proper diagnosis and prevention. It is important to identify the cause in order to avoid further destruction or damage. “Minimally Invasive Dentistry does not start with the removal of tooth structure but by first identifying pathogens and acid-producing bacteria and buffering them so they will not cause destruction. We need to deal with the oral environment before we use our handpiece. A stable oral environment means less drilling and less removal of tooth structure,” he explained. One technique Dr. Milnar highlighted is that of detecting a patient’s saliva pH in order to restabilise the alkalinity to a neutral pH. This is compared to taking a patient’s blood pressure to determine if one has high blood pressure. “I always check the saliva pH of a patient before I touch a tooth or do any procedure. This is my way of applying MID in my practice. This helpsme inform the patient if they have a high risk factor for decay which should be controlled before it worsens, as it has the potential to affect the long-term success of restorations,” he added. Achieving MID can be challenging, but having enough knowledge and information and sharing it with the rest of the team can benefit the dentist in the long run. It is important to note that the dental staff spends more time with the patient than the dentist, and they are the first and last person the patient encounters in the dental clinic. Aside from educating the staff, Dr. Milnar believes in educating and communicating with patients. “Risk factors go hand-in-hand with MID – they complement each other. After I educate my staff, they share the knowledge with the patients. Chances are, nobody has ever talked to them (patients) or communicated these new tools (checking saliva pH) before. For me, this is empowering. I make more money by doing less dentistry,” said Dr. Milnar. He added that having the proper tools and materials is beneficial for attaining MID. As his preparations are smaller andminimally invasive, he needs to have new materials and tools that can reach into small or even minute spaces/areas such as injectable/ flowable composites and smaller burs. “I need proper instrumentation which I can handle to get into micro crevices. I needed to retool my brain, my materials and my practice and then I needed to retrain my staff in order for them to understand what I am doing and why. Therefore, when I step out of the room, they can explain procedures to patients,” he explained. Product selection As Dr. Milnar said, retooling is required in MID, which means having the appropriate materials, products and equipment. Hence, selecting products is an important step for producing favourable and successful restorations or prosthesis. For product selection, the first thing he looks at is handling. He views the full dimension of product development from the beginning to the end before he starts using it. Dr. Milnar learned that when he tests a newmaterial, he needs to have trial rounds with it. He uses the material in all kinds of procedures to keep on practising and to get the feel of how the material works. “We must understand that products or materials are just like golf clubs; not everybody uses the same golf clubs. Everybody has a personal preference, likes and dislikes. Trying out materials is like playing golf. We need to keep practising to know every step and sequence when using the material.” New bioactive products In his search for new materials, Dr. Milnar realised that there were no pink bioactive (forms a tight seal between tooth and restoration to prevent microleakages, promotes remineralisation and apatite formation while being biocompatible in the oral environment) composites to be