I special _ smile design Minimally invasive cosmetic dentistry—Concept and treatment protocol Author_ Dr Sushil Koirala, Nepal _Introduction _Increased media coverage and the availability of free web-based information has lead to heightened public awareness and thus to a dramatic increase in patients’ aesthetic expectations, desires and demands. Today, a glowing, healthy and vibrant smile is no longer the exclusive domain of the rich and famous and most general practitioners are forced to incorporate various aesthetic treatment modalities in their daily practices to meet this growing demand. The treatment modalities of any health-care service are aimed at the establishment of health and the conservation of the human body with its natural function and aesthetics. The concept of minimally invasive (MI) treatment was initially introduced in the medical field and was adapted in dentistry in the early 1970s with the application of diamine silver fluoride.1 This was followed by the development of preventive resin restorations (PRR)2 in the 1980s and the atraumatic restorative treatment (ART) approach3 and Carisolv4 in the 1990s. The major components of MI dentistry are the risk assessment of the disease with a focus on early detection and prevention; external and internal re-mineralisation; use of a range of restorations, biocompatible dental materials and equipment; and surgical intervention only when required and only after any existing disease has been controlled.5–11 Fig. 1 Current basic treatment protocols (TPs) and approaches in MI dentistry are the use of air abrasion, laser treatment or sono abrasion to gain cavity access and excavate infected carious tooth tissue through selective caries removal or laser treatment;12,13 cavity restoration by applying ART, PRR, or sandwich restoration; and the use of computer controlled local anaesthesia delivery systems14 with emphasis on the repair of a failed restoration rather than its replacement.15 Thus far, the focus of MI dentistry has been on caries-related topics16 and has not been comprehensively adopted in other fields of dentistry. Dr Miles Markley, one of the great leaders of preventive dentistry, advocated that the loss of even a part of a human tooth should be considered a serious injury and that dentistry’s goal should be to preserve healthy and natural tooth structure. His words are much more relevant in today’s cosmetic dental practice, in which the demand for cosmetic procedures is rapidly increasing. With the treatment approach trend towards the more invasive protocols, millions of healthy teeth are aggressively prepared each year in the name of smile makeovers and instant orthodontics, neglecting the long-term health, function and aesthetics of the oral tissues. _The need for a new concept Contemporary aesthetic dentistry demands well-considered concepts and TPs that provide a simple, comprehensive, patient-friendly and MI approach with an emphasis on psychology, health, function and aesthetics (PHFA; Fig. 1). The need for a holistic concept and basic treatment guidelines was expressed by concerned practitioners, aesthetic dentistry associations and academics around the world for the following basic reasons: _Owing to an increased aesthetic demand, aesthetic dentistry is becoming an integral part 28 I cosmetic dentistry 4_ 2009