trends & applications Minimally dentistry Dr. Sushil Koirala Nepal invasive cosmetic A concept and treatment protocol for general practice its replacement.15 Thus far, the focus of MI dentistry has been on caries-related topics Increased media coverage and the availability of free webbased 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. This was followed by the development of preventive resin restorations (PRR)2 in the 1980s and the atraumatic resto-rative treatment (ART) appro-ach and Carisolv 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 remineralisation; use of a range of restorations, bio-compatible dental materials and equipment; and surgical intervention only when required and only after any existing disease has been controlled.5–11 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 3 4 1 16 management of dental carious lesions. It has failed to give the necessary attention to the problems that negatively affect smile aesthetics, for example non-carious dental lesions, or developmental defects and malocclusion. The treatment modalities of contemporary cosmetic dentistry are trending towards more invasive procedures with an over-utilisation of crowns, bridges, thick full veneers, and invasive periodontal aesthetic surgeries, while neglecting long-term oral health, actual aesthetic needs and the characteristics of the patient. Social trust in dentistry is degrading, owing to the trend of fulfilling the cosmetic demands of patients without ethical consideration and sufficient scientific background (the more you replace, the more you earn; more is more mentality). In this article, I introduce a concept and TP for minimally invasive cosmetic dentistry (MI CD), in order to address these and of has not been comprehensively adopted in other fields 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 & 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 longterm 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-frien-dly 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 Fig 1 basic reasons: Owing to an increased aesthetic demand, aesthetic dentistry is becoming an integral part of general dentistry. The aesthetic outcome of any dental treatment plays a vital role in the MI patient’s dentistry treatment currently satisfaction criteria. focuses on prevention, remineralisation and minimal dental intervention in the facts properly and integrate the evidence-based MI philosophy and its application into aesthetic dentistry. Defining MICD As the perception of aesthetics and beauty is extremely subjective and largely influenced by personal beliefs, trends, fashion, and input from the media, a universally applicable definition is not available. Hence, smile aesthetics is a multifactorial issue that needs 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