The management of carious primary teeth has evolved from traditional, invasive methods toward biologically driven, minimally invasive concepts. Historically, complete caries excavation and extensive cavity preparation were routine, often resulting in pulp exposure and premature tooth loss. Today, guided by the principles of minimal intervention dentistry (MID) and evidence-based understanding of caries biology, restorative care prioritizes preserving tooth vitality and structure.
Current evidence supports no caries removal and selective rather than complete caries removal, recognizing that caries is a dynamic, biofilm-driven disease rather than purely a mechanical defect. Many studies emphasized that complete excavation offers no additional benefit and increases the risk of pulpal exposure. In contrast, selective removal preserves affected but remineralizable dentin and allows the pulp–dentin complex to heal. This biologically respectful approach is particularly relevant in primary teeth, where the pulp is large and reactive, and structural preservation is critical for natural exfoliation.
The aims of restorative interventions, should consider retaining remineralizable dentin, perform proper seal with a good peripheral bondable area, with an anticipated long term restoration success and maintenance of pulp vitality.
Minimal intervention is not only confined to the capping of the affected deep dentin layers to avoid exposures, but also preserving the remaining pulp even if it’s deemed irreversibly inflammed. This is a growing concept and is currently backed up with studies. This concept wouldn’t have been attempted without the existence of the new formulas of effectively regenerating bioceramic materials.
Even management of infected primary teeth by pulpectomies or LSTR can be understood as being a less invasive technique, as it helps retaining space and function.
Advances in material science complement these techniques. Glass ionomers, resin-modified glass ionomers, and bioactive composites not only restore form and function but also promote remineralization through fluoride, calcium, and phosphate release. When pulp therapy becomes necessary, calcium silicate–based materials and bioceramics offer excellent biocompatibility and encourage dentin bridge formation, aligning with the goal of preserving the natural defense mechanisms of the pulp.
In the field of dental traumatology minimal intervention is also evident, starting from lesser need to expose the patient to radiation unless needed, to more preservative pulp handling with the same aims of anticipation of healing rather than excision.
