Minimal Intervention Dentistry (MID) for Managing Dental Caries

ADOPTED by FDI General Assembly October, 2002 in Vienna, Austria
REVISED by FDI General Assembly September, 2026 in Prague, Czech Republic

Context

Dental caries remains one of the most prevalent noncommunicable diseases worldwide. Since the 2016 revision of this policy statement, significant advances in evidence-based caries management and a refined understanding of Minimal Intervention Dentistry have emerged. Minimally Invasive Intervention for Caries Management (MIICM) prioritizes the early detection of carious lesions, prevention and control of carious lesions, minimally invasive conservative treatment strategies and personalized recall assessment to maintain tooth integrity (biology and biomechanical resistance) while improving patient outcomes. This sustainable approach aligns with contemporary demands for patient-centered dental care using preventive protocols and minimally invasive therapeutic interventions. 

Dental caries is caused by an imbalanced demineralization process. It can be arrested or reversed in its early stages through patient-centered, self-administered strategies, including dietary sugar reduction, twice-daily biofilm removal with tooth brushing and interdental cleaning, and use of fluoride toothpaste along with evidence-supported remineralizing materials. Strategies which address social determinants of health and barriers to preventive care that influence caries risk and activity should also be implemented. Professionally applied fluoride therapies (gel, mouthrinse, toothpaste, varnish, or silver diamine fluoride) and dental sealants remain foundational. Researchers continue to explore advanced dental materials to remineralize, repair or regenerate initial carious lesions1. 

MIICM integrates contemporary diagnostic tools, risk assessment protocols, and preventive-therapeutic strategies to manage dental caries at its earliest stages. MIICM focuses on early detection and prevention/management of initial caries. Visual-tactile examination and bitewing radiographs, if indicated, with the aid of advanced technologies such as LASER fluorescence or quantitative light-induced fluorescence (QLF), facilitates precise detection of carious lesions and assessment of carious risk and activity2. Validated risk assessment tools guide clinicians in selecting evidence-based interventions and tailoring intervals of supporting care for active monitoring of caries risk and progression3.  

Scope

Minimally invasive dentistry focuses on selective caries removal in deep carious lesions to preserve pulp vitality and avoid unnecessary pulp exposure 4,5. When clinically appropriate, this approach intentionally leaves and seals carious-affected dentin, as evidence shows such retained lesions may remain arrested, when sealed under a well-placed restoration and appropriately monitored, without causing clinical complications6. In its early stages, the demineralization process can be arrested or even reversed7. Evidence supports repairing defective restorations over replacement, reducing unnecessary treatment, preserving tooth integrity and creating less waste to the environment8. 

The MIICM approach focuses on conserving tooth structure through six core principles: (1) preventive strategies to maintain sound teeth, (2) early detection of carious lesions, (3) assessment of caries risk and activity, (4) remineralization of non-cavitated lesions, (5) minimally invasive operative techniques such as selective caries removal and restoration repair over replacement, where clinically appropriate, and (6) personalized recall intervals.  

Universal Policy Principles

MIICM is a prevention-oriented, patient-centered, evidence-based practice. Its core principles include equitable access, affordability, clinical and environmental sustainability, and scientific integrity, ensuring treatments are both biologically and biomechanically effective, as well as socially responsible across all population groups.

Policy

The FDI supports the integration of MIICM into prevention-focused, person-centred oral healthcare systems. MIICM aligns with evidence-based practice by prioritizing early identification, risk-based decision making, and minimally invasive care. Stakeholders at all levels are encouraged to promote MIICM through education, research, workforce training, interdisciplinary implementation, and school or community-based services that strengthen equitable access and long-term oral-health outcomes.

Keywords

Minimal Intervention Dentistry, dental caries, caries prevention, caries management, minimally invasive restoration. 

Disclaimer

This statement reflects the best available evidence at the time of publication. Implementation should consider cultural, economic, and clinical contexts. 

References

  1. Zhang OL, Niu JY, Yin IX, Yu OY, Mei ML, Chu CH. Bioactive Materials for Caries Management: A Literature Review. Dent J. 2023 Feb 23;11(3):59. 

  2. Tassery H, Levallois B, Terrer E, Manton DJ, Otsuki M, Koubi S, Gugnani N, Panayotov I, Jacquot B, Cuisinier F, Rechmann P. Use of new minimum intervention dentistry technologies in caries management. Aust Dent J. 2013; 58: 40-59. 

  3. American Academy of Pediatric Dentistry. Policy on minimally invasive dentistry. The Reference Manual of Pediatric Dentistry. Chicago, IL: American Academy of Pediatric Dentistry; 2025:107-9 

  4. Widbiller M, Weiler R, Knüttel H, Galler KM, Buchalla W, Scholz KJ. Biology of selective caries removal: a systematic scoping review protocol. BMJ Open. 2022 Feb 17;12(2):e061119.  

  5. Schwendicke F*, Kosan E*, Banerjee A, Baysan A, Bjørndal L, Ceballos L, Duncan HF, Herbst S, Neuhaus K, O'Connell AC, Paris S, Dujic H. Deep caries management: EFCD-ESE-ORCA S3-level Clinical Practice Guideline. Clin Oral Invest 2026: 30, 186. https://doi.org/10.1007/s00784-025-06727-1. 

  6. Schwendicke F, Frencken JE, Bjørndal L, Maltz M, Manton DJ, Ricketts D, Van Landuyt K, Banerjee A, Campus G, Doméjean S, Fontana M, Leal S, Lo E, Machiulskiene V, Schulte A, Splieth C, Zandona AF, Innes NPT. Managing carious lesions: Consensus recommendations on carious tissue removal. Adv Dent Res. 2016; 28(2):58-67. 

  7. Chaiwat A, Chunhacheevachaloke E, Kidkhunthod P, Pakawanit P, Ajcharanukul O. Enamel Remineralization and Crystallization after Fluoride Iontophoresis. J Dent Res. 2023 Apr;102(4):402-411. 

  8. Fernández E, Martín J, Vildósola P, Oliveira Junior OB, Gordan V, Mjor I, Bersezio C, Estay J, de Andrade MF, Moncada G. Can repair increase the longevity of composite resins? Results of a 10-year clinical trial. J Dent. 2015 Feb;43(2):279-86. 

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