What is different in operative dentistry?

There have been both large and small changes in operative dentistry in the last 30 years. Extension for prevention is no longer the mantra. The design features of amalgam preparations have moved into the smallest preparations possible to gain full access to the carious dentin. The default Class 2 amalgam or resin composite is a slot preparation with no preparation of the occlusal fissures. Class 1 fissure caries once implied the entire fissure system was to be cut out. Now only the known carious portions of the fissure are cut away, the tooth is restored, and the remaining fissures in that tooth are sealed. Resin composite preparations have no depth requirements and saucer shaped boxes are more favorable for lowering shrinkage strains on the bonded walls. Re-mineralization of proximal lesions that can be seen on a radiograph is now a proven successful service for many lesions that are at or just into the dentin by radiographic interpretation. The largest paradigm shift has been in the decision that in vital teeth with normal pulps soft dentin can be left over a vital asymptomatic pulp with every expectation that the direct restoration will be successful long term.