From Caries Arrest to Restoration Biomaterial Strategies for Minimally Invasive Geriatric Dentistry

Older adults retaining natural teeth frequently require care in the presence of frailty, multimorbidity, xerostomia, exposed root surfaces, impaired mobility and reduced tolerance of lengthy procedures. These factors can make conventional multistep restorative protocols difficult, particularly in domiciliary, residential aged-care and special-care settings. This narrative review proposes a function-based model for minimally invasive geriatric dentistry: first determine whether the required outcome is prevention, arrest, sealing, transitional repair or definitive restoration, then select the least burdensome biomaterial capable of delivering that outcome. Material composition, polymerisation kinetics, working and setting time, depth-of- cure reliability, adhesion to aged substrates, mechanical properties, ion release and marginal integrity are considered alongside treatment completion, comfort, maintainability and retreatment. Particular attention is given to Stela Automix with Stela Primer, conventional silver diamine fluoride (SDF), and the ammonia- free silver fluoride and potassium iodide system Riva Star Aqua. Automix delivery may reduce ratio variability, air incorporation and instrument exchange, while chemical polymerisation reduces dependence on curing-light access. These advantages remain conditional on diagnosis, isolation, substrate and clinician control. SDF has the strongest evidence for non-operative arrest of cavitated dentine and root caries but causes permanent dark staining and does not restore anatomy. Silver fluoride with potassium iodide may offer acceptability advantages, although its independent clinical evidence is less mature. High- viscosity glass-ionomer cement, resin-modified glass-ionomer cement, conventional light-cured composite and selected ion-releasing resin-based materials remain important alternatives. No material compensates for uncontrolled xerostomia, plaque or dietary risk. A staged pathway from disease control to selective reconstruction can preserve tissue, reduce treatment burden and maintain oral function. Three structured clinical applications demonstrate translation to neurodegenerative care.