Abstract Background: The philosophy of restorative dentistry has undergone a profound transformation, moving away from the historically dominant, surgically-oriented principles of G.V. Black. The traditional "extension for prevention" approach, which advocated for the prophylactic removal of sound tooth structure to prevent future caries, is now being superseded by a biologically conservative paradigm. Minimally Invasive Dentistry (MID) prioritises the preservation of healthy tooth tissue, promotes the natural remineralisation of early lesions, and aims to maintain pulp vitality throughout the caries management process. Objective: This review seeks to critically compare the clinical efficacy (including restoration longevity and pulpal health), biological outcomes, cost-effectiveness, and patient-centred experiences of minimally invasive restorative techniques against those of conventional restorative methods for the management of dental caries. Methods: A comprehensive literature search was conducted using major electronic databases (PubMed, Scopus, Google Scholar) for relevant clinical trials, cohort studies, and systematic reviews published between 2000 and 2024. The search focused on studies providing direct comparisons between MID and conventional approaches. Results: Evidence consistently demonstrates that MID techniques—such as Atraumatic Restorative Treatment (ART), selective and stepwise caries removal, and the use of advanced adhesive and bioactive materials—achieve clinical outcomes that are comparable to, and in many aspects superior to, conventional methods. Specifically, MID shows advantages in preserving sound tooth structure, reducing the risk of pulpal exposure and postoperative sensitivity, and enhancing patient comfort and acceptance. While conventional methods remain reliable for extensive, non-restorable cavities, they are associated with greater iatrogenic damage to the tooth and a higher long-term risk of complications like fracture. Conclusion: Minimally invasive restorative dentistry offers a scientifically sound, sustainable, and patient-friendly framework for managing dental caries. Its principles align seamlessly with modern preventive dentistry and are particularly well-suited to address public health challenges, both in India and across the globe.