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References

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Minimally invasive long-term management of direct restorations: the ‘5 rs’

From Volume 42, Issue 5, June 2015 | Pages 413-426

Authors

David Green

BDS (Hons) BSc (Hons) MSc (Res) MFDS RCS (Ed) MRD (Prostho) RCS (Eng) FDS (Rest)

StR in Restorative Dentistry, Birmingham Dental Hospital, London, UK

Articles by David Green

Louis Mackenzie

BDS, FDS RCPS FCGDent, Head Dental Officer, Denplan UK, Andover

General Dental Practitioner, Birmingham; Clinical Lecturer, University of Birmingham School of Dentistry, Birmingham, UK.

Articles by Louis Mackenzie

Avijit Banerjee

BDS, MSc, PhD (Lond), LDS, FDS (Rest Dent), FDSRCS (Eng), FCGDent, FHEA, FICD

Professor of Cariology & Operative Dentistry, Hon Consultant in Restorative Dentistry, King's College London Dental Institute at Guy's Hospital, KCL, King's Health Partners, London, UK

Articles by Avijit Banerjee

Abstract

The assessment and operative long-term management of direct restorations is a complex and controversial subject in conservative dentistry. Employing a minimally invasive (MI) approach helps preserve natural tooth structure and maintain endodontic health for as long as possible during the restorative cycle. This paper discusses how minimally invasive techniques may be applied practically to reviewing, resealing, refurbishing, repairing or replacing deteriorating/failed direct coronal restorations (the ‘5 Rs’) and provides an update of contemporary MI clinical procedures.

CPD/Clinical Relevance: The assessment and long-term clinical management of deteriorating/failing direct restorations is a major component of the general dental practice workload and NHS UK budget expenditure for operative dentistry.

Article

A failing restoration can be described as one that has suffered biomechanical defect or damage resulting in immediate or subsequent detrimental clinical consequences to the patient. This may affect the restoration alone (eg bulk fracture, staining etc), the supporting tooth structure (eg fractured cusps, new caries at the tooth-restoration surface (CARS) etc) or, more commonly, both, affecting the collective tooth-restoration complex. Such failure can present as obvious fractures of this complex, possibly detectable active caries associated with restoration/sealant surface (CARS, previously described as secondary or recurrent caries) or can be more subtle, such as marginal discoloration of an anterior aesthetic resin composite restoration or marginal ditching of a posterior restoration.

A number of clinical indices have been developed to help classify the extent of restoration failure, including the Ryge & Snyder Index (1973), useful for research analysis as well as clinical management (summarized in Table 1).1 A more recent classification by Hickel et al (2010) defined the clinical criteria for the evaluation of direct and indirect restorations.2 This index includes three separate groups:

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