The genesis of minimal cavity design

Cavity design is an important consideration in direct restorative dentistry: readers will be aware from their own clinical experience that large cavities fail more readily than small and that large cavities, especially in premolar teeth, may predispose to cusp fracture. Readers will also be aware that minimal non-retentive cavity design is really only possible using adhesive techniques and that recent improvements in dentine bonding agents have facilitated this.¹

However, readers may not be aware of the work of a pioneer in minimal cavity design, Professor Richard Elderton, who first proposed a ‘new look at cavity design’ in a paper published in 1979.² This was long before the era of adhesive dentistry, yet Elderton proposed serious deviations from GV Black's cavity designs and was roundly criticized for so doing in some quarters, as I recall. Yet his arguments had a basis in truth, as he stated that ‘a sizeable proportion of restorations at that time were found to fail in a few years', adding that ‘Black and generations of authors have erroneously led their readers to assume that the treatment that they prescribe would be successful in the long term’. He added that ‘teeth are small and their treatment requires attention to detail’.²