Burke F, Lucarotti P. Ten-year outcome of crowns placed within the general dental services in England and Wales. J Dent. 2008; 37:12-24
Meyers I. Herodontics – is there a place for maintaining the apparently hopeless tooth?. Aust Dent J. 2019; 64:S71-S79
Elangovan S, Guzman-Armstrong S, Marshall T, Johnsen D. Clinical decision making in the era of evidence-based dentistry. J Am Dent Assoc. 2018; 149:745-747
Bauer J, Spackman S, Chiappelli F, Prolo P. Evidence-based decision making in dental practice. J Evid Based Dent Pract. 2005; 5:125-130
Nalliah R. Clinical decision making – choosing between intuition, experience and scientific evidence. Br Dent J. 2016; 221:752-754
A definition of a restorative disaster is proposed. Reasons are discussed that contribute to restorative disasters that primarily focus on dentist factors within the dentist–patient relationship. For prevention of a restorative disaster in the failing dentition, the importance of effective communication, the use of an evidence-based approach and having clear consent processes are stressed. The negative consequences of an inability to say ‘no’, a reliance on experience and intuition in decision making, a simple misplaced desire to help and the creation of false hope are seen as factors in managing the failing dentition that may lead to restorative disaster. Using a clinical example, a broad strategy for effective management of a restorative disaster is discussed, which readers may find helpful to apply to similar situations that may occur on occasion in clinical practice.
CPD/Clinical Relevance: This article is relevant to both generalists and specialists involved in the clinical management of heavily restored and failing dentitions, together with students who will be likely to face similar issues in the future.
Article
Failure of restorations is an everyday occurrence for a dentist. Despite advances in materials and technology, the dental restoration remains imperfect, particularly when placed in the hostile environment of the oral cavity. A typical example is to consider that the survival rate of porcelain crowns placed in the General Dental Services in England and Wales is merely 48% at 10 years.1 So, for the dentist, clinical decision making (CDM) and treatment planning (TP) around restoration management, later failure and cycles of replacement are an unavoidable daily reality.
Dentists will, therefore, often find themselves attempting to manage failing dentitions where deteriorating teeth, restorations, medical issues or poor oral health, or a combination of these, means a loss of adequate basic oral functions, such as mastication and acceptable aesthetics, is inevitable if unaddressed. Managing some of these situations by herodontics (Table 1) to maintain function and dignity, particularly in the ageing, failing dentition, using largely minimal intervention dentistry, can be a practical and pragmatic solution when a robust consent process is adopted.2 Yet for some, patient preference for a fixed result rather than the dreaded denture can result in clinicians adopting a much more complex and invasive superherodontic (Table 1) approach in largely futile attempts to maintain the status quo, rather than facing the inevitable reality. In most of these cases, it is only a matter of time before restorative disaster results. When it does, not only can the situation be harder to manage, but the false hope and unwittingly increased expectations created can lead to negative physical, emotional and economic consequences for an increasingly disappointed patient. This in turn can have medico-legal or regulatory repercussions for dentists who may well feel genuinely aggrieved, believing that they have gone above and beyond the call of duty for an ‘ungrateful’ patient.
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