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References

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Decision-making in the provision of extra-coronal restorations

From Volume 40, Issue 5, June 2013 | Pages 378-384

Authors

Aws Alani

BDS, MFDS, MSc, FDS RCS, LLM, FHEA, MFDT, FCGD

Specialist in Restorative Dentistry. www.restorativedentistry.org

Articles by Aws Alani

Karl Bishop

MScD, DRD MRD, FDS RCS FDS (Rest Dent), RCS LLM

Consultant in Restorative Dentistry, Maxillo-Facial Unit, Morriston Hospital, Swansea SA6 6NL, UK

Articles by Karl Bishop

Serpil Djemal

BDS, MSc, MRD, RCS, FDS (Rest dent), RCS Dip Ed

Consultant in Restorative Dentistry, King's College Hospital, London SE5 9RS, UK

Articles by Serpil Djemal

Abstract

Abstract: Decision-making when choosing an extra-coronal restoration for a molar tooth is often multifactorial, requiring consideration for material properties, the underlying tooth tissue, aesthetics and functional requirements. This article reviews the various factors associated with the decision-making when considering an extra-coronal restoration for a molar tooth. The current literature is disseminated and compared to results obtained from clinicians at the Dental Pan Society meeting in 2007. Dentists were seemingly less likely to consider restorations with greater complications for themselves than they were for their patients. The various implications of the results are discussed.

Clinical Relevance: With the plethora of dental materials available, the clinician has a wide choice of restorations. As clinicians become increasingly aware of the relative complications associated with different restorations, they are less likely to choose those that may result in problems, such as loss of vitality. In comparison, patients, if not kept fully informed, are unlikely to be aware of these problems and therefore may be happy to accept a more ‘aesthetic’ restoration. This decision dynamic is examined in this article.

Article

The choice as to whether to provide an extra-coronal restoration for a molar tooth is often based upon the need to protect the remaining tooth structure.1 Once the need for an extra-coronal restoration is identified, the type of crown to be placed should be discussed with the patient, identifying any differences between each in addition to the advantages and disadvantages.2,3 One factor that may be of high importance to the patient is aesthetics of the final restoration.4 This can result in some disparity with the reasoning for crown provision as preparations for more aesthetic restorations often require a greater removal of tooth tissue and so may weaken tooth structure to a greater degree than all-metal restorations.5 This greater tissue removal is also more likely to result in loss of vitality with consequent morbidity (Figure 1).6 Indeed, the degree of tissue removal has been correlated to a greater risk of pulpal necrosis.7

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