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Grey Areas in Restorative Dentistry: Part 4. Mind the Gap 1: The Radiographic Space between Restoration and Tooth

From Volume 52, Issue 2, February 2025 | Pages 148-150

Authors

Robert L Caplin

BDS, MSc, DGDP (RCS Eng), Dip Teach Ed (King's), Retired Senior Teaching Fellow, Faculty of Dentistry and Oral and Craniofacial Sciences, King's College London; General Dental Practitioner, London

Articles by Robert L Caplin

Email Robert L Caplin

Abstract

Radiopacities and radiolucencies beneath restorations provide the dental practitioner with diagnostic challenges as to the nature of such findings. Understanding the possible aetiologies of these radiographic appearances is essential for their subsequent management to avoid unnecessary intervention.

CPD/Clinical Relevance: Radiographic changes around restorations are a relatively common finding and require the practitioner to decide whether to supervise or intervene.

Article

Those familiar with the London underground system might be aware of announcements at some stations to ‘mind the gap’. This occurs at curved stations where a gap will exist between the stationary carriage and the platform, posing a potential threat of harm by falling into the space if the danger is not recognized.

The dental ‘gap’ is the one that is visible on radiographs between a restoration and tooth tissue and which, without thought by the practitioner, can lead to harm for the patient: the dentist can ‘fall’ into the apparent space.

The practitioner must determine, as best possible, what is going on beneath the restoration, i.e. what is the nature of the radiographic change, and should be aware that active caries is not the only conclusion at which to arrive. The actual radiographic appearance of an area varies from grey to black to white, as radiolucencies or radiopacities, and this should be taken in tandem with the clinical findings. The radiopacities are caused by tin or zinc deposits in partially demineralized dental tissue and may be seen under amalgam restorations. These radiopaque zones consist almost entirely of irreversibly demineralized dentine.1

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