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Blum IR, Lynch CD. Repair versus replacement of defective direct dental restoration in posterior teeth of adults. Prim Dent J. 2014; 3:62-67
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Clinical Lecturer/Hon Specialist Registrar in Restorative Dentistry, University of Bristol Dental Hospital & School at Guy's, King's College and St Thomas' Hospitals, London, UK
This article provides an overview of current knowledge and understanding of existing criteria for the assessment of dental restorations and encourages dental practitioners to shift, if not already doing so, to considering minimally invasive interventions for manging deteriorating restorations. The repair of restorations in such a way extends longevity of the restoration without sacrificing intact, healthy tooth tissue, and is in the best interest of patients in terms of biological and economic costs. The replacement of a restoration should be only considered as a last resort, when there are no other viable alternatives.
CPD/Clinical Relevance: Standardised assessment of dental restorations, using established criteria for clinical judgement and decision-making, is particularly important when managing deteriorating restorations in clinical practice. Minimally invasive management of such restorations, in terms of restoration repair strategies, should be viewed as a safe, viable and effective alternative to other more invasive treatments. The reader should understand the clinical evaluation of dental restorations based on reported standardised parameters and appreciate the benefits of minimally invasive management of deteriorating, yet serviceable, dental restorations in clinical practice.
Article
All dental restorations will ultimately suffer deterioration and degradation in clinical service.1,2,3 It has been suggested that the management of deteriorating restorations, that is restorations with localized defects (henceforth, partially defective restorations), is a common occurrence in clinical practice and, as a consequence, practitioners spend much of their chair-side time on the management of partially defective restorations.4 In fact, it has been reported that over half of all direct restorations placed by practitioners in adults in general dental practice worldwide are replacements of existing restorations rather than the treatment of new lesions of caries.3,5 Globally, the cost of restoration replacement runs to many millions of pounds sterling.6
The most recent Adult Dental Health Survey highlighted that 84% of dentate adults in the UK have at least one restoration.7 Of these adults, each had, on average, 7.2 filled teeth. Such figures are of concern when one considers that patients maintain their dentition for longer and with an increasingly ageing population, often presenting with increasingly complex medical histories, the challenge for managing deteriorating restorations is likely to increase in general dental practice. Typically, the strategy for early deterioration may involve implementing a prevention regimen and monitoring. If progression is apparent, and localized defects of the restoration are diagnosed clinically or radiographically, the application of minimal intervention approaches to treatment, ie restoration repair, is recommended as a safe, effective, tooth-conservative and cost-effective approach.8,9,10 Thus, demand for restoration repair (ie partial replacement of the restoration, allowing preservation of the portion of the restoration that presents no clinical or radiographic evidence of failure) is high and is likely to increase in primary dental care, leaving teeth with repaired restorations more able to withstand loading in function and with an enhanced prognosis.11
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