Advanced restorative dentistry

Question 1

Restorative dentistry

Answer 1

Eliminating disease and restoring function and aesthetics using the most appropriate materials and techniques

Question 2

Why is replacing a restoration such an issue?

Answer 2

Initial lesion –> restoration placement –> structural degradation –> increased stress fields –> restoration failure –> restoration replacement –> further loss of tooth structure

Question 3

What leads to increased stress fields

Answer 3

Fatigue effects
Change in physical properties
Other destructive lesions
Placement of adjacent restorations
Restoration failure
Occlusal loading
Reduced occlusal support
Stress-induced parafunction

Question 4

How to predictably achieve a result

Answer 4

Choice of materials
-backed with good research data: lab and clinical trials
-read DFUs and follow them
-if you buy cheap you get cheap
Clinical technique
-attention to detail
-care at every stage
-correct use of technologies
-maintenance (professional and patient)

Question 5

Randomised clinical trials

Answer 5

1. Final step of the research ladder
2. Is the best evidence on the true performance of a medical device, techology or technique.. if correctly conducted
3. They inform our “evidence based practice”

Question 6

Heirarchy of evidence

Answer 6

1. Systematic reviews and meta-analysis of RCTs
2. RCTs
3. Cohort Studies
4. Case-control studies
5. Cross-sectional surveys
6. Case reports
7. Expert opinion

Question 7

The rationale for evidence

Answer 7

Support clinical decision making
Inform pt choice
Inform planning and commissioning of dental services
Support the development of dentistry

Question 8

From “concept” to “reality”

Answer 8

1. Concept
2. Development
3. Laboratory testing:
   - physical properties
   - citotoxicity and mutagenicity
   - cell studies
4. Animal studies
5. Clinical trials
6. Randomised Clinical Trials
7. Meta-analysis of RCTs

Question 9

Flowable composites

Answer 9

Do not reduce shrinkage stresses

Required, in miniscule volume, to round off sharp internal irregular cavity floor, to avoid air entrapment