Consequences of Treatment

Question 1

Why is it better to attempt repair/refurbishment a restoration before completely replacing it first?

Answer 1

• If it is replaced this leads to:
• A larger preparation
• Cavity gradually easing towards the pulp – increasing likelihood of pulpal involvement

Should always try and repair first although it will often fail.

Question 2

How is a restoration Repair and Refurbished?

Answer 2

• Refinishing/repolishing the restoration only
• Recontouring the margins/restoration surface to be continuous with tooth
• Adding material to existing restoration (addition)
• Removing a part of restoration and replacing (repair)

Question 3

How long do restorations last? (amalgam, composite, glass ionomer)

Answer 3

Studies show mean age for:

Amalgam – 10 years

Composite – 8 years

Glass ionomer – 3 years

However, several factors will have a bearing on the survival of a restoration

Question 4

What factors can affect the Survivability of Restorations?

Answer 4

• Caries risk
• Depth and extent of the cavity, number of surfaces involved
• Operator skill and techniques employed during cavity preparation and restoration placement
• Other local factors

Question 5

What can cause a restoration to fail?

Answer 5

• Secondary caries
• NCTSL
• Pulp pathology
• Trauma
• Fractures – restoration or tooth
• Bond failure
• Ditching
• Lack of retention
• Defective contacts
• Defective margins
• Aesthetics

Question 6

What happens in secondary caries?

Answer 6

Secondary Caries

• New lesions developing at the margin of the restoration/tooth interface
• Most common reason for replacement of restorations
• Very commonly found at gingival aspect of tooth – good placement technique often difficult to achieve

Question 7

What can tooth wear cause around a restoration?

Answer 7

• ‘Proud’ restoration due to erosion of tooth tissues surrounding filling
• Bruxism/attrition patient – prone to restoration fractures, > occlusal forces
• Important to make early diagnosis of tooth wear

Question 8

What can cause bond failure leading to overall failure of restoration?

Answer 8

• Improper bonding technique at time of composite placement (follow manufacturers guidance!)
• Dentine too wet/too dry
• Overzealous 3 in 1 use/airline contamination
• Improper matrix technique
• Contamination by saliva/GCF due to poor isolation and moisture control – rubber dam!