Many dentists repair defective restorations, but the repairs depend on the proper selection of cases, material and technique, according to an ADA Clinical Evaluators Panel report published in the April issue of The Journal of the American Dental Association.
When a restoration defect is limited and localized and the remaining tooth structure’s condition is sound, repairing the restoration may be a more conservative, minimally invasive approach than replacement, according to the ACE Panel report. The report includes responses from 400 ACE Panel member dentists about how they decide whether to repair or replace defective restorations and the technical aspects they consider when making a repair.
About 4 out of 5 respondents said they repair defective restorations. For those who said they make restoration repairs, the top three restoration conditions requiring repair were noncarious marginal defects (87%), partial loss or fracture of the restoration (79%) and crown margin repair because of carious lesions (73%).
"The main takeaway is that there is a paradigm shift from aggressive tooth removal to tooth preservation," said Juliana B. da Costa, D.D.S., one of the report's co-authors and a member of the ADA Council on Scientific Affairs' ACE Panel Oversight Subcommittee. "Dentists are making a conscious decision to be more conservative. Undoubtedly, the advances in dental materials, particularly direct resin composites, and research have given us the tools to conserve tooth structure. With that being said, the repair of secondary carious lesions was not in the top three conditions for performing restorations repair. Therefore, clinicians may not be as comfortable yet repairing over replacing restorations in the presence of a carious lesion."
Restoration repair typically involves removing part of the restoration at the defective site to eliminate a localized restorative material or tooth defect or to facilitate access to secondary carious lesions, according to the report. Amalgam and composite repairs are effective in increasing the original restoration's survival rate and may last as long as replacements.
When repairing amalgam restorations, mechanical retention in the remaining amalgam and surface roughening with a diamond bur before applying new amalgam are recommended, according to the report. There are several protocols for tooth preparation before resin composite application. The recommended surface treatment protocol from the only long-term randomized controlled trial is applying an adhesive system containing an etchant, primer and bonding agent, followed by application.
Among survey respondents who said they repair defective restorations, 98% repair direct resin composite restorations, and about one-third do not repair amalgam, glass ionomer or fractured indirect all-ceramic crowns.
Resin composite is used most often to repair direct resin composite restorations, and glass ionomer is used most often to repair glass ionomer restorations, according to the survey results. Only 54% of respondents use amalgam to repair amalgam restorations. Surface treatments varied when repairing amalgam, direct resin composite and fractured indirect all-ceramic crown restorations.
"I thought it was important to report not only when clinicians are repairing restorations but also how they are performing these procedures," Dr. da Costa said. "The survey showcased that dentists are confused about appropriate surface treatment when repairing restorations. This is most likely due to the inconsistency of restoration repair protocols in dental literature."
Dentists can view the entire ACE Panel report online and download the PDF at JADA.ADA.org.
ACE Panel reports feature data from ADA member dentists who have signed up to participate in short surveys related to dental products, practices and other clinical topics. The ACE Panel Oversight Subcommittee of the ADA Council on Scientific Affairs writes the reports with ADA Science & Research Institute staff.
The reports offer ADA members a way to understand their peers' opinions on various dental products and practices, providing insight and awareness that can benefit patients and the profession.
Members are invited to join the ACE Panel and contribute to upcoming surveys, which occur no more than once every few months and usually take five to 10 minutes to complete.
To learn more or join the ACE Panel, visit ADA.org/ACE.