COMMENTARY. Clinical Decisions for Anterior Restorations: The Concept of Restorative Volume1

Abstract

Minimally invasive treatment has become a mantra for all health care providers. It has often been said that “dentistrybegets dentistry.”The more dentistry you perform for an individual, the more dentistry that person will be likely toneed in the future.We know there is no such thing as a “permanent restoration.”With future treatment a possibilityfor many restored teeth, it becomes apparent that the more tooth structure that can preserved, the more that will beavailable later.Years ago, the only type of indirect restoration that could adequately restore significant amounts of diseased toothstructure was gold.The demand for more esthetic restorations led to the development of acrylic to gold and porcelainfused to metal restorations.These required removal of more tooth structure to allow for thickness of both metal- andtooth-colored material.The advent of all-ceramic crowns often necessitated even more removal of tooth structure foradequate strength. More involved and demanding adhesive techniques were required.The combination of moreintrusive preparation and technique-sensitive bonding procedures resulted in an increased need for endodonticroot-canal therapy.The public has become aware of these problems and is demanding more conservative treatment. Itis not surprising that controversies abound today about prepared versus non-prepared porcelain laminate veneers.In today’s economic environment patients are seeking more economical solutions to their problems.They arechallenged to afford extensive indirect procedures and are opting for simpler, less expensive direct restorations.Thenumber of indirect procedures has reportedly decreased in North America the past 3 years. During this same periodof time, several new all-ceramics restorations with increased strength have become popular. Lithium disilicaterestorations and zirconia-based crowns have increased.These restorations do not require bonding but can becemented.The all-zirconia crowns do not require as much removal of tooth structure.This paper is one of the first to logically address the treatment decision-making process for specific treatments withregards to the amount of tooth structure that will have to be removed.