Long-term management of direct restorations

Abstract

As has been emphasized throughout this book, minimum intervention oral/dental care involves more than just the minimally invasive operative treatment of the consequences of dental disease. It involves identifying and predicting disease patterns, and concerns the control/ prevention of disease by modifying aetiological factors and reassessing the adherence to changes in patient behaviours, attitudes, and responsibility. Monitoring the oral cavity and restored dentition ensures that the treatment undertaken, and subsequently improved oral health, is maintained. This should be accomplished through individualized strategic recall regimes. Restorations need to be reviewed regularly and occasionally refurbished, resealed, repaired, or replaced (see Figures 9.1, 9.2, and 9.3, and Section 9.5). Therefore periodic recall appointments, once an episode of treatment has been completed, are just as important as the treatment itself. It is critical that the patient understands the importance of these recall consultations as part of the ongoing care that is being offered to help to maintain their oral health. Three aspects of dental care need to be assessed at recall visits:… • the overall state of the patient’s oral and dental health (review) • the individual patient’s longer-term response/adherence to previous preventive advice and/or treatment, in moderating any aetiological factors that could cause future dental disease (reassessment) • the status and quality of the restorations present (monitoring and maintenance)…. The potential causes of restoration failure have been identified and outlined in Table 9.1. It is important to appreciate that the causes of restoration and tooth failure (see Table 9.2) are often multifactorial in nature. Indeed, as the causes of both tooth and restoration failure are inextricably linked, it is wise to consider them together, as a tooth–restoration complex. The multifactorial aetiology of restoration failure is often due to manifestations of inherent long-term weaknesses in the mechanical properties of different restorative materials (e.g. poor edge strength, wear, compressive strength, water absorption, etc.) and/or problems with the technical application of the restorative material for the chosen clinical situation (i.e. incorrect choice of material and poor placement technique). The chemistry and physical properties of the different direct, plastic restorative dental materials at a dentist’s disposal have been discussed in Chapter 7.