|Year : 2015 | Volume
| Issue : 2 | Page : 35-36
Conservative ideology of tooth preservation by means of the repair of defective restorations
Department of Conservative Dentistry, Ishik University School of Dentistry, Erbil, Iraq
|Date of Web Publication||8-May-2015|
Department of Conservative Dentistry, Ishik University School of Dentistry, Erbil
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Colak H. Conservative ideology of tooth preservation by means of the repair of defective restorations. J Res Dent 2015;3:35-6
Dental practitioners are concerned with two main issues when attempting to treat dental caries: Performing treatment methods in the least invasive manner and ensuring restorations are effective over a long-term basis.
In recent years, the dental industry has benefited from improvements in patient wellbeing, nutrition, and the development of improved esthetics. However, conserving teeth that have been treated with long-term restorations, for example those found in individuals whose mouths have been heavily restored through the use of amalgam fillings, aka "The Heavy Metal Generation," is challenging. A great deal of debate has emerged as to the best methods of treating defective restorations. Some practitioners argue that the best approach is to totally replace a defective restoration as opposed to repairing it through procedures such as restorative cycle, spiral, or staircase dentistry, while others support the school of thought that the cost of performing such procedures should be avoided by removing the tooth completely.  Every intervention/restoration will result in further eradication of the tooth structure and will ultimately lead to the need for the tooth to be extracted. Further arguments against repairing restorations as opposed to replacing them include concerns about bond strength, residual caries, and recurrent carries that may increase the risk of caries on additional sites, including under existing restorations. 
Although a number of factors can contribute to the deterioration of a restoration over time, such as bruxism and oral hygiene, the majority of restorations will inevitably weaken and the restoration itself and/or the bond between the tooth and the interface of the amalgam may become deficient. As defects can develop gradually over time, many practitioners will perform restorative procedures-such as marginal sealing, refurbishment, and repair-on an ongoing basis. However, data available in many longitudinal observational studies indicates that such repair processes represent short-term fixes that will ultimately lead to the need for total replacement.
In modern dental practice, more and more professionals are changing their approach to operative dentistry. For example, an increasing number of practitioners are using resin composites to restore defective restorations and a more conservative approach to managing defects has become evident. One of the biggest contributory factors to this change in mentality can be attributed to the fact that resin composite materials have undergone considerable improvement in recent years and now offer much better functionality and durability. Furthermore, patients themselves have rejected silver amalgam for esthetic reasons.
In a study that examined contemporary teaching of composite repair techniques in Scandinavian dental schools revealed that majority of the schools (92%) included the teaching of composite repair techniques within their dental school program. One survey by Lynch et al.,  examined the training that students at US and Canadian dental schools were receiving on the treatment of defective dental restorations and the extent to which repair was being favored over replacement. According to their findings, 88% of the dental schools taught students to repair defective direct resin-based composite restorations, 79% of which schools taught both didactic and clinical methods. However, according to the researchers, some students in some schools were not taught to repair defective direct resin-based composite restorations.
It goes without saying that what students are taught in schools will have an impact on their later approach to practice. Furthermore, it will also influence the methods established clinicians apply, as these individuals tend to learn new techniques from recent graduates. The education and clinical experiences that are provided by dental schools; therefore, has a bearing on what techniques are used in practice.  However, despite this, the information and skills taught in dental schools do not always translate to practice. A study among dental practice-based research network dentists revealed that 65% of dentists would opt to replace a composite restoration if the defective margin was located on dentin and 49% would repair the restorative if the defective margin was on the enamel. Furthermore, the same study revealed that 52% of practicing dentists would not perform any surgical procedures if the restoration in the scenario was amalgam. Interestingly, this study also indicated that those dentists who do not routinely assess the risk of caries when planning a course of treatment were also the ones who were most likely to perform surgery as opposed to preventative treatment.
A large amount of debate has emerged concerning whether dental schools should teach repair and refurbishment of defective restorations as opposed to total replacement. Many of today's students will continue to practice into the mid-2050s; as such, what is taught in schools today will influence the teeth of the population for many years to come.  For this reason, dental schools throughout the world should ensure that their curriculum is up-to-date and provides students with knowledge and practical experience of the least invasive procedures.
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