Determinants of Quality in Operative Dentistry

Abstract

The definition of quality in operative dentistry has often, at least in part, been related to how well a cut preparation compares with an ideal preparation. The ideal preparation follows well-defined design principles. These design principles have their roots in empirical dentistry and scientific evaluations, the latter often being conducted in vitro. Because of the complexity of following these design principles practically, a large portion of dental education consists of perfecting cavity preparations. By focusing on how to cut these cavity preparations as closely as possible to the ideal preparation, dentists with high psycho-motor skills have been able to provide the public with restorative procedures of high standards over the years. However, because of the tendency of relating quality in operative dentistry to the ideal preparation, we found it justifiable to review the literature dealing with the cavity design principles of the Class II amalgam preparation. What triggered this review was a request from the International Dental Federation (FDI) to start a process leading to a scientifically based quality definition of dental restorations, a definition that determines how different factors, including cavity design principles, affect the longevity of both tooth and restoration. From our review, we conclude that patient response and restoration performance over time, rather than how closely a cavity preparation compares with the ideal preparation, will be of more significance in determining the longevity of a Class II amalgam restoration.

Longitudinal Results of a 10-year Clinical Trial of Repair of Amalgam Restorations

“…The restorative treatment is only a symptomatic treatment for secondary caries; the patient response, in addition to the quality of the restoration evaluation, must be considered with this factor. 45 This alternative treatment represents an additional option to address many of the increasing number of restorations each year that require treatment due to deterioration. Repair instead of replacement of localized defective restorations significantly improved their morphology and function.…”

The impact of dental restorations’ quality on caries risk

“…The same findings have been observed in other studies (Kidd et In analysing the acquired data the question about quality raises. There isn't one definition what a dental restoration should look like, but there are some points which should be observed -a cavity should have well-defined margins with perfectly adapted restoration and accurate reproduction of anatomic form of the tooth (Söderholm et al, 1998). Of course, recurrent caries as primary caries is caused by acids produced from plaque bacteria, but, if the restoration is rough, with marginal defects, it can create additional retentive places for plaque accumulation (Söderholm et al, 1998).…”

“…There isn't one definition what a dental restoration should look like, but there are some points which should be observed -a cavity should have well-defined margins with perfectly adapted restoration and accurate reproduction of anatomic form of the tooth (Söderholm et al, 1998). Of course, recurrent caries as primary caries is caused by acids produced from plaque bacteria, but, if the restoration is rough, with marginal defects, it can create additional retentive places for plaque accumulation (Söderholm et al, 1998). Although glass ionomers have been improved it doesn't mean that materials used in Gulbene were the same quality, as 66% of tooth coloured restorations had rough surface and 20% had marginal defects.…”

How to intervene in the caries process: proximal caries in adolescents and adults—a systematic review and meta-analysis

“…For more advanced lesions, caries on proximal surfaces of permanent teeth mostly require operative treatment to substitute the hard tissue loss. Most studies in this direction assessed the filling material [15], but also the design of various cavity preparations has been discussed [16].…”