Minimally invasive long-term management of direct restorations: the ‘5 rs’

Mackenzie, Louis; Banerjee, Avijit

doi:10.12968/denu.2015.42.5.413

Cited by 36 publications

(30 citation statements)

References 44 publications

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“…If detected as suspect, but not treated, lesions should be monitored regularly. Moreover, dentists should consider to refurbish, reseal, or repair partially defective restorations if possible, as this allows the preservation of tooth structure and reduces the risk of subsequent treatment-related complications [27]. The evidence quality supporting the decision between refurbishment/reseal/repair vs. replacement, however, was found to be weak.…”

Section: Dietary Advicementioning

confidence: 99%

How to intervene in the caries process in adults: proximal and secondary caries? An EFCD-ORCA-DGZ expert Delphi consensus statement

et al. 2020

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Objectives To provide consensus recommendations on how to intervene in the caries process in adults, specifically proximal and secondary carious lesions. Methods Based on two systematic reviews, a consensus conference and followed by an e-Delphi consensus process were held with EFCD/ORCA/DGZ delegates. Results Managing an individual's caries risk using non-invasive means (oral hygiene measures including flossing/interdental brushes, fluoride application) is recommended, as both proximal and secondary carious lesions may be prevented or their activity reduced. For proximal lesions, only cavitated lesions (confirmed by visual-tactile, or radiographically extending into the middle/ inner dentine third) should be treated invasively/restoratively. Non-cavitated lesions may be successfully arrested using noninvasive measures in low-risk individuals or if radiographically confined to the enamel. In high-risk individuals or if radiographically extended into dentine, for these lesions, additional micro-invasive (lesion sealing and infiltration) treatment should be considered. For restoring proximal lesions, adhesive direct restorations allow minimally invasive, tooth-preserving preparations. Amalgams come with a lower risk of secondary lesions and may be preferable in more clinically complex scenarios, dependent on specific national guidelines. In structurally compromised (especially endodontically treated) teeth, indirect cuspal coverage restorations may be indicated. Detection methods for secondary lesions should be tailored according to the individual's caries risk. Avoiding false positive detection and over-treatment is a priority. Bitewing radiographs should be combined with visualtactile assessment to confirm secondary caries detections. Review/refurbishing/resealing/repairing instead of replacing partially defective restorations should be considered for managing secondary caries, if possible. Conclusions An individualized and lesion-specific approach is recommended for intervening in the caries process in adults. Clinical significance Dental clinicians have an increasing number of interventions available for the management of dental caries. Many of them are grounded in the growing understanding of the disease. The best evidence, patients' expectations, clinicians' expertise, and the individual clinical scenario all need to be considered during the decision-making process.

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Section: Dietary Advicementioning

confidence: 99%

How to intervene in the caries process in adults: proximal and secondary caries? An EFCD-ORCA-DGZ expert Delphi consensus statement

et al. 2020

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“…On GIC TRC failure, Green et al [13] outlined the '5Rs' management protocol which consists of Reviewing, Refurbishment, Resealing, Repair and Replacement of such restorations, according to the philosophy of minimally invasive (MI) dentistry. This protocol will reduce the risk of unnecessary total replacement of failed TRCs that may have a number of adverse effects including further irreversible damage of natural tooth structure, spiralling TRC failure, cusp fracture and difficulty in future re-restoration [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

“…This protocol will reduce the risk of unnecessary total replacement of failed TRCs that may have a number of adverse effects including further irreversible damage of natural tooth structure, spiralling TRC failure, cusp fracture and difficulty in future re-restoration [14][15][16]. Using the 5Rs strategy, repairing directly on the existing failed GIC restoration can be considered a viable clinical option [13,17]. In past decades, there have been limited studies investigating the direct repair of GICs.…”

Section: Introductionmentioning

confidence: 99%

In vitro compressive strength and edge stability testing of directly repaired glass-ionomer cements

2019

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Objective To study the repair potential of seven commercial glass-ionomer cements (GICs) using an in vitro edge compression test model. Materials and methods A total of 448 normal and 192 repaired cylindrical specimens (6 × 4 mm) were produced from 6 GICs and one resin-modified GIC. Repaired samples consisted of a base aged for 1 month before repaired by an overlying layer. All samples were matured for 1 day, 1 week, 1 month or 3 months before compression, and edge tests were performed respectively on the whole surface (compressive strength, CS) or on the edge (edge stability, ES) using a universal testing machine. Results For normal specimens, Ketac Universal (KU) illustrated a significantly higher CS than other groups at all time points (p < 0.001). ES of KU was weaker than EQUIA Forte (EQF), FIX (Fuji IX) and RSC (Riva Self Cure) after 1 day, increasing after 1 week. Repaired specimens showed CS comparable to normal specimens (p > 0.05). Repaired KU significantly improved CS compared to repaired EQF and Fuji II (FII) after 1 day. No statistical difference was found in ES among these groups (p > 0.05). Conclusions KU provided the fastest maturation and greatest CS and ES in both normal and repair models after short-term ageing. Repair of GICs could potentially be achieved directly onto the fractured substrate and the subsequent improved mechanical performance could be maintained for at least 3 months. Clinical relevance This study provides a potential alternative in-vitro method to assess GIC restoration failure as well as provide insight into the mechanisms of GIC restoration repair.

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“…The repeated complete replacement of defective restorations results in excessive removal of dental hard tissue and shortens the lifespan of the tooth [49][50][51]. This is the reason why partial correction, using repair or re-resealing partially defective restorations [52], has become popular [53][54][55]. Such partial corrections are accepted among dentists [53], and a wide range of protocols of how to correct (mainly repair) such restorations exists (see below).…”

Section: Dealing With Secondary Caries: Repair or Replace Restorations?mentioning

confidence: 99%

Secondary caries: what is it, and how it can be controlled, detected, and managed?

et al. 2020

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Objectives To assess how to control, detect, and treat secondary caries. This review serves to inform a joint ORCA/EFCD consensus process. Methods Systematic and non-systematic reviews were performed or consulted and narratively synthesized. Results Secondary (or recurrent) caries is defined as a lesion associated with restorations or sealants. While the restorative material itself has some influence on secondary caries, further factors like the presence and size of restoration gaps, patients' caries risk, and the placing dentist's experience seem more relevant. Current detection methods for secondary caries are only sparsely validated and likely prone for the risk of over-detection. In many patients, it might be prudent to prioritize specific detection methods to avoid invasive overtreatment. Detected secondary caries can be managed either by repair of the defective part of the restoration or its complete replacement. Conclusions There is sparse data towards the nature of secondary caries and how to control, detect, and treat it. Clinical significance Despite often claimed to be a major complication of restorations, there is surprisingly little data on secondary caries. Longer-term studies may be needed to identify differences in secondary caries risk between materials and to identify characteristic features of progressive lesions (i.e., those in need of treatment).

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Minimally invasive long-term management of direct restorations: the ‘5 rs’

Cited by 36 publications

References 44 publications

How to intervene in the caries process in adults: proximal and secondary caries? An EFCD-ORCA-DGZ expert Delphi consensus statement

How to intervene in the caries process in adults: proximal and secondary caries? An EFCD-ORCA-DGZ expert Delphi consensus statement

In vitro compressive strength and edge stability testing of directly repaired glass-ionomer cements

Secondary caries: what is it, and how it can be controlled, detected, and managed?

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