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Repair Versus Replacement of Restoration

REPAIR VERSUS REPLACEMENT OF RESTORATION

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mrkhalid.sobhy67
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1K views77 pages

Repair Versus Replacement of Restoration

REPAIR VERSUS REPLACEMENT OF RESTORATION

Uploaded by

mrkhalid.sobhy67
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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REPAIR VERSUS

REPLACEMENT OF
RESTORATION
○ Maintenance of previously inserted restorations
constitutes a considerable part of dental care
○ Replacement of restorations represents the
major workload, especially for adult patients
○ Replacements amount to about 60% of all the
operative work done
○ Replacement of restoration costs at least as
much as the one inserted initially & probably
more ………
(its increased size)
REPLACEMENT
Complete removal of the existing
restoration & placement of another one or
prosthesis
REPAIR
Replacement of the only defective or
fractured aspect of the restoration with
new one
CONSEQUENCES OF THE
REPLACEMENT
I. Biological consequences

Pulpal, gingival & periodontal irritations during


removal of the restoration
CONSEQUENCES OF THE
REPLACEMENT
II. Mechanical consequences

Gross weakening of remaining tooth structures


CONSEQUENCES OF THE
REPLACEMENT
III. Esthetic consequences

Increased restorative display

IV. Others

More time, money & effort with difficult


maintenance
DISADVANTAGES OF REPLACEMENT
1. Enlargement of cavity preparation
2. With tooth colored restoration ® excessive loss
of tooth structure due to difficulty in
demarcation between teeth & restorative
DISADVANTAGES OF REPLACEMENT

3. Time consuming
4.Technically difficult
5. May be potentially damaging to the pulp &
supporting structures
GENERAL INDICATIONS OF
REPLACEMENT

1. Symptomatic tooth
2. Lack of retention of the restoration
3. Bad esthetic of the restoration
GENERAL INDICATIONS OF
REPLACEMENT

4. Caries under the restoration


5. Unrepairable marginal void
6. Poor proximal contour ® overhang
7. Unrepairable marginal ditch
8. Large voids
OVERHANGING MARGIN OF RESTORATION
& ATROPHIED, INFLAMED GINGIVAL
PAPILLA
Matrix system & matricing

WHAT TO CHECK
Matrix system & matricing
Improper matrix and wedge adaptation

c
Matrix system & matricing

The wedge should not encroach towards the contact area: this will deform
the matrix and leave a large approximal gap under the contact point
Matrix system & matricing
Improper matrix and wedge adaptation

-The wedge in this radiograph had encroached towards


the contact area, leaving a poor contour
-This results in food packing and plaque accumulation
Matrix system & matricing
Improper matrix and wedge adaptation
Should be replaced
ADVANTAGES OF REPAIR
1. Conservation of tooth structure
2. Increased longevity of restorations at
low cost
3. Saving of time, money and effort
4. Simplicity of the technique
GENERAL INDICATIONS OF REPAIR
1. Isolated or localized defects
2. If all carious tooth structures were
removed operatively
3. If the rest of restoration was found to
be clinically sound
FACTORS AFFECTING THE REPAIR OF THE
RESTORATION

I. Patient related factors

Caries index, oral hygiene, occlusion, habits &


motivation & education

Forces leading to fracture of cusps where


cuspal coverage is not used & the marginal
ridges are compromised
FACTORS AFFECTING THE REPAIR OF THE
RESTORATION

II. Restorative materials related factors

Direct or indirect,
metallic or
non-metallic
FACTORS AFFECTING THE REPAIR OF THE
RESTORATION

III. Tooth related factors


Esthetic zone, functional or non-functional zone,
anterior or posterior
IV. Defect
Size, site & etiology
REASONS AND CRITERIA FOR REPAIR AND REPLACEMENT (MJOR
2002)

1. Secondary caries
2. Marginal breakdown
3. Bulk fracture of the restoration
4. Fracture of the adjacent tooth
5. Defective contact & contour
6. Marginal overhangs & submargination
7. Discoloration
8. Pits
9. Chipping
10. Wear
POSTERIOR AMALGAM AND RESIN COMPOSITE
RESTORATIONS SHOW VARYING DEGREES OF
MARGINAL FRACTURE & STAINING
DEFECTIVE, LEAKING, AND BROKEN TOOTH
COLORED FILLING
CLINICAL EVALUATION SYSTEMS
FOR THE RESTORATIONS
The USPHS criteria
○ Cvar and Rvge (1971) developed the U.S. Public Health Service (USPHS)
criteria.

○ Based upon the concept describing the degradation process of amalgam


and esthetic restorative materials, this system is so basic and profound
that it is still being used for the clinical evaluation of a wide variety of
restorative materials and techniques.

○ The USPHS system measures or characterizes significant changes in the


degradation process of restorative materials.

○ For example, for resin composite restorations the USPHS criteria deal
with: color and translucency, micro leakage, secondary caries, wear or
loss of anatomic form and marginal integrity.
CLINICAL EVALUATION SYSTEMS
FOR THE RESTORATIONS
Basically, the USPHS criteria are based upon three
levels of performance

1. Clinically ideal
relates to a condition that cannot be surpassed.
2. Clinically acceptable
deals with a condition in which all of the characteristics
are satisfactory & the restoration is still functional.
3. Clinically unacceptable
describes a condition in which the restoration must be
replaced.
CLINICAL EVALUATION SYSTEMS
FOR THE RESTORATIONS
The second system is a variation of USPHS system &
titled Standard of quality of dental care used by
California Dental Association (CDA 1995) to evaluate
color, anatomical form and marginal characteristics.
CLINICAL EVALUATION SYSTEMS
FOR THE RESTORATIONS
The modified criteria is a complement of both systems
that use the following scoring system:

1. ALPHA (A) clinically perfect


2. BRAVO (B) few defects
3. CHARLIE (C) severe defects
4. DELTA (D) immediate replacement is necessary
Occlusion

High Spots

WHAT TO REMOVE
REASONS AND CRITERIA FOR REPAIR AND REPLACEMENT (MJOR
2002)

1. Secondary caries
2. Marginal breakdown
3. Bulk fracture of the restoration
4. Fracture of the adjacent tooth
5. Defective contact & contour
6. Marginal overhangs & submargination
7. Discoloration
8. Pits
9. Chipping
10. Wear
DECISION- MAKING
SECONDARY CARIES
o The most common reason for replacement 50-60%

Gingival caries in molars & premolars → difficult access to


proximal area

For anterior teeth → buccal or palatal access is possible to


proximal area
SECONDARY CARIES
Predisposing factors → overhangs
or submargination → leakage

Occlusal 2ry caries → easy


access → repair after removal
of caries Secondary caries molars 16 17

Site of the defect affect selection of the repair material


(anterior → composite)
MARGINAL BREAKDOWN
§ Non carious ditched margins → 10% of failed
restoration (Mjor 2002)

Small/moderate size → repair by finishing &


polishing of the margin

May be filled with pit & fissure sealant, flowable composite or


even amalgam
MARGINAL BREAKDOWN

Fracture and marginal breakdown of a two-year-old class II restoration


BULK FRACTURE
o Very important to know the reason of fracture
either:
èCarious gingival floor
èShallow cavity

Bulk fracture in a six-years-old large MOD restoration in


tooth 24
è LACK OF RETENTION
The cause must be corrected first before
replacement
FRACTURE OF THE ADJACENT
TOOTH
o Small enamel fractures → refurbishing & polishing of
enamel or by composite

o Medium fractures →repair with resin composite using


bonding & mechanical means of retention
FRACTURE OF THE ADJACENT
TOOTH
o Cusp fracture → complex bonded restoration or pin
retained restoration or indirect restoration
DEFECTIVE CONTACT AND
CONTOUR
o Defective contact → immediate cause of failure +
patient complains of food accumulation
o Defective contact → replacement

o Wide proximal cavity → indirect restoration


DEFECTIVE CONTACT AND
CONTOUR

Repair may be done by making cavity within the


defective restoration with mechanical means of
retention + matricing & wedging → place new
restoration of the same type
DEFECTIVE CONTACT AND
CONTOUR
o Over contoured restoration → reduction, finishing and
polishing
o Under contoured restoration → replacement except for
composite that can be added
MARGINAL OVERHANGS &
SUBMARGINATION
o Overhangs may lead to periodontal problems &
secondary caries
o Overhangs can be diagnosed visually, tactility &
radiographically

Minimal overhangs → smoothening & polishing


Gross overhangs → replacement
MARGINAL OVERHANGS &
SUBMARGINATION
o Small submargin → smoothening & polishing
o Large submargin → replacement
DISCOLORATION
o Marginal discoloration without recurrent caries →
refinishing & polishing (refurbishment) or repair with
the same shade
o In deep discoloration → replacement
DISCOLORATION
o Surface discoloration → refinishing & polishing
(refurbishment)
o Bulk discoloration → replacement
DISCOLORATION
o Amalgam blues → replacement of the restoration to
improve esthetic or prevent fracture of undermined
enamel
DISCOLORATION
o White line around composite may be due to improper
finishing procedure → proper finishing & polishing
with discs
PITS
o Small pits in metallic restoration → finishing &
polishing
o Pitted composite → enlarge the pit first, then use
delayed resin- resin bonding technique

WEAR
o Wear of composite → veneering of the worn surface
with new composite restoration
(a) A large MOD preparation in tooth 36 was restored with composite resin
(b) The 4-year-old restoration demonstrates generalised wear, discolouration and
marginal breakdown
CHIPPING
o Very common with large composite restorations as
veneers that are subjected to excessive load

Chip fracture of a large class IV restoration


Repair

AMALGAM RESTORATION
During insertion Old amalgam

(old) Small marginal defects of amalgam could be repaired using glass


ionomer cement or composite resin
Repair

COMPOSITE RESIN RESTORATION


During insertion Old composite

1.

If
contaminated ?
(old) Defective area should be
roughened with a diamond stone
Repair

INDIRECT RESTORATION
o Mechanical roughening of the involved surface using
diamond or air-abrasion

Ceramic restorations
2 minutes application of 10% hydrofluoric acid gel
Repair

INDIRECT RESTORATION
Composite restorations
phosphoric acid ®to clean the composite surface after roughening

Silane coupling agent


to mediate chemical bonding between ceramics & resin, may improve
resin-resin repairs
Repair

INDIRECT RESTORATION
Resin-bonding agent is applied and light-cured

Composite of appropriate shade is applied, cured,


contoured and polished
Repair

CAST METAL RESTORATIONS


o Weak link of most cast metal inlay & onlay: cement
seal
o If the restoration is intact & the defective marginal
area is small , accessible ®small repairs with composite
or resin modified glass ionomer
o The most common procedure, once defects are found, is
to remove the defective restoration & replace it
THANK
YOU

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