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03 April 2019

To intervene or not to intervene: decision-making in secondary caries based on bite-wings

Lorenzo Breschi


In everyday practice, caries is considered the most common reason for the replacement or repair of a defective dental restoration, and for the general dentist, the detection of secondary lesions is often a challenge. To detect an interproximal lesion, clinical inspection is not always sufficient, as the presence of adjacent teeth and gingival tissue in cervical areas do not allow an appropriate visual examination of the marginal defects. In such cases, bitewings radiographs are considered the gold standard for an appropriate evaluation of interproximal restored surfaces. However, even if x-rays could be of help, a lack of standardized diagnostic criteria and treatment guidelines for monitoring, restoring or replacing a defective restoration is reported.
An interesting article written by Signori et al. in the late 2018, investigates the different approach of experts in cariology and restorative dentistry compared to general dentistry practitioners when facing a bitewing of a restored proximal surface.
770 posterior bitewing radiographs of teeth with proximal restored surfaces were selected from the database of 7 general dental offices and evaluated by three experts in the field. Experts indicated intervention due to caries in 26.8% of the cases, whereas general dentists established the need for a new restoration in 90.6% of cases. Moreover, general dentists suggested a re-intervention more frequently than experts in case of marginal defects or lack of adaptation of the restorations.
 However, as known from the scientific literature, marginal defects around restorations are poor predictors of caries and have limited clinical relevance, since theirs the presence does not predict the longevity of the restoration, and in general is not an indication for a new treatment.       

In conclusion, according to the present study, general practitioners and experts show fair agreement regarding the decision-making process in case of interproximal restorations. Non-experts tend to have a less conservative approach regarding the decision to intervene or not on previous treatments.


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