Wary of secondary caries
Featured Products Promotional FeaturesPosted by: Dental Design 13th November 2024
Global restorative dentistry is worth over £4.42 billion and is expected to hit £5.84 billion by 2028.[i] Unhealthy food habits are impacting the world’s oral health, increasing the demand for restorative work. The growing innovations in CAD/CAM technologies are also allowing greater dental work to be done, ensuring the standard of restorative outcomes continues to improve with more advanced equipment.
Due to the continuous growth in restorative dentistry expected in the future, it is crucial that practitioners recognise the two biggest factors for restoration failure: bulk/marginal fracture and secondary dental caries. The most common cause of restoration failure, secondary caries is defined as a lesion associated with restorations or sealants.[ii] It will be an important issue for practitioners to contend with as patient need in this area grows.
Control factors
Identifying the risk of secondary caries can help practitioners treat their patients by providing the best treatment plans. Some of the leading risk factors for caries include the frequent snacking on fermentable carbohydrates, hyposalivation, plaque build-up on the teeth, and smoking. As such, caries is the most widely prevailing non-communicable disease, and secondary caries shares its causes.[iii] Encouraging the changing of lifestyle or diet is highly recommended, whilst hyposalivation can be counteracted by chewing sugar-free gum or a prescription of pilocarpine or cevimeline.[iv]
Treatment time
As caries and secondary caries have similar causes, a high number of restorative patients who may be susceptible to caries may have a higher risk of restoration failure. This can then lead to many additional treatments and procedures for the repair or complete removal of a restoration. In this event, more invasive treatments could be required each time.
Repeated replacements of defective restorations can lead to the excessive removal of dental hard tissue and can shorten the lifespan of the tooth.ii It is therefore more common for practitioners to deal with secondary caries through partial correction, repairing or re-resealing the defective restoration.ii These procedures are less costly and quicker than complete replacements, making them more comfortable and agreeable for the patient. However, they may not be as successful in the long-term. [v]
To avoid invasive treatments and the discomfort they may cause the patient, focusing on a non-invasive approach for preventing restoration failure is imperative. Dental caries is identifiable and reversible at an early stage, so practitioners should find and manage lesions quickly before any damage is done to a restoration.[vi] This non-invasive approach prioritises remineralisation, disease prevention, and minimal intervention when placing or replacing restorations.
For identifying secondary caries at its earliest stage, visual, radiographic and laser fluorescence might be valuable diagnostic measures.[vii] Other methods include using a CBCT scanner for detecting secondary caries in occlusal resin composite restorations. Overall, however, there is a shortage of consensus and reliable strategies among practitioners for the accurate diagnosis of secondary caries – this will be an area of research to look out for in the future.v
The presence, size and the risk of caries are the biggest factors for restorative failure.[viii] By encouraging the education of patients on the importance of good oral hygiene, practitioners can minimise the risk of secondary caries sabotaging any restorative work.
Material concerns
Despite the impact secondary caries has on restoration failure, there is divided evidence on whether the restorative material increases the risk of lesions. For instance, studies have observed that amalgam restorations showed a higher frequency of secondary caries compared to composite.[ix] Regardless of the material, 90% of secondary carious lesions are found at the gingival margins of the restoration, and more research is needed to determine a more direct causation between material and caries.[x]
As secondary caries poses the greatest threat to the success of restorative dentistry, managing restorations with quality repair work is essential. For reliable single-tooth restorative work, consider BRILLIANT Crios from Coltene, a high-performance composite block for aesthetic and fast restorations that doesn’t require a separate firing process. Offering 15 shades and 3 translucencies, BRILLIANT Crios is perfect for daily use in both the anterior and posterior region, suitable for inlays, onlays, crowns and veneers. Its shock-absorbing effects make it perfect for bruxism patients or implant supported crowns.
Identifying patients at risk for secondary caries can help improve the lifespan of their restoration. By managing lesions in their early stages, the practitioner and the patient can ensure that restoration failure is avoided, promoting the long-term success of the treatment.
For more on COLTENE, visit www.coltene.com,
email info.uk@coltene.com or call 0800 254 5115.
Author: Nic Coomber, National Account Manager & Marketing Strategist at Coltene
[i] MarketsandMarkets. (n.d.). Restorative Dentistry Market Size, Share, Trends and Revenue Forecast [Latest]. [online] Available at: https://www.marketsandmarkets.com/Market-Reports/restorative-dentistry-market-210042423.html#:~:text=The%20global%20restorative%20dentistry%20market [Accessed 18 Jun. 2024].
[ii] Askar, H., Krois, J., Göstemeyer, G., Bottenberg, P., Zero, D., Banerjee, A. and Schwendicke, F. (2020). Secondary caries: what is it, and how it can be controlled, detected, and managed? Clinical Oral Investigations, 24(5), pp.1869–1876. doi:https://doi.org/10.1007/s00784-020-03268-7.
[iii] Elgezawi, M., Haridy, R., Abdalla, M.A., Heck, K., Draenert, M. and Kaisarly, D. (2022). Current Strategies to Control Recurrent and Residual Caries with Resin Composite Restorations: Operator- and Material-Related Factors. Journal of Clinical Medicine, [online] 11(21), p.6591. doi:https://doi.org/10.3390/jcm11216591.
[iv] Gil-Montoya, J., Silvestre, F., Barrios, R. and Silvestre-Rangil, J. (2016). Treatment of xerostomia and hyposalivation in the elderly: A systematic review. Medicina Oral Patología Oral y Cirugia Bucal, 21(3), pp.e355–e366. doi:https://doi.org/10.4317/medoral.20969.
[v] Askar, H., Krois, J., Göstemeyer, G., Bottenberg, P., Zero, D., Banerjee, A. and Schwendicke, F. (2020). Secondary caries: what is it, and how it can be controlled, detected, and managed? Clinical Oral Investigations, 24(5), pp.1869–1876. doi:https://doi.org/10.1007/s00784-020-03268-7.
[vi] Gov.uk (2021). Chapter 4: Dental caries. [online] GOV.UK. Available at: https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention/chapter-4-dental-caries.
[vii] Elgezawi, M., Haridy, R., Abdalla, M.A., Heck, K., Draenert, M. and Kaisarly, D. (2022). Current Strategies to Control Recurrent and Residual Caries with Resin Composite Restorations: Operator- and Material-Related Factors. Journal of Clinical Medicine, [online] 11(21), p.6591. doi:https://doi.org/10.3390/jcm11216591.
[viii] Askar, H., Krois, J., Göstemeyer, G., Bottenberg, P., Zero, D., Banerjee, A. and Schwendicke, F. (2020). Secondary caries: what is it, and how it can be controlled, detected, and managed? Clinical Oral Investigations, 24(5), pp.1869–1876. doi:https://doi.org/10.1007/s00784-020-03268-7.
[ix] Kamel, Jabbar & Salman, Faraed. (2022). Prevalence of Secondary Caries Around Posterior Restoration. Acta Scientific Medical Sciences. 6. 10.31080/ASMS.2022.06.1154. Accessed via https://www.researchgate.net/publication/357735863_Prevalence_of_Secondary_Caries_Around_Posterior_Restoration
[x] Aminoroaya, A., Neisiany, R.E., Khorasani, S.N., Panahi, P., Das, O., Madry, H., Cucchiarini, M. and Ramakrishna, S. (2021). A review of dental composites: Challenges, chemistry aspects, filler influences, and future insights. Composites Part B: Engineering, 216, p.108852. doi:https://doi.org/10.1016/j.compositesb.2021.108852.
Askar, H., Krois, J., Göstemeyer, G., Bottenberg, P., Zero, D., Banerjee, A. and Schwendicke, F. (2020). Secondary caries: what is it, and how it can be controlled, detected, and managed? Clinical Oral Investigations, 24(5), pp.1869–1876. doi:https://doi.org/10.1007/s00784-020-03268-7.
