Current Strategies to Control Recurrent and Residual Caries with Resin Composite Restorations: Operator- and Material-Related Factors

Abstract

This review addresses the rationale of recurrent and/or residual caries associated with resin composite restorations alongside current strategies and evidence-based recommendations to arrest residual caries and restrain recurrent caries. The PubMed and MEDLINE databases were searched for composite-associated recurrent/residual caries focusing on predisposing factors related to materials and operator’s skills; patient-related factors were out of scope. Recurrent caries and fractures are the main reasons for the failure of resin composites. Recurrent and residual caries are evaluated differently with no exact distinguishment, especially for wall lesions. Recurrent caries correlates to patient factors, the operator’s skills of cavity preparation, and material selection and insertion. Material-related factors are significant. Strong evidence validates the minimally invasive management of deep caries, with concerns regarding residual infected dentin. Promising technologies promote resin composites with antibacterial and remineralizing potentials. Insertion techniques influence adaptation, marginal seal, and proximal contact tightness. A reliable diagnostic method for recurrent or residual caries is urgently required. Ongoing endeavors cannot eliminate recurrent caries or precisely validate residual caries. The operator’s responsibility to precisely diagnose original caries and remaining tooth structure, consider oral environmental conditions, accurately prepare cavities, and select and apply restorative materials are integral aspects. Recurrent caries around composites requires a triad of attention where the operator’s skills are cornerstones.

Biological evaluation of Partial caries removal in class II resin composite restorations with two different clinical endpoints of excavation: A 12-month clinical study

“…The current study is similar in design to pervious clinical studies (14) Although stepwise and partial caries removal have received promising outcomes, the debate regarding the reliability of these procedures among clinicians and dental educational institutes remains with particular concern for the clinical endpoint of caries excavation in deep cavities. This might need long established clinical experiences (3,15) and a variety of complex clinical cases in educational and training programs of undergraduates and junior clinicians. Post restoration hypersensitivity and tooth vitality have been listed among the FDI biological properties of ranking restorations (16,17) .…”

“…Therefore, the current study has used those two parameters for assessing the biological reliability of partial caries removal procedure. The literature provides inadequate reports that partial caries removal is a successful procedure that conserves pulp vitality and tooth structure (3,5) with progressing clinical trials to confirm the clinical reliability of the procedure. Two clinical end points of caries excavation, leathery/firm dentin or soft dentin have been reported with partial caries removal (3,5) with little information regarding the safety and validity of the procedure in both cases.…”

“…This establishes a balance between confirming effective bonding to sound substrate tooth structure and reliable peripheral marginal and interfacial seal from one side and preservation of pulp vitality of the underneath healthy pulp on the other side. (3) Partial caries removal makes use of cumulating evidence indicating that bacteria in the left infected dentin layer, when become deprived of essential nutrients by establishing a restoration with tight peripheral seal, they either die or remain inactive (4) . However, the long-term fate of residual caries in partial and stepwise caries removal is lacking.…”

“…Moreover, there is no diagnostic technique to assess progress of residual caries. (3) Two clinical endpoints have been reported for carious dentin excavation in partial caries removal. Excavation to leathery/firm dentin in moderately deep lesions not reaching the inner third of dentin and selective caries excavation to soft dentin where caries has extended to the deepest zone of dentin.…”

“…While firm/leathery dentin has been described to be physically resistant to hand excavation, soft caries is cottage cheesy in texture, and is easily removed with hand excavators (3,4) The literature shows inferior quality of resin bonding to carious dentin than to sound healthy dentin. Therefore, the success of partial caries removal procedure is based on effective bonding to sound peripheral dentin walls (5) .…”