Recurrent Caries at Crown Margins: Making a Decision on Treatment

Abstract

Objective: To evaluate dentists’ treatment choices for a crowned tooth with varying degrees of recurrent caries. Materials and Methods: A total of 158 dentists participated in the study. A paper patient case (PPC) depicting a radiograph showing varying degrees of recurrent caries at the crown margin was used: PPC1 = small carious lesion away from crown margin; PPC2 = small carious lesion at crown margin; PPC3 = small carious lesion at crown margin extending onto the root, and PPC4 = large carious lesion at the margin; PPC5–PPC8 had the same carious conditions as PPC1–PPC4, respectively, but the teeth were non-vital. Participants were asked to indicate their choice of treatment from a list of options for each PPC. Crown removal tendency was computed after dichotomization of the responses for the different cases for each participant. Demographic information, educational background and practice characteristics were collected. Descriptive statistics, logistic regression analysis and paired-sample t test were used to analyse the data at a statistically significant level of p < 0.05. Results: For PPC1 and PPC5, most of the participants recommended management without crown removal (p < 0.05). For PPC6, there was wide disagreement about management (p = 0.81). For all other PPCs, the majority of participants chose to remove the crown before making a treatment decision (p < 0.05). Logistic regression analysis showed that the size of the lesion, vitality of the tooth, participants’ age as well as the undergraduate training background of dentists were factors that affected treatment decisions. Conclusion: The data showed a lack of agreement among dentists regarding the management of recurrent caries around crown margins. Size of the lesion, vitality of the tooth, educational training and experience appeared to be the main factors that affected their decisions.

Study protocol for a diagnostic randomized clinical trial to evaluate the effect of the use of two clinical criteria in the assessment of caries lesions around restorations in adults: the Caries Cognition and Identification in Adults (CaCIA) trial

“…The dentists do not show the same line of thinking about what is and what is not a caries lesion adjacent to the restoration. Also, there is a diversity of clinical criteria available to assess the caries lesions, which may influence the dentists' different opinions and on the treatment decisions taken [6,7,11]. In addition, there is a lack of evidence regarding the best criterion to detect secondary caries lesions.…”

“…In contrast, the number of failed restorations due to secondary caries is notedly lower (2-3%) in controlled clinical trials [3,4], which raises doubts about the real prevalence of this condition and the possibility of overtreatment. Besides, the dentists show heterogeneity in the treatment decision-making regarding secondary caries [6,7].…”

Wurzelkaries – kennen, erkennen, erfolgreich therapieren

“…In den Kriterien Sekundärkaries und marginale Adaptation gab es keine Unterschiede [39]. Bei der Therapie von kavitierten Läsionen an Restaurationsrändern gibt es bislang keine Richtlinien, wann Restaurationen vollständig abgenommen und erneuert werden müssen und bis wann eine minimalinvasive Reparaturfüllung ohne Entfernen der Restauration möglich ist [40].…”

Impact of a diagnostic workshop on undergraduate teaching‐learning process for the diagnosis and management of tooth restorations—A randomised controlled study

“…There is wide variation among dentists and lack of consistency in diagnostic criteria used in clinical practice, which justifies the search for alternatives to improve quality of diagnosis and evaluation of restorations. Education and level of training are likely the main factors affecting clinical decision making, and dentists must develop during their diagnosis competence according to patient data collection, signs and symptoms .…”

“…There is wide variation among dentists and lack of consistency in diagnostic criteria used in clinical practice, which justifies the search for alternatives to improve quality of diagnosis and evaluation of restorations. Education and level of training are likely the main factors affecting clinical decision making, and dentists must develop during their diagnosis competence according to patient data collection, signs and symptoms . However, pedagogy in preparing students for daily clinical practice is often based on theoretical lectures, presenting with important limitations such as lack of development of critical thinking and problem‐solving abilities .…”