Restorative dentistry: 2. prospects for the future

Current thinking on cavity design revolves around an increased understanding of the need for extremely conservative cavity preparations that are determined mainly by the extent of the caries at the enameldentine junction, rather than upon preconceived ideas embraced by the term ‘outline form’.¹

However, considerations of the whole basis of restorative dentistry as a method of managing caries and its sequelae are even more important. It is all too easy to assume that restorations are the perfect and ultimate way of managing caries, but restorative dentistry has many shortcomings and it is necessary to bring these into focus before making any predictions as to prospects for the future. This article looks briefly at some of these shortcomings and forecasts the way in which many of them will have been overcome by the year 2000.

Restorative dentistry is based upon the concept that the surgical excision of carious tissue followed by the restoration of the tooth is the treatment of choice for caries. These procedures in themselves, of course, do not cure the disease; rather, the cause remains and lesions may therefore progress elsewhere in the mouth or, subsequently, occur as secondary caries near the original sites. A true cure for this disease only occurs when the iconic balance between the loss and uptake of calcium and phosphate ions from the lesion can be made to swing in the overall direction of remineralization. The implementation of appropriate preventive measures, such as dietary control, frequent fluoride applications and plaque control, are the main established ways of engendering this.