Defective dental restorations: to repair or not to repair? part 1: direct composite restorations

There is clearly an increasing demand for aesthetic dental restorations from the general public and dentists are spoilt for choice as to which materials to use and how best to use them. There is no disputing the excellent aesthetics that can be achieved with composite resin as a restorative material; however, the longevity of these materials can be disappointing, especially if not placed using a careful incremental technique.1 With the increasing use of these materials for the restoration of large defects in posterior teeth, these materials are tested to the maximum.

The management of composite restorations with localized defects is a common challenge in clinical practice. While some restorations will inevitably require replacement, it has been suggested that some deteriorating, yet serviceable, restorations may be given extended longevity through the use of repair procedures.2 This comparatively more conservative approach to the management of defective restorations, if appropriate, has the potential to be less costly in terms of time and financial resources, less traumatic for patients, less likely to result in iatrogenic damage, possibly obviate the need for the use of local anaesthesia and be more conservative of tooth tissue.3^–5 It is clearly preferable, therefore, to perform a restoration repair (ie partial replacement of the composite restoration allowing preservation of that portion of the composite restoration which presents no clinical or radiographic evidence of failure) as an alternative to restoration replacement (removal of an entire composite restoration followed by the placement of a new composite restoration) wherever possible. It is accepted that removal of part of the restoration without the aid of magnification loupes can further result in removal of sound tissue and subsequent increase in the size of the cavity.