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Grey areas in restorative dentistry: part 5. Mind the gap 2: the restoration with a deficient margin Robert L Caplin Dental Update 2025 52:3, 212-217.
Authors
Robert LCaplin
BDS, MSc, DGDP (RCS Eng), Dip Teach Ed (King's), Retired Senior Teaching Fellow, Faculty of Dentistry and Oral and Craniofacial Sciences, King's College London; General Dental Practitioner, London
Restorations, whether direct or indirect, may display clinically detectable gaps between themselves and tooth tissue, i.e. deficient margins. These deficiencies may arise from degradation of the material over time or may be deficient from the outset, such as fitting an indirect restoration with suboptimal marginal adaptation. The most frequently cited reasons for the replacement of restorations are recurrent caries, fracture of the restoration, marginal deficiency, lack of a contact point, and occlusal discrepancy, and of these, the clinical diagnosis of secondary caries is the most common. The diagnosis of recurrent caries at the margins of restorations is difficult and liable to misinterpretation leading to perhaps unnecessary remedial work.
CPD/Clinical Relevance: ‘Failing’ restorations are commonly seen in dental practice and pose unique challenges to the dental practitioner in terms of their management.
Article
In an ideal world, a restoration would be invisible to the eye, blending in with the colour of the tooth where aesthetics was a consideration, the transition from the restoration to the tooth would be imperceptible to a probe, and the restoration would not show any degradation over time, maintaining a perfect seal with the tooth tissue. In the real world, perfect colour matching is extremely difficult to achieve, as is a restoration without some detectable margin. And of course, degradation of most materials can be expected, possibly resulting in a detectable gap between restoration and tooth.
This reality poses difficult questions for restorative dentists because where there are existing restorations, the practitioners are constantly having to make decisions about the tooth–restoration interface; is it acceptable or not? Is the existing restoration failing, or has it failed, where fail means ‘to lose strength, to stop functioning normally’.1 The role of a restoration is to restore form, function and features (considered in more detail in Part 6 of this series) and implicit in these parameters is that the restoration will have as close a relationship as possible with the cavity or preparation surfaces to reduce the risk of recurrent caries and subsequent failure. And this applies equally to direct and indirect restorations that are to be fitted. How much of a gap is too big?
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