children, but integrated within a treatment plan which is best in the long-term interest
of the child and not an easy way out for the dentist. If this predisposes the child to
repetitive treatment, and worse still pain, abscesses, and extractions under general
anaesthesia, then it should be rejected in favour of comprehensive care using
restorative techniques, such as described in this chapter.
8.5 DURABILITY OF RESTORATIONS
8.5.0 Introduction
In contrast to the amount of useful research that has been carried out with regard to
the diagnosis and prevention of dental caries, methods of treatment are still empirical.
Treatment decisions ought to be based on sound scientific evidence but,
unfortunately, despite the great effort that has been spent providing treatment over
many years, little in the way of resources has been spent on clinical research into the
success or otherwise of dental treatment methods. This is especially true with regard
to the primary dentition. There are few reports in the literature on the relative success
in the primary dentition of different treatment methods or materials. The majority of
those reports are retrospective and therefore need to be treated with caution.
The choice of restoration for primary teeth is based upon the degree of carious
involvement, whether the marginal ridge is intact or not and the length of time that
will elapse before exfoliation. The decision regarding the type of restoration to be
used is therefore based on the diagnosis of the extent of the dental caries. Here again
if the marginal ridge has broken away then simple Class II type restoration will fail as
the pulp involvement has possibly occurred already.
8.5.1 Conventional restorative materials
Many different materials have been advocated over the years, but, as indicated above,
very little research has been carried out to find out which ones might be the most
useful. Therefore the popularity of any particular material has depended on clinical
impression and fashion. This section provides a brief overview of those materials that
are both currently widely available and have been subject to some clinical research.
Silver amalgam
Silver amalgam has been used for restoring teeth for over 150 years and, despite the
fact that it is not tooth coloured and that there have been repeated concerns about its
safety (largely unfounded), it is still widely used. This is probably because it is
relatively easy to use, is tolerant of operator error, and has yet to be bettered as a
material for economically restoring posterior teeth. Modern, non-gamma 2 alloy
restorations have been shown to have extended lifetimes in permanent teeth when
placed under good conditions, and have also been shown to be much less sensitive to
poor handling than tooth-coloured materials.
In clinical trials and retrospective studies, no intracoronal material has so far
performed more successfully than amalgam.
Stainless-steel crowns