The Value of Conservative Tooth Restorations

The Value of Conservative Tooth Restorations

Has there been a movement away from conservative tooth restorations in recent years towards large, deep, aggressive preparations and full crowns? Dr. Gordon Christensen, co-founder and senior consultant of Clinical Research Associates in Provo, Utah believes so ("What Has Happened to Conservative Tooth Restorations?" Gordon Christensen, DDS, J am Dent Assoc, Vol 136, No 10, 1435-1437).

The belief is that too many full-coverage restorations are provided when less radical restorations could have been placed. As an example, a popular speaker at a continuing education course taught that a tooth with any restoration to be replaced, regardless of the restoration size, should be replaced with a full crown. Instead, Dr. Dulski believes that conservative restorations should be encouraged. This report discusses some of the reasons full crowns are being accomplished more commonly than in the past, the rationale for returning to more conservative restorations, the financial implications of crowns versus conservative treatment, and the potential longevity differences between small and large restorations.

The rationale for conservative restorations is preservation of tooth structure. Assuming that a given tooth has a significant amount of tooth structure remaining and that the structure is not discolored or cracked, conservative restorations have some significant advantages. Among these advantages is long-term esthetic acceptability for the tooth restored with a conservative tooth-colored restoration. When a tooth-colored full crown is placed in the smile zone of the mouth, the esthetic desirability of the crown is usually good for only the first years. Eventually, the gums around the crown begin to shrink and recede, and the margin joining the crown and the remaining tooth structure is revealed. The overall esthetic result is then unacceptable.

Most dentists agree that preservation of tooth is a desirable goal. Once enamel is removed, it cannot be replaced with anything as long-lasting. If tooth structure and restorative material can be bonded successfully, the result achieves the goal of preserving tooth structure. Bonding tooth structure, especially enamel, to restorative materials is a reality today.

It is well-known that restorations, including full crowns, have a finite life expectancy. People are living longer than ever before. At some point in the life of every restoration, replacement is inevitable. Why not restore teeth conservatively for a filling or two before a full crown is required? Full crowns can be placed in the future.

What are the financial implications of conservative tooth restorations? If a full-crown costs about $1000, a typical three surface white filling costs about one-sixth or $167. If the conservative filling can be placed with the confidence that it has a reasonable chance of achieving adequate longevity, such conservative placement allows several replacements before the patient's financial outlay reaches the cost of a crown.

There is a tendency in dentistry to place more full crowns than may be necessary. This report has discussed the rationale for a reduction in the use of full crowns and a preservation of enamel. Dr. Dulski supports the desirability of placing more conservative restorations to realize the financial and longevity benefits offered by more conservative restorative dentistry. Visit www.dulski.com to learn how contemporary methods give us the tools to give you a gorgeous, bright smile with minimally invasive treatments and fewer repeat visits.

Tags: Conservative Tooth Restorations, Crowns, Tooth-Colored Restorations, Conservative Restorative Dentistry, Minimally Invasive Dentistry