Recognition of failure

Failure of a restoration may take many forms and may be due to major defects (such as fracture and loss of a portion of the supporting tooth or restoration) or may be due to minor defects such as marginal deficiencies, staining or microleakage. When a restoration has failed, but does not involve loss of restoration or tooth bulk, it is unlikely that the failure will be noticed by the patient unless there are symptoms or there is a visible aesthetic problem. This is apparent for both direct and indirect restorations9. A delay in treatment of a failed restoration may result in further damage to the tooth or render repair impossible and as such it is important that an appropriate maintenance programme for a patient with a restored dentition includes frequent recall appointments, at which deterioration or failure can be recognised at an early stage by a clinician.

Most marginal defects are directly observable. In addition to clinical examination, radiographs are a useful adjunct to identify interproximal marginal defects/deficiencies or caries that may otherwise go unnoticed10. Also given the incidence of loss of vitality of teeth with indirect restorations, especially long-term11, periapical radiographs may be useful to detect peri-radicular pathology.

It is easy to replace a failed restoration without considering the implications of failure, which are often underestimated. Situations such as sub-standard treatment, incorrect diagnosis (initially or of failure) or provision of restorations with a short life expectancy will all result in more frequent intervention. Quite simply, the implications of failure relate to cost, both in terms of economic implications as well as harm to the tooth.

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