What is the best approach to prevent secondary caries from spreading under composite restorations?
This question was submitted by a general dentist: What is the best approach to prevent secondary caries from spreading under composite restorations?
Dr. Jacinta Santos, Assistant Professor of Restorative Dentistry, Schulich School of Dentistry at Western University, has provided this quick initial response.
Drafted by Alexandra Rabalski, JCDA Oasis Intern
Resin-modified glass-ionomer (RMGI) can be used as a liner or as a restorative material. RMGI releases fluoride, thus protecting the tooth against possible secondary caries. In addition, polymerization shrinkage is much lower for RMGI than for resin composite, generating less stress on the walls of the tooth. I always teach my students to place RMGI under the composite restoration if there is room for it. This method is often referred to as the “sandwich technique.”
References
Liebenberg, W. (2005). Return to the Resin-Modified Glass-Ionomer. Journal of the Canadian Dental Association, 71 (10); 743-747.
I find this post too simplistic and not addressing a broader issue of why there is secondary caries around resin restorations.
The most obvious are the basics of doing a restoration: isolation, not removing the whole caries, curing technique, c factor, depth of cure, to mention a few.
As far as the materials are concerned I have been using a couple of newer resin materials namely SureFil SDR and SonicFil. Both materials have greatly improved polymerization stress, depth of cure and adaptability. As good as those materials might be it is not going to replace a thorough knowledge of bonding protocol and lets not forget that composite restorations are VERY different from amalgams and require conscious effort in education not just using white stuff in place of silver one
It seems that the bacteria in the mouth are breaking down the composite materials. There is new evidence from the university of Toronto. So, no matter how careful you are it becomes a really bad restorative material.
So then, what are the alternatives? Amalgam? or only Ceramics?