Clinical diagnosis of recurrent caries.

BACKGROUND: The clinical diagnosis of recurrent caries is the most common reason for replacement of all types of restorations in general dental practice. Marked variations in the diagnosis of the lesions have been reported. The prevention of recurrent lesions by the use of fluoride-releasing restorative materials has not been successful. TYPES OF STUDIES REVIEWED: The author focused on practice-based studies in the literature. These studies are not scientifically rigorous, but they reflect "real-life" dental practice. Few experimental studies on recurrent carious lesions in vivo have been reported, but bacteriological studies indicate that the etiology is similar to that of primary caries.
RESULTS: Recurrent carious lesions are most often located on the gingival margins of Class II through V restorations. Recurrent caries is rarely diagnosed on Class I restorations. The diagnosis is difficult, and it is important to differentiate recurrent carious lesions from stained margins on resin-based composite restorations. Over-hangs, even minute in size, are predisposed to plaque accumulation and the development of recurrent caries. The development of recurrent lesions is unrelated to microleakage. CLINICAL IMPLICATIONS: As recurrent carious lesions are localized and limited, alternative treatments to restoration replacement are suggested. Polishing may be sufficient. If not, exploratory preparations into the restorative material adjacent to the localized defect can reveal the extent of the lesion. Such explorations invariably show that the lesion does not progress along the tooth-restoration interface. The defect, therefore, may be repaired in lieu of being completely replaced. Repair and refurbishing of restorations save tooth structure. These simple procedures also increase the life span of the restoration.