Professional Documents
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Failure of Tooth Structure
Failure of Tooth Structure
Continuing Caries
There is no doubt one of the most common reasons for the need to replace a restoration is failure to
eliminate the disease of caries in the first place. The term recurrent caries is the most usual reason
cited in the majority of surveys of replacement dentistry but it should really be used with caution.
If the original disciplines to control caries are not undertaken then it shpuld not surprise if further
lesions develop in relation to the margin between restoration and tooth structure. Obviously the
intimary of the union between the two is a weakness because of the potential for bacterial
microleakage into the gap.
However, there are a number of other factors that need to be understood and controlled. Tooth
structure can fail at the cavity margin adjacent to a restoration for a variety of reasons, including
leaving a margin under direct occlusal load or introducing microcracks in the enamel during cavity
preparation.
Root Surface caries is not specifically failure of a dentine margin although. It will often be
interproximal and easily confused with failure of the adjacent restoration margin.
Bulk loss of tooth structure
The strength of the crown of a tooth lies in maintenance of the circle of enamel around the full
circumference of the crown. Once the circle is broken by the preparation of a cavity on a proximal
surface for placement of a restoration the integritety of the cusp at risk.
Loss of an entire cusp is distressing for the patiet. It often arises through failure to take into account
the weakened nature of the remaining tooth structure in an extensively restored tooth and failure to
provide some form of protective restoration. It is also necessary to continually monitor changes to the
occlusal anatomy may result in a nonworking cusp eventually standing high and becoming subject to
lateral stress.
Split root
This occurs generally in the remaining root structure of a nonvital tooth which has been rstored with a
post crown. The post is essentially an intraradicular restoration which relies on the integrity of the root
to sustain it.
Diagnosis of split root is very difficult and almost invariably, terminal in the life of the tooth. When a
post crown becomes uncemented the remaining root must be carefully explored for signs of a split.
Loss of Vitality
There will need to be a modification to the treatment plan following loss of vitality whatever the
cause. There is likely to be a shift in the translucency colour of the remaining crown and some further
weakening following the enlargement of the root canal during root canal therapy.
Composite resin
Composite resin has no resistance at all to renewed invasion of caries so failure, through loss of
adhesion at the margin, requres immediate attention. If the margin is left open on the occlusal surface,
plaque will be forced in to tje gap under the high hydraulic pressure generated by mastication and
caries will develop rapidly. right down to sound tooth structure so that it will be possible to generate a
new ion exchange adhesion layer with enamel or dentine.
Gold
Occasionally, gold will fail along a margin as a result of further wear on the occlusal surface,