Longevity of the tooth/restoration complex: a review

The contemporary dentist has a wide variety of materials to utilize in the restoration of defective teeth. The decision as to which restorative approach should be utilized in any given clinical situation is a joint one between the patient and the treating dentist. The dentist's primary obligations are to understand the indications and contraindications of various materials, understand how to optimally manipulate those materials, and educate the patient so that they make intelligent decisions and give proper informed consent. The ultimate decision as to which approach to use rests with the patient, and the patient must clearly understand the benefits and risks associated with different restorative options. Clearly, one of the important considerations with any treatment is the prognosis and restoration longevity. When attempting to predict the long-term prognosis of any restoration, it is important to consider both the restorative material being considered as well as the specific tooth that is being restored. Many times the amount of remaining tooth structure has a more significant bearing on long-term prognosis than what material is used for restoration. Thus, the tooth/ restoration complex must be considered as a whole when predicting potential longevity. Many clinical trials have been conducted to attempt to answer those questions, and relatively few unbiased, unambiguous answers are available. The only completely honest answer to those questions is "It depends". This is because the prognosis of all restorative therapy depends on the complex interaction of a number of variables, some of which are controlled by the dentist, and some of which are totally out of the dentist's control. This article will attempt to delineate some of the factors related to the long-term prognosis of the tooth/restoration complex, and specifically identify factors that decrease the prognosis of the tooth/restoration complex.