by Dr. Olga Karnakova
The practice of dentistry over the years has made many advancements in the conservation of tooth structure when performing restorations. Ideally, only the decayed tooth structure should be removed to keep the procedure as minimally invasive as possible. It is important to maintain as much of the original tooth structure in order to preserve its integrity, strength, and reduce postoperative sensitivity.
An example of choosing a minimally invasive restoration is to use a composite instead of an amalgam filling. Unlike a composite fillings, amalgam does not bind to the tooth structure. Amalgam fillings are composed of metals, and require the drilling of additional tooth structure in order to create enough surface area to hold the filling in place. Amalgam fillings that are too large can cause unnecessary stress on the tooth, and can lead to fractures or recurrent decay.
Teeth that have decay with cuspal involvement usually require onlays or crowns for additional strength. An onlay is a restoration that is fabricated to restore one or two cusps, while a crown is needed to restore or cover all the cusps. Unlike an onlay, a crown requires more removal of tooth structure to allow the crown to fit similar to a cap. An onlay would only require the removal of structure that is decayed, leaving healthy tooth structure intact.
Maintaining tooth structure increases the prognosis of the tooth if the restoration should fail in the future. If the restoration should fail, a second restoration would not be possible if there is not adequate tooth structure to support it. As dentists, we encourage the long-term prognosis of the tooth, and to work together with our patients to select the best and most minimally invasive procedures