Table 2.
Terminology and definitions and description of commonly used terms
| Term | Definition | |
|---|---|---|
| Methodology | Minor/slight | The terms “minor” and “slight” indicate a small difference in comparison to an excellent restoration. Differences are detectable by visual means or with additional procedures, e.g., short air drying or gentle probing. It represents a fully sufficient clinical situation, which does not need any further intervention |
| Distinct | The term “distinct” indicates a clinically relevant difference in comparison to an excellent or good restoration. Otherwise, the clinical situation is basically acceptable and sufficient. Intervention by refurbishment potentially improves functionality or aesthetics | |
| Severe | The term “severe” indicates a substantial deviation in comparison to a sufficient restoration and characterizes a serious clinical condition which most likely requires operative intervention by repair or replacement | |
| Localized | Minor parts: less than half of the restoration (margin) is affected | |
| Generalized | Major parts: more than half of the restoration (margin) is affected | |
| Speaking distance | Typically ~ 80–100 cm/ ~ 3 ft. Dental operation light is switched off | |
| Examination distance | Typically ~ 40 cm/ ~ 1–1½ ft. The patient is placed on a dental chair, and the oral cavity is professionally illuminated. Tooth cleaning and short air drying of the teeth and restorations improve visual examination | |
| Tooth cleaning and air drying | A good examination of dental restorations requires the removal of the dental biofilm and tooth drying with compressed air for a few seconds until all saliva is removed. Avoid over drying! | |
| Visual examination | Visual examination without any magnification is the standard procedure for the evaluation of dental restorations. In case that magnifying loups or microscopes are used it needs to be reported. Acuity of operators and examiners should be regularly checked | |
| Restorations defects | (Marginal) gap | Defective interface between the dental hard tissue and the restoration material, which is leaving parts of the restoration margin clinically exposed. A wide range of width and depth is possible. Optimally, there is a smooth transition between the dental hard tissue and the restorative material |
| Negative/positive step | Steps are differences in height between the dental hard tissue and the restorative material. A step is formed due to under-contour (negative step) or over-contour of the restoration at the restoration margin (positive step). Different dimensions are possible | |
| Enamel and dentin cracks/cracked dental hard tissue | Crack lines in enamel/dental hard tissue are commonly detectable in (un)restored teeth and mostly represent no pathology. Nontraumatic tooth cracks have a wide clinical spectrum and reach from small enamel breakdowns to complete tooth fractures. If such a clinical situation directly involves a restoration or its margin it will be considered in the category “Dental hard tissue defect at restoration margin (B2)”. Traumatic dental injuries have to be separated from this entity | |
| Material crack | Crack lines within the restoration material may indicate that restoration could not withstand occlusal forces and might be interpreted as an initial material fracture | |
| Fracture | There is a huge spectrum, which reaches from small defects (chipping fractures) to a substantial loss of material (bulk fractures). Typically, a residual restoration material is present and cavity walls are exposed | |
| Bulk fracture | Fracture within the body of the restoration mostly perpendicular to the occlusal surface | |
| Chipping/Chip fracture | A chipping is a minor or major cohesive fracture of tooth-coloured restoration material or an indirect restoration with a veneered framework mostly parallel to the occlusal surface. In most cases the overall functionality of the restoration is not affected and the chipped area can be polished or repaired | |
| Delamination | Partial or complete adhesive failure of the veneering material of an indirect restoration | |
| Decementation | Loose or lost conventionally cemented indirect restoration. Typically, loose/lost but proper indirect restorations can be recemented/reluted | |
| Debonding | Loose or lost adhesively bonded direct or indirect restoration. Typically, loose/lost direct restorations have to be replaced. Loose/lost but proper indirect restorations can be recemented/reluted (= repair) | |
| Loss of retention | A restoration can be fully retained, partially retained or lost. Furthermore, each type of restoration can be adapted to the dental hard tissue (full retention) or decemented/debonded (loss of retention). Loose or lost, but properindirect restorations can be recemented/reluted. Loose or lost direct restorations have to be replaced | |
| Caries at restoration margin (CAR) | CAR is located directly at the restoration margin without sound tooth structure in between. CAR can reach from a non-cavitated carious lesion to large cavities. It represents a new carious process at the restoration margin. Demineralisations can be left at cavity margins during restoration placement as part of a minimal invasive intervention strategy | |
| Intervention/management strategies | 5R | The “5 Rs” include reviewing/monitoring, refurbishment, resealing, repair, and replacement of deteriorating or failed restorations [6] |
| Reviewing | Regular monitoring in risk-related and individualized intervals | |
| Refurbishment | Refurbishment is a minimal invasive, subtractive intervention, which includes contouring of the form and/or margins as well as polishing of the restoration`s surfaces to reduce biofilm accumulation. No new adhesive, sealant, or filling material will be added | |
| Reseal | Reseal/sealing is a noninvasive, additive technique, which includes the direct application of an adhesive or sealant on gaps or defects without cavity preparation. Typically, superficial localized marginal gaps can be sealed | |
| Repair | Repair is a minimal invasive, additive technique that involves the direct application of restorative material after minor cavity preparation or roughening/conditioning of remaining surfaces (artificial/biological surfaces) and preservation of sufficient parts of the existing restoration. Typically, localized defects with clinical access can be repaired, e.g. chipping, minor bulk or cusp fractures or CAR | |
| Replacement | Replacement is required if the restoration defects are so extensive that a repair is not reasonable. This procedure requires the removal of the existing material, cavity/tooth preparation and the application of a new direct or indirect restoration | |