We appreciate the opportunity to respond to Dr. Quinn’s comments on our article. He considers the topic so simple and ordinary that it did not warrant a seven-page article. His recipe is simple: when caries is diagnosed, remove it and if the adjacent restoration is esthetically satisfactory, then do a repair. That is in full agreement with our view. However, there is more to it than that.
Dr. Quinn states that "when caries is detected, remove it." That detection is no easy task, and the variation among clinicians in diagnosing caries, including "recurrent" caries, is astounding. This variation has been shown in numerous investigations. If Dr. Quinn and others want to explore this field, an article by Drs. Bader and Shugars may be a good start.1
The uncertainty in diagnosing recurrent caries also is reflected in the teaching at dental schools.2 Note also that "drilling and filling" cannot remove caries alone. The 1995 JADA caries diagnosis and risk assessment supplement3 is an excellent review of caries diagnosis and preventive strategies, but these topics were not intended for discussion in our article.
Dr. Quinn must have noticed that not all dental schools in North America teach repair of restorations, primarily due to the lack of clinical evidence. In Germany, half the dental schools do not teach repair of restorations, while all Scandinavian and most British dental schools teach this procedure. Those dental schools that do not teach repair apparently replace restorations in toto when localized defects, such as recurrent caries, are diagnosed or misdiagnosed.
The consequences are unnecessary loss of tooth tissue, including that from intact areas, and increased cost. An exploratory preparation into the restorative material adjacent to the area where the recurrent lesion was clinically diagnosed will allow a correct diagnosis to be made. Repair then often becomes the optimal treatment.4
Repair of localized defects apparently is an obvious alternative treatment to complete replacement of restorations for Dr. Quinn and for us, but unfortunately not for every clinician or teacher at dental schools. That is why we, and the JADA reviewers of our article, believed publication of the article was justified. It was not part of the "publish or perish" syndrome.
How much do repairs enhance the longevity of restorations? No published data are available, but research is on the way. Our prediction is that a repair may increase the longevity by up to 100 percent; that is, the restoration is as good as new after the repair. Even if we do not double the longevity of the restoration, the procedure is considered an excellent alternative to replacement in many clinical situations.
