We are pleased to note the attention our article has received. Disagreements and diversity of opinions like those presented will stimulate thoughts and further deliberations that will often end up in advancement of the topic in question.
Dr. Quinn considered the publication of a seven-page article too much to draw attention to what he (as we) considered to be a simple procedure that should be performed when indicated. The intonation in the present reaction to our article by Dr. Margetis is different because he considers repair of restorations to be an inferior type of treatment, which he refers to as "patch-and-mend dentistry."
This view is based on opinion, not on scientific evidence, nor on general clinical experience. Considering that the majority of dental schools in North America teach repair of local defects on otherwise intact restorations, the body of evidence/clinical experience with repair of restorations is considered extensive and positive. However, the longevity of repaired restorations is not known, and therefore, as indicated in our response to Dr. Quinn, we are in the process of collecting longevity data on repaired restorations.
Since Dr. Margetis considers repair as an inferior treatment, he may not want to know the result from these studies, but we can assure him that the rest of the dental community will be informed.
Note also that we have not suggested "trapping decay and everything that it needs to progress beneath cosmetically refreshed restorations," although that may be a feasible approach based on 10-year data published in JADA.1
If localized recurrent caries is diagnosed, we recommend an exploratory preparation into the adjacent restorative material to verify the diagnosis and remove any carious tissue present. We do not use "20-micrometer explorers and electron-microscopic loupes" to diagnose recurrent caries, but common clinical criteria as for primary caries: softening of the tissues, discoloration and wetness of the lesion. If the lesion is localized, and it usually is, then a repair rather than a replacement of the restoration should be done.
The inference in Dr. Margetis’ letter about dental care based on inferior techniques in countries where treatment is "regulated and monitored by governments" has no bearing on the article we published. However, we feel it is symptomatic for the tone in the letter, and it should not be overlooked.
In Scandinavian countries, for example, some government regulations of dental care exist, but dentists and patients do not need to follow these regulations, although nearly 100 percent do. Improvements in dental health over the last decades in these countries for the entire populations have been astounding, and they continue to have excellent care by private and salaried practitioners, even after community programs have terminated. In the United States, large parts of the population never receive regular dental care. We rate this as a failure, not as a success.
Finally, let us also comment on Dr. Margetis’ outcry regarding "antimetal, bond-it-all philosophy" (which also is unrelated to the content of our article). We can assure him that metal restorations also lend themselves to repair, and they are part of our longevity study.
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