A new protocol and standard of care for managing open crown margins

Open margins on indirect restorations (such as crowns) are the bane of dentists. Judging margins is a subjective undertaking, and there is no agreement among dentists on "how open is open?" Board actions and lawsuits commonly include charges concerning open margins. Immediate replacement of the offending restoration is claimed as the standard of care, particularly when litigation or state dental board actions are involved. However, repair and monitoring of margins are options that have recently become available. These approaches have been widely accepted and are less invasive alternatives to immediate replacement. Silver diamine fluoride (SDF) has provided new options for the management of margins. SDF, which is inexpensive and easy to apply, kills pathogens; hardens softened dentin (making it more acid and abrasion resistant); and does not stain sound dentin, enamel, or porcelain. SDF does stain any caries black. Except for those with demonstrably grossly open margins, restorations with marginal defects can and should be treated conservatively. Repairing or resealing, where possible, along with continued monitoring of all indirect restorations, has now become the standard of care. If caries develops, the tooth can often be conservatively treated by applying a layer of SDF. Only within the esthetic zones would the option of repair or replacement of the restoration be necessary.