Restorations without conventional cavity preparations

Dentists in developed countries tend to provide highly restoration-oriented dental care, yet recent research has shown that restorations have many shortcomings and that a costly and repetitious restorative cycle is easily established. In particular, caries diagnosis and restorative treatment planning are subject to considerable idiosyncrasies. Coupled with mediocrity in cavity preparation and restorative technique, this results in many restorations having poor life expectancy. The non-invasive management of small carious lesions in a manner that will bring about some remineralization offers, under certain circumstances, a viable and superior alternative to conventional restorations. However, carious lesions in smooth surfaces of the teeth present very different diagnostic and assessment problems from those in fissured surfaces and the methods of clinical management differ markedly. Fissure sealants have been applied to early or moderately sized pit and fissure carious lesions in many studies during the last 20 years. Where the sealant has remained intact, evidence has been provided to show that the caries has not progressed. There would seem, therefore, to be a strong case for using fissure sealants more widely in the management of pit and fissure lesions and, in this way, to provide restorations without cavity preparations. In situations where invasive procedures are required, conventional 'Black' cavity preparations should not be used. Rather, they should be ultra-conservative and of very high quality. Clearly, a preventive philosophy in caries management should actively be encouraged in countries with developed dental services.(ABSTRACT TRUNCATED AT 250 WORDS)