Failures in Restorative Treatment and Post-operative Assessment
Achieving long-term success in restorative dental treatments depends not only on procedures performed during treatment but also on the careful management of pre- and post-operative processes. Common failures encountered in clinical practice include shade mismatch, composite restoration failure, restoration fractures, marginal adaptation problems, discoloration, inadequate surface morphology, surface wear related to parafunctional habits, and post-operative periodontal complications. These issues often arise from neglected details during treatment planning and may negatively affect both the esthetic and functional expectations of the patient.
Shade Mismatch and Translucency Assessment
Shade mismatch is one of the most frequent causes of esthetic failure, particularly in the anterior region. This problem is closely associated with the inability to adequately replicate the natural translucency of the tooth structure within the restoration. Translucency assessment should be performed before tooth preparation and during the try-in phase, with careful analysis of opacity levels and dentin-shade effects. Studies have demonstrated that the appropriate use of nanohybrid composite materials with varying opacity levels can significantly reduce the risk of shade mismatch and improve esthetic outcomes.
Post-operative fractures are commonly observed in patients with high functional loads, particularly in posterior regions. For direct composite restorations, the correct application of high-strength materials and proper adhesion protocols is crucial, especially for high-stress areas. When fractures occur, the location of the fracture and the condition of the remaining restoration should be carefully evaluated before a prosthetic solution. Contemporary approaches emphasize that minimally invasive restorative repairs can be long-lasting and that not every fracture necessarily indicates the need for full-coverage crown.
Post-operative Periodontium Complications and the Importance of Marginal Adaptation
The long-term success of restorative treatments is influenced not only by material durability but also by biological compatibility with the surrounding periodontal tissues. Restorations with inadequate marginal adaptation promote plaque accumulation, leading to gingival inflammation and, over time, clinical attachment loss. Subgingival marginal discrepancies, in particular, may compromise periodontal health through marginal leakage, microbial infiltration, and the negative effects of biofilm formation. Therefore, careful evaluation of marginal finishing, contouring, and placement in accordance with biological width principles is essential during post-operative assessment. The literature indicates that well-polished and properly contoured restorations significantly reduce gingival index and plaque scores, highlighting the critical role of marginal integrity in maintaining periodontal health.
Watch the Course:
In this session “Failures in Restorative Treatment & Post-operative Assessment”, prepared by Assoc. Prof. Bora Korkut, faculty member at the Faculty of Dentistry, Marmara University, restorative treatment failures are discussed in detail through clinical case photographs, and practical clinical solutions are presented.
References
1.Sulaiman TA, Rodgers B, Suliman AA, Johnston WM. Color and translucency stability of contemporary resin-based restorative materials. J Esthet Restor Dent. 2021;33(6):899-905. doi:10.1111/jerd.12640
2.Lehmann A, Nijakowski K, Jankowski J, et al. Clinical Difficulties Related to Direct Composite Restorations: A Multinational Survey. Int Dent J. 2025;75(2):797-806. doi:10.1016/j.identj.2024.06.012
