6

Treatment Planning for Single-Tooth

Restorations

Using cast metal, ceramic, and metal-ceramic restorations, large areas of missing coronal tooth
structure can be replaced while the remainder is preserved and protected. Function can be restored,
and where required, a pleasing esthetic effect can be achieved. The successful use of these
restorations is based on thoughtful treatment planning, which is manifested by choosing a restorative
material and design that are suited to the needs of the patient. In a time when production and
efficiency are heavily stressed, it should be restated that the needs of the patient take precedence over
the convenience of the dentist.
In what circumstances should cemented restorations made from cast metal or ceramic be used
instead of amalgam or composite resin restorations? The selection of the material and design of the
restoration is based on several factors.
The first factor is destruction of tooth structure. If the amount of destruction previously suffered
by the tooth to be restored is such that the remaining tooth structure must gain strength and protection
from the restoration, cast metal or ceramic is indicated over amalgam or composite resin.
Esthetics is another important factor. If the tooth to be restored with a cemented restoration is in a
highly visible area, or if the patient is highly discriminating, the esthetic effect of the restoration must
be considered. Sometimes a partial coverage restoration will serve this function. Where full coverage
is required in such an area, the use of ceramic in some form is indicated. Metal-ceramic crowns can
be used for single-unit anterior or posterior crowns, as well as for fixed partial denture retainers.
All-ceramic crowns are most commonly used on incisors, although they can be used on posterior teeth
when an adequate amount of tooth structure has been removed and the patient is willing to accept the
possibility of more frequent replacement.
Plaque control also plays a role. The use of a cemented restoration demands the institution and
maintenance of a good plaque-control program to increase the chances for success of the restoration.
Many teeth are seemingly prime candidates for cast metal or ceramic restorations, based solely on the
amount of tooth destruction that has previously occurred. However, when these teeth are evaluated
from the standpoint of the oral environment, they may, in fact, be poor candidates for cemented
restorations. If extensive plaque, decalcification, and caries are present in a mouth, the use of crowns
of any kind should be carefully weighed. The design of a restoration should take into account those
factors that will enable the patient to maintain adequate hygiene to make the restoration successful.
The patient must be motivated to follow a regimen of brushing, flossing, and dietary regulation to
control or eliminate the disease process responsible for destruction of tooth structure. It may be
desirable to use pin-retained amalgam provisional restorations to save the teeth until the conditions
responsible for the tooth destruction can be controlled. This will give the patient the time necessary to
learn and demonstrate good oral self-care. It will also permit the dentist and staff to reinforce the
skills required of the patient and to evaluate the patient’s willingness and ability to cooperate. If these
measures prove successful, cast metal, ceramic, or metal-ceramic restorations can be fabricated.
Because these restorations are used to repair the damage caused by caries and do nothing to cure the
condition responsible for the caries, they should not be used if the oral environment has not been
brought under control.
A fourth factor is financial considerations. Finances influence all treatment plans because
someone must pay for the treatment. That may be a government agency, a branch of the military, an
insurance company, and/or the patient. If the patient is to pay, the dentist should provide good advice
and then allow the patient to make the choice. A conscientious dentist must walk a fine ethical line.
On the one hand, a dentist should not preempt the choice by selecting a less-than- optimum restoration
just because he or she thinks that the patient cannot afford the optimum treatment. On the other hand, a
dentist should be sensitive enough to the individual patient’s situation to offer a sound alternative to
the optimum treatment plan and not apply pressure.
A final factor is retention. Full coverage crowns are unquestionably the most retentive1,2 (Fig 6-1).
However, maximum retention is not nearly as important for single-tooth restorations as it is for fixed
partial denture retainers. It does become a special concern for short teeth and removable partial
denture abutments.

Fig 6-1 A comparison of resistance to removal forces for four types of crowns (P = .05).1,2 MOD,
mesio-occlusodistal.

Twelve restoration types are presented in the following pages to provide a frame of reference for
making a decision whether to use a “plastic” restoration or a cemented restoration. The plastic
restoration is inserted as a soft (ie, plastic) mass into the cavity preparation, where it will harden and
be retained by mechanical undercuts or adhesion. The cemented restoration, made of cast metal,
metal-ceramic, or all-ceramic material, is fabricated outside of the operatory and is luted or bonded
to the patient’s tooth at a subsequent appointment. One type can be better suited for a particular
application than the other, or in some cases either may be suitable.

Intracoronal Restorations
When sufficient coronal tooth structure exists to retain and protect a restoration under the
anticipated stresses of mastication, an intracoronal restoration can be employed. In this circumstance,
the crown of the tooth and the restoration itself are dependent on the strength of the remaining tooth
structure to provide structural integrity.

Glass ionomer
Small lesions where extensions can be kept minimal and where preparation retention will be
minimal can be restored with glass ionomer. It is useful for restoring Class V lesions caused by
erosion or abrasion (Fig 6-2). It also can be employed for incipient lesions on the proximal surfaces
of posterior teeth by use of a so-called tunnel preparation, which leaves the marginal ridge intact (Fig
6-3).
Glass ionomer has found a niche in the restoration of root caries in geriatric and periodontal
patients (Fig 6-4). An occlusal approach may be precluded by the presence of an otherwise
acceptable crown, or a conventional restoration at such an apical level might require the destruction
of an unacceptable amount of tooth structure. In addition, handpiece access may be too restricted to
create the needed retention for a small amalgam restoration.
Glass ionomer also can be placed rapidly enough to serve as an interim treatment restoration to
assist in the control of rampant caries (Fig 6-5). This is further enhanced by the release of fluoride by
the material.

Composite resin
This material can be used for minor to moderate lesions in esthetically critical areas (Fig 6-6).
While it can be used in the restoration of incisal angles assisted by acid etching, a tooth that has
received a Class IV resin restoration ultimately will require a crown.
Composite resin has been used in the restoration of posterior teeth with mixed results. Sufficient
abrasion resistance to prevent occlusal wear has been a problem. Also, unless the resin is carefully
applied in small increments, polymerization shrinkage will lead to leakage and ultimately to failure.
Its use probably should be restricted to small occlusal and mesio-occlusal restorations on first
premolars.
An innovative approach to the prevention of root caries at the margins of restorations that extend
from enamel to cementum is the application of a slurry of unfilled resin and sodium fluoride
combined with laser energy.3 This approach resulted in a significantly increased resistance to acid
and mechanical destruction. In another study, topical fluoride in combination with laser energy
provided resistance to enamel caries.4
A technique devised to combat the problems of shrinkage and leakage is the fabrication of a
composite resin inlay (Fig 6-7). This can be accomplished in the dental office, using a fast-setting
gypsum cast, or in a dental laboratory. The resultant bench-polymerized inlay will have greater
hardness, and the thin layer of resin used for affixing it to tooth structure will be less susceptible to
significant shrinkage at the margin than a restoration that is bulk cured in situ.

Simple amalgam
The simple amalgam, without pins or other means of auxiliary retention, for decades has been the
standard one- to three-surface restoration for minor- to moderate-sized lesions in esthetically
noncritical areas (Fig 6-8). It has received a good amount of negative attention in the media, and some
segments of the profession use this as an excuse to replace otherwise acceptable amalgam
restorations with composite resin. The American Dental Association’s Statement on Dental Amalgam
states that amalgam is a valuable, viable, and safe choice for dental patients.5 A European
Commission’s Scientific Committee also concluded that amalgams are effective and safe.6 They
further state that there is no clinical justification for removing satisfactory amalgams except for
allergic reactions. Nor is the mere presence of a defective margin alone enough to require
replacement.7 Approximately 71 million or more simple amalgam restorations are placed annually.8
They are best used where more than half of the coronal dentin is intact.

Fig 6-2 Glass ionomer can be used to restore gingival abrasion or erosion.

Fig 6-3 Tunnel preparation and glass ionomer can be used to restore an incipient lesion on the
proximal surface of a posterior tooth.
Fig 6-4 Root caries restored with glass ionomer.

Fig 6-5 Rampant caries can be brought under control with glass ionomer.

Tooth preparation size for incipient lesions has diminished in recent years as the popularity of the
concept of “extension for prevention” has waned. This move toward less destructive preparations has
been augmented by the development of smaller instruments and stronger amalgams. Nonetheless, even
a minimal preparation for an amalgam restoration significantly weakens the structural integrity of the
tooth.9

Complex amalgam
Amalgam augmented by pins or other auxiliary means of retention can be used to restore teeth with
moderate to severe lesions in which less than half of the coronal dentin remains (Fig 6-9). Amalgam
used in this manner can be employed as a definitive restoration when a crown is contraindicated
because of limited finances or poor oral hygiene. It can be used in the restoration of teeth with
missing cusps or endodontically treated premolars and molars—teeth that ordinarily would be
restored with mesio-occlusodistal (MOD) onlays or other extracoronal restorations. In such
situations, amalgam is used to replace or overlay the cusp to provide the protection of occlusal
coverage. Although amalgam produces good strength in the restored tooth,10 ideally a crown should
be constructed over the pin-retained amalgam, using it as a core, or foundation restoration.
Fig 6-6 Composite resin is commonly used to restore Class III and Class V lesions on anterior
teeth.

Fig 6-7 Indirect inlays of composite resin can be used for proximo-occlusal restorations on
posterior teeth.

Fig 6-8 A simple amalgam restoration placed in an MOD preparation on a molar.

Fig 6-9 A complex amalgam restoration replaces a missing cusp on a molar.

Fig 6-10 A metal inlay is used to restore a molar.

Fig 6-11 Ceramic inlays can be used to restore posterior teeth.

Fig 6-12 An MOD onlay for a maxillary premolar.

Metal inlay
Teeth with low esthetic requirements and small- to moderatesized lesions can be restored with
metal inlay restorations (Fig 6-10). Although usually made of softer gold alloys, metal inlays also can
be fabricated of etchable base metal alloys if a bonding effect is desired.11,12 The preparation isthmus
should be narrow to minimize stress in the surrounding tooth structure. Premolars should have one
intact marginal ridge to preserve structural integrity and minimize the possibility of coronal fracture.
The additional bulk of tooth structure found in a molar permits the use of this restoration type in an
MOD configuration. The indications for this type of restoration are much the same as those for an
amalgam because this restoration only replaces lost tooth structure and will not protect remaining
tooth structure. Because of the amount of destruction of tooth structure required by this restoration, it
is not recommended for incipient lesions.

Ceramic inlay
Ceramic inlay restorations are used to restore teeth with smallto moderate-sized lesions that permit
a narrow preparation isthmus in an area of the mouth where the esthetic demand is high. Premolars
should have one intact marginal ridge, but MOD ceramic inlays can be used in molars (Fig 6-11).
This type of restoration can also be etched to enhance bonding, and there is some evidence that the
structural integrity of the tooth cusps may be stabilized by bonding.13 The relatively large size of the
cavity preparation required for this restoration precludes its use in the treatment of incipient lesions.

Mesio-occlusodistal onlay
This design can be used for restoring moderately large lesions on premolars and molars with intact
facial and lingual surfaces (Fig 6-12). It will accommodate a wide isthmus and up to one missing
cusp on a molar. If a cast metal restoration is needed on a premolar with both marginal ridges
compromised, it should include occlusal coverage to protect the remaining tooth structure. This
restoration also can be considered an extracoronal restoration because of the occlusal coverage that
overlays and protects the tooth cusps.
The MOD onlay does not have the necessary resistance to be used as a fixed partial denture
retainer. Although ordinarily fabricated of a gold alloy, this restoration design has been used with
cast glass and other types of ceramics. Ceramic MOD onlays should be used very cautiously. Without
generous occlusal thickness, these restorations are susceptible to fracture.

Extracoronal Restorations
If insufficient coronal tooth structure exists to retain the restoration within the crown of the tooth,
an extracoronal restoration, or crown, is needed. It may also be used where there are extensive areas
of defective axial tooth structure or if there is a need to modify contours to refine occlusion or
improve esthetics.

P artial coverage crown

This is a crown that leaves one or more axial surfaces uncovered (Fig 6-13). Therefore, it can be
used to restore a tooth with one or more intact axial surfaces with half or more of the coronal tooth
structure remaining. It will provide moderate retention and can be used as a retainer for short-span
fixed partial dentures. If tooth destruction is not excessive, a partial coverage crown with a minimally
extended preparation and carefully finished margins can satisfy moderate esthetic demands in the
maxillary arch.

All-metal crown
The all-metal conventional crown can be used to restore teeth with multiple defective axial
surfaces (Fig 6-14). It will provide the maximum retention possible in any given situation, but its use
must be restricted to situations where there are no esthetic expectations. This will usually limit it to
second molars, some mandibular first molars, and occasionally mandibular second premolars.
Because less tooth structure must be removed for its preparation than for crowns with a ceramic
component, and because its fabrication is the simplest of any crown, this restoration should remain
among those designs considered in planning single-tooth restorations on molars as well as posterior
fixed partial dentures.

Metal-ceramic crown
A metal-ceramic crown also can be used to restore teeth with multiple defective axial surfaces
(Fig 6-15). It, too, is capable of providing maximum retention, but it also will meet high esthetic
requirements. It can be used as a fixed partial denture retainer where full coverage and a good
cosmetic result must be combined.
Fig 6-13 A three-quarter crown being seated on a molar.

Fig 6-14 An all-metal full crown on a maxillary second molar.

Fig 6-15 A metal-ceramic crown on a maxillary premolar.

Fig 6-16 An all-ceramic crown on an incisor.

Fig 6-17 A ceramic veneer on a maxillary incisor.

All-ceramic crown
When full coverage and maximum esthetics must be combined, an all-ceramic crown is the
treatment of choice (Fig 6-16). All-ceramic crowns are not as resistant to fracture as metal-ceramic
crowns, so their use must be restricted to situations likely to produce low to moderate stress. They
are usually used for incisors, although cast glass ceramics are also employed in the restoration of
posterior teeth. Preparations for this type of restoration on premolars and molars require the removal
of large quantities of tooth structure.
Ceramic veneer
Because all-ceramic and metal-ceramic crowns require the removal of such large quantities of
tooth structure, there has been considerable interest in less destructive alternatives. The ceramic
veneer has emerged as a means of producing an esthetic result on otherwise intact anterior teeth that
are marred by severe staining or developmental defects restricted to the facial surface of the tooth
(Fig 6-17). This restoration also can be used to restore moderate incisal chipping and small proximal
lesions. The use of a veneer requires only minimal tooth preparation and therefore offers an
alternative to crowns that is attractive to the patient and dentist alike.
The features and capabilities of the 12 types of singletooth restorations described in this chapter
are shown in Table 6-1.

Table 6-1 Features and applications of single-tooth restorations

Restoration Longevity
Every dentist would like to be able to answer the patient’s question, “How long will my
restoration last?” Logical though this question may be, unfortunately it is impossible to answer
directly. We cannot predict the life span of a pair of shoes or a television set, and these everyday
items are not custom made, nor do they perform their service in a hostile biologic environment,
submerged in water.
Clinical studies of restoration longevity have produced widely disparate figures. As a general rule,
cast restorations will survive in the mouth longer than amalgam restorations, which in turn will last
longer than composite resin restorations. 14 A compilation of five studies of 676 patients concluded
that amalgam restorations exhibit a 50% failure rate between 5.5 and 11.5 years, with an extrapolated
life expectancy of 10 to 14 years.15
Meeuwissen et al16 reported a 10-year survival rate of 58% for amalgam restorations in Dutch
military patients; Arthur et al17 reported an 83% survival rate for the same time span in a US military
population. Qvist et al18 found that 50% of the amalgam restorations in a group of Danish patients had
failed at 7 years. Christensen19 estimated a 14-year longevity for amalgam restorations. In selected
populations, amalgam restorations of unspecified types or sizes in one study14 have shown 10-year
survival rates as high as 72%. A 15-year survival rate of 72.8% was reported for simple amalgams in
another study.20
A survey of 571 fixed prosthodontists, nonspecialist restorative dentists, and dental school faculty
projected an average life span of 11.2 years for simple amalgams and 6.1 years for complex
amalgams.21 One group of 125 complex amalgams was reported to have a 76% survival rate at 15
years,20 whereas another group of 171 complex amalgam restorations exhibited a 50% survival rate
at 11.5 years.22
Composite resin restorations have not been included in many longevity studies. A study of dental
school patients that did incorporate them reported a 10-year survival rate of 55.9%.14 Another report,
based on a general patient population, described a shorter life span for composite resin restorations,
with 50% of them having failed in 6.1 years.23
Mount24 disclosed an overall success rate of 93% for 1,283 glass-ionomer restorations for up to 7
years, with the rate varying from 2% to 36% depending on the class of cavity and the brand of
cement. In that study, the patients evaluated had been treated by only two dentists, and not all of the
restorations had been in place for the full 7-year span of the study. While promising, these figures
must be assessed cautiously until longer studies of a broader population have been completed.
Schwartz et al,25 after studying a group of 791 failed restorations, reported mean life spans, at
failure, of 10.3 years for full crowns, 11.4 years for three-quarter crowns, and 8.5 years for porcelain
jacket crowns (anterior all-ceramic crowns). The mean life span for all fixed prosthodontic
restorations was 10.3 years. Walton and associates,26 evaluating a group of 424 restorations, found
full crowns lasting 7.1 years, partial veneer crowns 14.3 years, metal-ceramic crowns 6.3 years,
inlays and onlays 11.2 years, and porcelain jacket crowns 8.2 years.
The dentists responding to Christensen’s survey estimated the longevity of crowns to be from 21 to
22 years.19 The estimates supplied by the respondents to a survey by Maryniuk and Kaplan21 were
12.7 years for metal-ceramic crowns and 14.7 years for all-gold restorations. Kerschbaum,27
examining German insurance records, found 91.5% of gold crowns still in the mouth after 8 years. In
a review of records in 40 Dutch dental offices, Leempoel et al28 told of 10-year survival rates of
98% and 95.3% for full crowns and metal-ceramic crowns, respectively.
A compilation of longevities from several studies is presented in Table 6-2.
The question of longevity is an important one to consider when choosing treatment for a patient.
The more destructive the preparation required for the restoration, the greater the potential risk for the
tooth and ultimately the greater expense. In 1989, it was estimated that if a crown were placed in a
patient’s mouth at age 22, at a fee of $425, attendant services and replacements of that crown would
cost the patient nearly $12,000 considering an average life expectancy of 75 years.32 Today, the
original fee may be double, or $850, with a corresponding doubling of the subsequent effect, resulting
in a cost to the patient of nearly $24,000.

Table 6-2 Longevity of single-tooth restorations

References
1. Potts RG, Shillingburg HT Jr, Duncanson MG Jr. Retention and resistance of preparations for cast
restorations. J Prosthet Dent 1980;43:303–308.
2. Kishimoto M, Shillingburg HT Jr, Duncanson MG Jr. Influence of preparation features on retention
and resistance. Part I: MOD onlays. J Prosthet Dent 1983;49:35–39.
3. Holt RA, Nordquist RE. Effect of resin/fluoride and holmium:YAG laser irradiation on the
resistance to the formation of caries-like lesions. J Prosthodont 1997;6:11–19.
4. Hicks J, Winn D 2nd, Flaitz C, Powell L. In vivo caries formation in enamel following argon laser
irradiation and combined fluoride and argon laser treatment: A clinical pilot study. Quintessence
Int 2004;35:15–20.
5. American Dental Association Council on Scientific Affairs. Statement on Dental Amalgam.
Revised August 2009. http://www.ada.org/1741.aspx. Accessed 29 May 2011.
6. European Commission, Scientific Committee on Emerging and Newly Identified Health Risks. The
Safety of Dental Amalgam and Alternative Dental Restoration Materials for Patients and Users, 6
May 2008. http://ec.europa.eu/health/ph_risk/committees/04_scenihr/docs/scenihr_o_016.pdf.
Accessed 29 May 2011.
7. Kidd EA, O’Hara JW. The caries status of occlusal amalgam restorations with marginal defects. J
Dent Res 1990;69:1275–1277.
8. Krupa D. Press Release: Review and Analysis of the Literature on the Potential Health Effects of
Dental Amalgams. 9 December 2004. http://www.lsro.org/amalgam/frames_amalgam_home.html.
9. Mondelli J, Steagall l, Ishikiriama A, de Lima Navarro MF, Soares FB. Fracture strength of human
teeth with cavity preparations. J Prosthet Dent 1980;43:419–422.
10. Reagan SE, Schwandt NW, Duncanson MG Jr. Fracture resistance of wide-isthmus mesio-
occulusodistal preparations with and without amalgam cuspal coverage. Quintessence Int 1989;
20:469–472.
11. Kent WA, Shillingburg HT, Duncanson MG, Nelson EL. Fracture resistance of ceramic inlays
with three luting materials. J Dent Res 1991;70(1 suppl):561.
12. Livaditis GJ. Etched-metal resin-bonded intracoronal cast restorations. Part II: Design criteria for
cavity preparation. J Prosthet Dent 1986;56:389–395.
13. Bodell RW, Kent WA, Shillingburg HT, Duncanson MG. Fracture resistance of intracoronal
metallic restorations and three luting materials. J Dent Res 1991;70(1 suppl):562.
14. Bentley C, Drake CW. Longevity of restorations in a dental school clinic. J Dent Educ
1986;50:594–600.
15. Maryniuk GA. In search of treatment longevity—A 30-year perspective. J Am Dent Assoc
1984;109:739–744.
16. Meeuwissen R, van Elteren P, Eschen S, Mulder J. Durability of amalgam restorations in
premolars and molars in Dutch servicemen. Community Dent Health 1985;2:293–302.
17. Arthur JS, Cohen ME, Diehl MC. Longevity of restorations in a U.S. military population. J Dent
Res 1988;67(1 suppl):388.
18. Qvist V, Thylstrup A, Mjör IA. Restorative treatment pattern and longevity of amalgam
restorations in Denmark. Acta Odontol Scand 1986;44:343–349.
19. Christensen GJ. The practicability of compacted golds in general practice—A survey. J Colo
Dent Assoc 1971;49:18–22.
20. Smales RJ. Longevity of cusp-covered amalgams: Survivals after 15 years. Oper Dent
1991;16:17–20.
21. Maryniuk GA, Kaplan SH. Longevity of restorations: Survey results of dentists’ estimates and
 attitudes. J Am Dent Assoc 1986;112:39–45.
22. Robbins JW, Summitt JB. Longevity of complex amalgam restorations. Oper Dent 1988;13:54–
57.
23. Qvist V, Thylstrup A, Mjör IA. Restorative treatment pattern and longevity of resin restorations in
Denmark. Acta Odontol Scand 1986;44:351–356.
24. Mount GJ. Longevity of glass ionomer cements. J Prosthet Dent 1986;55:682–685.
25. Schwartz NL, Whitsett LD, Berry TG, Stewart JL. Unserviceable crowns and fixed partial
dentures: Life-span and causes for loss of serviceability. J Am Dent Assoc 1970;81:1395–1401.
26. Walton JN, Gardner FM, Agar JR. A survey of crown and fixed partial denture failures: Length of
service and reasons for replacement. J Prosthet Dent 1986;56:416–421.
27. Kerschbaum T. Long-term prognosis of crowns and bridges today [in German]. Zahnarztl Mitt
1986;76:2315–2320.
28. Leempoel P, de Haan A, Reintjes A. The survival rate of crowns in 40 Dutch practices. J Dent
Res 1986;65:565.
29. Swift EJ, Friedman MJ. Critical appraisal. Porcelain veneer outcomes. Part I. J Esthet Restor
Dent 2006;18:54–57.
30. Burke FJ, Lucarotti PS. Ten-year outcome of porcelain veneers placed within the general dental
services in England and Wales. J Dent 2009;37:31–38.
31. Bernardo M, Luis H, Martin MD, et al. Survival and reasons for failure of amalgam versus
composite posterior restorations placed in a randomized clinical trial. J Am Dent Assoc
2007;138:775– 783.
32. Cohen BD, Milobsky SA. Monetary damages in dental-injury cases. Trial Lawyers Quarterly
1989;20:80–81.
Table 6-1 Features and applications of single-tooth restorations

Si z e of Longe v i t y FPD RPD

Re s t or at i on Es t he t i c s
l e s i on r at i ng abut me nt abut me nt

I nt r ac oronal

Glass ionomer Incipient 5 No No Adequate

Incipient
Composite
to 4 No No Good
resin
moderate

Incipient
Simple Poor to
to 1 No Yes
amalgam adequate*
moderate

Complex Poor to
Large 3 No Yes
amalgam adequate*

Poor to
Metal inlay Moderate 2 No Yes
adequate*

Ceramic inlay Moderate 3 No No Good

Moderate Poor to
MOD onlay 1 No Yes
to large adequate*

Ex t r ac oronal

Partial
Poor to
coverage Large 1 Yes Yes
adequate
crown

All-metal
Large 1 Yes Yes Poor
crown
 Metal-ceramic
Large 2 Yes Yes Good
crown

All-ceramic
Large 3 No No Good
crown

Ceramic
Incipient 3 No No Good
veneer

FPD, fixed partial denture; RPD, removable partial denture; NA, not applicable; rev, reverse; prox,
proximal.

*Dependent on tooth position, location of restoration (mesial or distal), and patient expectation.
†Structurally sound, but not esthetic.
‡An acceptable compromise treatment if cusps are capped with amalgam.
§ May offer some protection in conjunction with etching and bonding.
||When used with a core or foundation restoration.
¶Can be used to replace an incisal corner.
Table 6-2 Longevity of single-tooth restorations

Ty pe of No. of
I nv e s t i gat or (s )
s t udy re s t or at i ons Gl as s Compos i t e Si mp
i onome r re s i n amal g

Bentley and 55.9% at 10 72.0%

Clinical 1,207 —
Drake14 y 10 y

Maryniuk15 Clinical* 1,940 — — 10 to 1

Meeuwissen 58.0%
Clinical 8,492 — —
et al16 10 y

83% at
Arthur et al17 Clinical 2,200 — —
y

50% at
Qvist et al18,23 Clinical 442 — 50% at 6.1 y
y

Christensen19 Survey 731 — 7.3 y 13.8

72.8%
Smales20 Clinical 768 — —
15 y

Maryniuk and
Survey 571 — — 11.2
Kaplan21

Robbins and
Clinical 128 — — —
Summit22

93% at 7
Mount24 Clinical 1,283
y
— ——
 Schwartz
Clinical 791 — — ——
et al25

Walton et al26 Clinical 451 — — —

Kerschbaum27 Clinical 9,737 — — —

Leempoel et al28 Clinical 10,000 — — —

Swift and
Clinical 372 — — —
Friedman29

Burke and
Clinical 2,562 — — —
Lucarotti30

50.0%–
90.5%
Bernardo et al31 Clinical 1,748 — 93.6% at 7
y
y‡

—, not included in study. *A complilation and interpretation of five clinical studies. †Average of
survival rates for anterior, premolar, and molar crowns. ‡Inversely varied with no. of surfaces
restored.