Operative dentistry aje qualtrough, jd satterthwaite la morrow, pa brunton

Economics of failure
It is axiomatic that there is an economic cost implication in provision
of any treatment, whether this cost is met by individual patients or 
is state funded. There are financial implications in treatment of 
failed restorations and also in preventing failure, and this should be
transparent at the outset of treatment to both operator and patient.
The relationship between initial cost and longevity is not always 
obvious, and in some cases a more costly initial treatment option may
prove to be more cost effective in the long term
4
.
Costs to the tooth
With any operative intervention there is a ‘cost’ to the tooth in terms of
loss of tooth structure and trauma to the dentino-pulpal complex. This
is true for any procedure, and loss of healthy tooth structure can be
significant when restorations are removed for replacement, especially
when tooth-coloured restorations are removed
12
. Two concepts of use
are that of the ‘life cycle’ of a restored tooth, and that of the ‘stressed
pulp syndrome’
13
. The first describes the (sometimes inevitable) pro-
gression from a minimal intervention to a larger and larger restora-
tion eventually necessitating an indirect restoration – emphasising the
cumulative destructive nature of multiple interventions. The concept
of a stressed pulp arises from the supposed healing of the dental pulp
following trauma during an operative procedure. With each trau-
matic event, the pulp heals with a degree of tertiary dentine formation
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Chapter 7
and fibrosis within the pulp. Successive interventions leave the pulpal
tissues more fibrosed and less able to respond dynamically to trauma.
Eventually, the pulp will be unable to withstand even a minor insult
and may become non-vital with a relatively small intervention. These
concepts suggest that whenever possible, the number of interventions
during a tooth’s life span should be minimised and each ‘stage’ of a
tooth should be prolonged and interventions minimised in order to
prolong the overall life of the tooth.