Buonocore Memorial Lecture 2023: Longevity of Dental Restorations or Longevity of Teeth: What Matters?

This paper aims to raise a discussion from the perspective of maintaining long-term oral health, posing a critical question: What holds greater significance for maintaining oral health, the longevity of restorations or teeth? This question explores the aspects that truly matter in ensuring sustained oral health throughout an individual's life. Restoration longevity is well-researched, and evidence shows several risk factors influencing longevity. The dentist's decision-making factor may be of utmost importance, and further studies are needed to investigate its relevance. The critical risk factors for restoration longevity are active pathology (high caries risk), less prominent parafunction, and extensive defects such as endodontic treatment. However, tooth longevity and the main risk factors for tooth loss are not well-researched. The evidence shows dental caries, and its sequelae, are the principal reasons for tooth loss. Patient-related risk factors, especially those associated with lifestyle and health choices, play a major role in the longevity of restorations and, more importantly, tooth longevity. To provide personalized dental care with maximum patient benefit, clinicians should identify and record potential risk factors, promoting a healthy lifestyle to ensure tooth and dentition longevity. Moreover, the evidence suggests that decision-making frameworks based on minimal intervention principles offer the best standard for clinical practice, promoting a longstanding healthy oral environment.