Factors Contributing to The Development of Secondary Caries Following Restorative Treatment: Clinical Analysis, Author's Protocol, and Approaches to Preserving Tooth Hard Tissues

Abstract

Secondary caries accounts for 25–35% of all return visits and is one of the main reasons for the replacement of restorations. Each such replacement reduces the volume of hard tooth tissue. Despite constant improvements in materials, the frequency of this complication does not decrease; therefore, the restoration technique and the patient's behavior after treatment play a key role. Objective. To evaluate the structure of risk factors for secondary caries following restorative treatment based on five years of clinical observations and to describe Stoianov's Protocol for secondary caries. Methods. A retrospective analysis of 60–90 confirmed cases of secondary caries per year over a 5-year period in a private dental practice. For each case, the time of onset, type of material, isolation conditions, hygiene level, presence of bruxism, and nature of technical errors in the initial treatment were recorded. Results. Secondary caries was detected predominantly in the first 1–3 years after treatment (45–50% of cases). Among the causes: microleakage (25%), inadequate hygiene (25%), technical errors (20%), bruxism (20%), material properties (10%). Isolation of the working field increased the stability of restorations from 60–70% to 85–90%. After implementing the author's protocol, the incidence of secondary caries decreased from 25–30% to 15–20%. Conclusions. Secondary caries arises from a combination of clinical and behavioral factors; the isolated effect of a single factor is rare. On the part of the dentist, the greatest influence comes from isolation of the working field and adherence to the adhesive protocol. On the part of the patient, the decisive factors are the quality of hygiene and dietary habits. Stoianov's protocol for secondary caries combines these aspects into a single, reproducible clinical algorithm.