I love the idea of partial coverage restorations:  Being conservative and less invasive!  But I hate seeing some of these restorations where there now is obvious decay in the interproximal area of the wall we did not reduce.  Eventhough we made every effort to check for caries at the intial placement, there are times where they go undetected and surface years later.  This is one of the few arguments against partial coverage.  What adjuncts do you use to make sure the tooth structure you leave behind is not compromised?

I think your statement - "they surface years later" is the key. Every restoration will not be 100% caries free in the future. At some point, some subset of restorations will get caries. I have not reviewed the literature lately but previous research has shown that supragingival margins have less risk for caries. So if we all did full crowns we maybe increasing the overall risk for caries. I don't know if you feel the same but I have never been really comfortable that I am truly getting all the cement removed interproximally ( not just looking at macro pieces of cement) but cement at the margin. We have either pulled cement from the margins at the jell state or left some microscopic partical of cement at the margins that can act as an area for bacteria to be retained. So I would rather have to go back and replace a few restorations that did not show the decay then do full crowns that may increase the risk of caries. Also, since patients are living longer and staying dentate the more tooth structure left for future crowns if needed the better in my opinion.
Really interesting question. In the end as much as we want predictability we seem not to have it!
David

How long ago was the adjacent tooth restored? Could be lots of things. Not always our fault. Just say so when it is...and I love partial coverage...just like I do with gold. This is the best time to be a dentist!

Great input. For me, I don't catch these on x-rays until 5 years + 1 day from original seat date :)

It's a hard call. I don't like removing tooth structure just as a preventative measure either. Sometimes the onus has to be on the patient to floss :)

Even in this situation you could do a conservative DO restoration. If it were a fulll coverage crown you would have to replace the entire restoration. I hope that we are moving away from GV black and extension for prevention!
Kevin

That's exactly what I did. DO. Making sure not to encroach the restoration which is tough. Then you wonder what the next guy is going think!