Wrong indication: direct restoration placed where indirect is needed
What it is
Placing a direct composite in a tooth that has too much structural loss or too high functional risk for a predictable long-term direct restoration — so the case really needs an indirect restoration (e.g., inlay/onlay/overlay/partial crown/crown) based on remaining tooth structure and biomechanical demands. Indirect restorations (especially onlays/partial coverage) are designed to replace missing structure and/or provide cuspal coverage when the tooth is weakened.
Why it happens
• Underestimating extent of damage: when the cavity is large (wide MOD, cusp undermining, fractures/cracks), direct restorations become more technique- and load-sensitive. Systematic reviews note better performance for indirect restorations in teeth with extensive damage in some evidence syntheses. • Assuming direct = always more conservative/cheaper and ignoring risk factors like cusp loss, deep margins, heavy occlusion, and parafunction. • Not planning cuspal coverage when needed: large posterior defects may require cusp coverage (direct or indirect), but the decision threshold is commonly linked to degree of tissue loss and functional risk. • Confusion from mixed evidence: recent guidance supports direct composites in many posterior indications (even some cusp replacement), but that doesn't mean every severely compromised tooth is a good direct case.
The full clinical mistake entry includes
- How to avoid it — the prevention protocol
- The clinical tip experienced clinicians use
- The documented reference behind the mistake
More clinical mistakes
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