Restorative & Materials · patient case question
Which material is most appropriate for restoring these cervical lesions?
Patient case: Cervical lesions in a care-home resident
Patient: Male, 84 years old
Chief Complaint: Brought by his caregiver — “His teeth are wearing away at the gumline.”
Background: Lives in residential care with an all-day caregiver. Mild cognitive impairment; cooperates for short appointments only. Takes four medications, three of them anticholinergic. Limited manual dexterity.
Vital Signs: BP 142/80 mmHg · HR 70 bpm
Findings: Generalised recession with multiple soft, leathery root-surface Class V lesions across all quadrants. Markedly reduced salivary flow. Isolation is difficult and he cannot tolerate rubber dam or long appointments.
Show answer and explanation
Correct answer: C. Glass ionomer cement
- A. Composite gives superior aesthetics and wear resistance, but it demands meticulous MOISTURE CONTROL and a multi-step adhesive protocol. A subgingival cervical margin in a xerostomic patient who cannot tolerate rubber dam or a long appointment is precisely the situation in which composite fails.
- B. Indirect ceramic restorations are wholly inappropriate in cost, complexity and the number of appointments required.
- C. CORRECT. GLASS IONOMER is the material of choice here, and every property that matters is in its favour. It bonds CHEMICALLY to dentine and cementum without a separate adhesive step, so placement is quick. It is far more TOLERANT OF MOISTURE than resin, which matters when isolation is impossible. It RELEASES FLUORIDE over time into a mouth at continuing high caries risk. Its weaknesses — lower strength and inferior aesthetics — are of little consequence at a cervical margin in this patient.
- D. Amalgam requires mechanical retention cut into sound tooth structure, which is unnecessarily destructive for a shallow cervical lesion, and it gives no fluoride release in a high-risk mouth.
Note: RESIN-MODIFIED GLASS IONOMER is a sensible compromise, giving improved strength and aesthetics while keeping fluoride release and moisture tolerance. And remember SILVER DIAMINE FLUORIDE for the lesion that cannot be restored, or the patient who cannot tolerate restoration — arrest first, restore later if circumstances allow. The most important long-term intervention in this case is not a material at all: it is training the CAREGIVER in supervised daily brushing with 5000 ppm fluoride toothpaste.
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