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Seminal Papers in Restorative Dentistry

 ‘……I am so glad to hear the positive feedback comments that I receive from dentists I meet and teach.  The seminal reading is clearly a helpful resource for the busy dentist who wants to take the time to learn more about Restorative Dentistry.  I will add more in 2016…..’

Peter Briggs 3rd January 2016 –

I am often asked by course delegates and dentists of all ages  “……how do I go about finding essential / core scientific papers to aid and underpin my understanding and practice of clinical dentistry?  I just do not even know where to start?….”

My realisation that evidence-based practice was so useful started when I was forced to photocopy and then read industrial numbers of scientific papers (not books) to prepare for seminars at the Eastman Dental Institute in 1987.   Although not realised by me at the time this seeded my  positive approach to reflective practice set me on a path of lifelong learning which balances relevant knowledge (which will continually change) to clinical application and clinical practice and experience (a combination of self-directed and supervised).

My personality has never allowed me to do something simply because I am told to so.  Unless it makes logical sense I cannot sign up.  A wise clinician should always be prepared to change their mind when presented with good evidence that another approach is better.

The issue in our busy lives is how and where we can all gain the information that we need?

I remember Cliff Ruddle, the famous American Endodontist, was describing to delegates at the European Endodontology Conference in Ireland some years ago the major difference between a public and medical/dental school library. His view was that: with a public library you are clearly informed what is fiction and non-fiction.

With younger practitioners more aware of the need to improve their evidence-based knowledge – filtering out the important papers can be daunting. The dento-legal pressures on us all further demand that we are all up-to-date and doing the right things for our patients.

In response to these requests I have attempted, on this page, to describe some Seminal papers (PDFs) in Restorative dentistry.

I hope to gradually build up the library of core / seminal scientific papers that underpin my approach to clinical dentistry.   The hope is that this page will be helpful to all dentists, hygienists, therapists and clinical technicians wanting to improve their knowledge-base without relying on commercial bias.   I want it to help those wanting to foster a ‘postgraduate approach’ to their own development and reflection on their clinical practice.

Some of the papers are old and others new.  There will undoubtedly will be scientific ‘holes’ in all of the papers included and very few will be within level 1 (systematic reviews of RCTs) of the evidence-based quality pyramid.  Do not let this put you off and I hope you will appreciate their unique qualites. I will add a new paper each month. Enjoy.

Materials – Modern Ceramics

Can I please ask all dentists that are confused on which modern non-metal ceramic / glass material(s) are best to (or not) use.  Below are two good  reviews – really helpful non-commercial guides to what we can best use. It also explains the most appropriate alternatives to expensive precious alloys and please note the difference between monolithic and layered restorations.

Evaluation of Contemporary Ceramic Materials

Authors : Sumithan N Ahmed BDS MS, Terry E Donovan DDS

Associate Editor : Edward J Swift Jr DMD MS

Journal of Esthetic and Restorative Dentistry Vol 27,No 2, 59–62, 2015

A New Classification System for All-Ceramic and Ceramic-like Restorative Materials

Authors : Stefano Gracis, DMD, MSD/Van P.Thompson, DDS, PhD/Jonathan L. Ferencz., DDS/Nelson R.F.A. Silva, DDS, MSc, PhD/Estevam A.Bonfante, DDS, MSc, PhD

Int J Prosthodont 2015;28:227-235

Treatment Planning & Option Appraisal in Restorative Dentistry

Vertical Dimension in Prosthodontics – what we can and cannot get away with in 2015

I enclose a PDF of a recent seminar that I put together on my own understanding of the management of vertical dimension in the dentate (and often worn dentate) patient.  I was lucky to be involved with some of the UK studies that helped the evolution towards a more simplified and less destructive path. We now better understand that we can manage a lack of inter-occlusal room with confidence.  Within the PDF I cite some very old and newer studies.

Accompanying PDF:

Tooth Restorability

We all have to make decisions on whether a tooth is restorable. It is a very important decision to get right as none of us want a patient to undergo extensive and expensive treatment to find that the tooth / restoration fails soon after. Bandlish et al (2006) from the Eastman Dental Hospital put forward a ‘Tooth Restorability Index’ in 2006 that objectively made an attempt to assess te amount of remaining coronal dentine in root treated teeth.

Assessment of the amount of remaining coronal dentine in root-treated teeth

Authors : R.B. Bandlish, A.V. McDonald, D.J. Setchell

Journal of Dentistry 34 (2006) 699-708

Pre-operative prediction of pathology beneath existing cores and crowns of teeth that require RCT – do we need to strip down teeth prior to providing endodontics

Do we need to remove all of the coronal restoration before we carry out root fillings? Is it there sensible to root-treat a tooth through an existing restoration? If we choose to on the grounds of cost or re-restoring the tooth what messages should be given to the patient?   A thought-provoking clinical paper by a ‘wet-fingered’ Australian endodontist who looked at the predictability of identifying cracks, caries and leakage of beneath existing restorations of teeth that require endodontics. He was concerned that coronal leakage is likely to be a problem if such pathology is present. He both clinically and radiographically assessed the teeth and then stripped them down prior to root canal therapy.  His findings were very interesting in terms of what we can and cannot predict pre-operatively.   For those with an interest in what we might have to deal with on the phase down of amalgam – this paper is for you. For those pushing rapid phase down of amalgam in favour of the alternative a paper to digest and reflect on please. Note that the author suggests that his pre-operative assessment would have been better if his Long Cone Periapical Radiographs were accompanied by Bitewings. Enjoy.

Assessing restored teeth with pulp and periapical diseases for the presence of cracks, caries and marginal breakdown

Author : PV Abbott
Australian Dental Journal 2004;49:(1):33-39

Management decision making of Failing Indirect Restorations

We all need to be able to plan the best management for patients with failed or failing indirect restorations. This practical clinical paper discusses this from a pragmatic standpoint to outline sensible approaches and realistic messages to our patients.

Accompanying PDF:

Tooth or Implant – what do patients think is the best – a restored endodontically-treated tooth or an implant crown?

Gatten et al (2011) carried out a small randomised clinical study in a USA hospital environment to assess ‘patient attitude’ and the ‘quality of life’ scores of both options. This patient-centred study looked at the impact of both treatment modalities from the view of the patient. More and more studies in medicine and dentistry are now rightly looking at the impact of the impact and outcome of the treatment we provide to the patient. You may be surprised by the result.

Quality of Life of Endodontically Treated versus Implant Treated Patients: A University-based Qualitative Research Study
Authors : Dustin L. Gatten, DDS, Christine A. Riedy, PhD, MPH, Sul Ki Hong, DDS, James D. Johnson, DDS, MS, Nestor Cohenca, DDS
Journal of Endodontics — Volume 37, Number 7, July 2011

An up-to-date clinical review of the comparative aspect of endodontically treated – v – implants

Two papers to help with this one.

I like this detailed clinical review by Bill Saunders (former editor of the European Endodontic Journal (EEJ)).  This review is wide-ranging and looks at all aspects of Endodontics, (to include surgery and revision) and post endodontic restoration.  He does the same with all aspects of surgical and prosthodontics implant therapy.  Second is a paper by Setzer and Kim from 2014 that attempts to compare the outcome and survival of Implants and endodontically-treated teeth. Again both very well known in the endodontic world (re-treatment and surgical re-treatment. I hope they help

Treatment planning the endodontic-implant interface
Author : W. P. Saunders
British Dental Journal 2014;216:325-330

Comparison of Long-term Survival of Implants and Endodontically Treated Teeth
Authors : F.C. Setzer and S. Kim
J Dent Res 93(1):19-26, 2014


I really like this paper on peri-implantits by Prof Donos from QMUL.  It asks and answers the most important questions that you or any patient will ask when weighing up the options of tooth preservation or extraction and implant therapy.  It is particularly good around the issues of patients with periodontal disease susceptibility and what issues should be taken into account. Excellent stuff

Hierarchical decisions on teeth vs. implants in the periodontitis susceptible patient: the modern dilemma
Authors : Nikolaos Donos, Lars Laurell, Nikolaous Mardas
Periodontology 2000, Vol. 59, 2012, 89–110

An up-to-date paper by Saaby et al 2016 which looks at the factors associated with peri implantitis

Factors influencing severity of peri-implantitis
Authors : Martin Saaby, Eva Karring, Søren Schou, Flemming Isidor
Clin. Oral Impl. Res. 27, 2016, 7–12


Sjorgren et al 1990 – a prospective clinical study over 8-10 study which is still quoted as one of the great clinical endodontic papers to comment on the factors that are likely to affect Endodontic outcome. It is also worth remembering that this is clinical prospective study (that includes radiographic healing) carried out by undergraduate dental students in Gothenburg.

Factors Affecting the Long-term Results of Endodontic Treatment
Authors : UIf Sjogren, DDS, Bjorn Hagglund, DSS, Goran Sundqvist, DDS, PhD, Kenneth Wing, DMD, PhD
Journal of Endodontics Vol 16 No 10 Oct 1990

I like this paper by Siqueria published in 2003 that looks at the evidence that relates to the microbiology of endodontic flare ups.  An essential paper to read for all those providing endodontics for their patients

Microbial causes of endodontic flare ups
Author : J.F. Siqueira Jr.
Inrernational Endodontic Journal 36, 453-463, 2003

Nair 2006 – Causes of Persistent Apical Periodontitis – would recommend this to anyone interested in understanding more about the biology and causes of persistent apical disease.   Nair first describe True and False peri-apical cysts and explains why our root fillings can fail.

On the causes of persistent apical periodontitis: a review
Author : P. N. R. Nair
International Endodontic Journal, 39, 249–281, 2006

Prosthodontics – Resin Bonded Bridges

Two UK outcome studies on the performance of Resin Bonded Bridges.  One a retrospective study at the Eastman Dental Hospital in London (Djemal et al 1999) and the more recent (King et al 2015) a prospective study of RBBs provided at Bristol Dental School. Interestingly Paul King is an author on both papers. As a prospective study the more recent is more scientifically valid and has interesting conclusions including 20% failure in first 5 years which then stabilises for the mature restorations. Factors of statistical note include coverage, bridge design and operator.  Rubber dam use does not help survival and the double-winged butterfly bridge to replace missing maxillary lateral incisors performs well.  The number of abutments, rather than the number of pontics, was more important for the outcome of multi-winged bridges. Enjoy and see if your view on the long-term predictability of RBBs is changed.

Long-term survival characteristics of 832 resin-retained bridges and splints provided in a post-graduate teaching hospital between 1978 and 1993
Authors : S. Djemal, D.Setchell, P.King, J.Wickens
Journal of Oral Rehabilitation 1999 26; 302–320

Survival characteristics of 771 resin-retained bridges provided at a UK dental teaching hospital
Authors : P. A. King, L. V. Foster, R. J. Yates, R. G. Newcombe, M. J. Garrett
British Dental Journal 2015;218:423-428
British Dental Journal Volume 218 No.7 Apr 10 2015

A Long-Term Survey of Tooth Loss in 600 Treated Periodontal Patients
Authors : Leonard Hirschfeld, DDS, Bernard Wasserman, DDS
J. Periodontal 1978 May;49(5):225-37


First up for perio is the famous Hirschfield and Wasserman paper of 1978.

Although old (this paper was published before I qualified) it follows 600 periodontal patients treated for 25 – 30 30 years within a USA private perio practice. The patients are followed up and managed with various treatments. The paper found that the biological response of patients treated for periodontal disease falls into three clear groups – with the majority of patients (85%) falling into a ‘well-maintained’ group. This group displayed little tooth loss over the study period with over 50% losing no teeth. A famous and often quoted outcome paper which illustrates the effectiveness of periodontal therapy. Unfortunately there is little in the modern literature to touch it.  Compare this with the more modern quoted survival figures of implants in the periodontally- susceptible patient.

Accompanying PDF:

Two papers written by Phil Ower in 2013.  I met Phil when he was doing his Perio MSc at the Eastman when he was in the RAF.  The papers provide a good and sensible synopsis of the changes in both our understanding of aetiology and also modern approaches to the therapy of periodontal disease. Phil Ower was a trainee of Bernie Kieser (who unfortunately is no longer with us) and clearly influenced his passion. They illustrates with evidence why we should all be moving towards a more biological (plaque-centred) rather than mechanical approach to periodontal therapy. A good review on the reasons why and how this should affect our daily clinical practice.

The Role of Self-Administered Plaque Control in the Management of Periodontal Diseases: 2. Motivation, Techniques and Assessment
Author : Philip Ower
Dent Update 2003; 30: 110-116

Minimally-Invasive Non-Surgical Periodontal Therapy
Author : Philip Ower
Dent Update 2013; 40: 289–295

 Occlusion and Periodontology – Tooth ‘Jiggling’ animal experiments’

Seminal papers from Lindhe (1974) and Burgett et al (1992). 

Lindhe is one of the papers that reported experimental periodontitis and plaque in combination with tooth ‘jiggling’ forces to show that within the limitations of an animal study that poor plaque control and experimental tooth jiggling could accelerate experimental periodontitis.  This was only one of several experiments from the Swedish team that used Beagle dogs.  Polson et al in the USA was using Squirrel monkeys to look at similar issues.

Influence of trauma from occlusion on progression of experimental periodontitis in the beagle dog
Authors : Jan Lindhe, Gunnar Svanberg
Journal of Clinical Periodontology: 1974; 1: 3-14

These are famous papers which suggested, in the presence of poor plaque control, that occlusal ‘jiggling’ overload may be an important factor in the progression of periodontitis and that there may be a therapeutic role for occlusal adjustment to control this factor.  As a result there were many studies that followed the outcome of  splinting periodontally-compromised teeth and also the therapeutic effects of occlusal adjustment.  The second paper (Burgett et al 1992) randomly follows the ‘effect’ of occlusal adjustment on patients treated for periodontal disease in Michigan – enjoy and discuss the pros and cons – why are we no longer suggesting this treatment philosophy?

A randomized trial of occlusal adjustment in the treatment of periodontitis patients
Authors : Burgett FG, Ramfjord SP, Nissle RR, Morrison EC, Charbeneau TD, Caffesse RG.
J Clin Periodontal 1992; 19: 381-387

Prosthodontic Decision-Making

Replace posterior teeth or accept the space?

The functional implications of Tooth Loss in the Kennedy I and II situations – the Shortened Dental Arch.

Kayser, AF. Shortened Dental Arches and Oral function JOR 1981 8 457-462. One of the most famous Prosthodontic papers within the dental literature that looked at the functional implications to patients of a reduced posterior dentition. This paper is used by dental commissioners around the world to defend a commissioning policy that focusses limited on the restorative needs of the anterior and premolar dentition. The paper does not focus on aesthetic issues and takes no account of other factors such as skeletal pattern, incisal relationship, tooth wear and periodontal disease.

Restore a natural endodontically-treated tooth with a crown or extract and restore space with an Implant-supported crown – which do patients find best?

Gatten et al (2011) Quality of life of Endodontically Treated versus Implant Treated Patients – a University based Qualitative Research Study carried out a small randomised clinical study in a USA hospital environment to assess ‘patient attitude’ and the ‘quality of life’ scores of both options. This is a patient-centred study that looks at the impact of both treatment modalities from the view of the patient. More and more studies in medicine and dentistry are now looking at the impact on the outcome to the patient. You may be surprised by the result

Restoration of the Root Canal Treated Tooth

Eliyas et al (2015)  Restoration of the Root Canal Treated Tooth

another up-to-date clinical review of the important factors to take into consideration when deciding (or not) to restore and preserve a root treated tooth. Excellent stuff

Restoration of the root canal treated tooth
Authors : S. Eliyas, J. Jalili, N. Martin
British Dental Journal 2015; 218: 53-62

Performance of Different Restorations types (conventional and adhesive) when used to Restore Worn Teeth

A well quoted paper that follows up both the survival performance and re-restoration strategies and options at failure re-cycling in patients with worn teeth.  Enjoy the Smales and Berekally 2007 paper – it is one that I really like.

Long-term Survival of Direct and Indirect Restorations Placed for the Treatment of Advanced Tooth Wear
Authors : Roger J. Smales, Thomas L. Berekally
Eur. J. Prosthodont. Rest. Dent., Vol.15, No. 1, pp 2-6 (2007)

There is a lot wrong (low numbers, different numbers, limited follow up etc) – but there is good stuff too.  A good guide when talking patients through the short, intermediate and long term outcome, risks and benefits of restoring worn teeth.

Tooth Wear

Common signs and symptoms of patients with tooth wear

El Wazani et al published an observational study in 2012 of 290 patients referred to Liverpool Dental Hospital. A good current assessment and update of the common signs and symptoms associated with UK patients referred to secondary care due to Tooth Wear.

The signs and symptoms of tooth wear in a referred group of patients
Authors : B. El Wazani, M. N. Dodd, A. Milosevic
British Dental Journal 2012; 213: E10

The use and predictability of Direct Composite to restore worn anterior teeth with aid of Dahl Concept

Gulamali et al reported in 2011, the 10 year follow up of direct resin composites the performance of de-novo and repair direct anterior composite restorations. They were all placed on vital anterior teeth to restore worn anterior teeth with the aid of the Dahl Concept. The restorations covered the palatal and incisal aspects of the teeth.

Survival analysis of composite Dahl restorations provided to manage localised anterior tooth wear (ten year follow-up)
Authors: A. B. Gulamali, K. W. Hemmings, C. J. Tredwin, A. Petrie
British Dental Journal 2011; 211: E9

The use of Removable Partial Dentures in the Tooth Wear Patient

Woodley et al published an audit in 1996 of overlay, onlay and over-dentures which had been used to manage advanced tooth wear. Interesting results that include the follow-up need for repair and replacement of restorations and also unplanned patient attendances.

Retrospective Audit of Patients with Advanced Toothwear restored with removal partial dentures
Authors : Nicola J Woodley, Brigitte M Griffiths, Kenneth W. Hemmings
Eur.J. Prosthodont Rest.Dent., Vol.4, No. 4, pp 185-191 (1996)




    Peter qualified from King’s College Hospital in 1983, and completed a Cons MSc at the Eastman in 1988. He has worked as a Consultant in Restorative Dentistry and a Specialist Referral Practitioner since 1995.


    In 2014 the following postgraduate teaching programme is available at Hodsoll House for small groups of motivated general dental practitioners.


    Read the feedback from some of our recent courses.


    British Society for Prosthodontics (BSSPD) Webinar programme for 2014/15.

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