Secondary caries: what is it, and how it can be controlled, detected, and managed?

Objectives: To assess how to control, detect, and treat secondary caries. This review serves to inform a joint ORCA/EFCD consensus process. Methods: Systematic and non-systematic reviews were performed or consulted and narratively synthesized. Results: Secondary (or recurrent) caries is defined as a lesion associated with restorations or sealants. While the restorative material itself has some influence on secondary caries, further factors like the presence and size of restoration gaps, patients' caries risk, and the placing dentist's experience seem more relevant. Current detection methods for secondary caries are only sparsely validated and likely prone for the risk of over-detection. In many patients, it might be prudent to prioritize specific detection methods to avoid invasive overtreatment. Detected secondary caries can be managed either by repair of the defective part of the restoration or its complete replacement. Conclusions: There is sparse data towards the nature of secondary caries and how to control, detect, and treat it. Clinical significance: Despite often claimed to be a major complication of restorations, there is surprisingly little data on secondary caries. Longer-term studies may be needed to identify differences in secondary caries risk between materials and to identify characteristic features of progressive lesions (i.e., those in need of treatment)