Repair vs replacement of composite restorations with secondary caries: A narrative review of current clinical strategies

Secondary caries remain a leading cause of restoration failure and replacement in contemporary dental practice. The aim of this paper is to review current clinical criteria guiding the decision-making process between repair and replacement of composite restorations affected by secondary caries. Additionally, the paper assesses the effectiveness of surface conditioning techniques and prepares a repair protocol for recurrent caries. The electronic database search was carried out using PubMed and Google scholar databases with the keywords: “secondary caries”, “repair”, “replacement”, “surface conditioning”, “minimally invasive dentistry”. The reference lists of selected articles were manually searched for appropriate studies. The literature search included publications from 01/01/2015 to 15/05/2025 and was limited to English language. Studies show that it is preferable to perform a repair rather than a replacement whenever possible. Surface conditioning techniques like bur roughening, air abrasion, acid etching, and the use of salinizing and adhesive agents can enhance the success of the repair method. However, evidence on how effective these methods are is less certain. When deciding between repair and replacement, clinicians should consider restoration material properties, patients caries risk, their personal experience, and the decay advancement. The currently obeyed rules of minimally invasive dentistry favour the decision of repair. Many methods of increasing the effectiveness of a restoration repair have been introduced. This study presents an exemplar repair protocol using air abrasion.