Marginal staining around composite restoration — ORE Part 1 MCQ

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ModerateRestorative DentistryMarginal staining around composite restorationORE Part 1

A 27-year-old patient is concerned about brown staining at the margin of a two-year-old anterior composite. The restoration is smooth, there is no ditching, the tooth is vital, and a bitewing shows no recurrent caries. The patient is otherwise happy with the shape. What is the most appropriate treatment?

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Correct answer: D — Refinish and polish the restoration margin

This is a case of extrinsic marginal staining without evidence of recurrent caries, structural failure, or pulpal pathology. Current NHS England guidance identifies polishing and refinishing as the first-line 'refurbish' step for managing marginal staining, 'reducing the need for more invasive treatments'. A 5-year clinical trial demonstrated that resealing margins (involving removal of interfacial stain, etching, adhesive, and flowable composite) significantly reduced penetrating discoloration. This approach aligns with minimal intervention principles: the restoration is sound and asymptomatic. Option A (crown) is grossly overtreatment; B (RCT) is unjustified—the tooth is vital with no pathology; D (antimicrobial rinse) has no evidence base for composite staining; E (extraction) is extreme overtreatment. Refinishing and polishing is the proportionate, evidence-supported first step.

Reference: NHS England Care Pathways Guidance (2024): 'Refurbish – polishing and refinishing existing restorations to remove surface stains and improve margins, reducing the need for more invasive treatments'; Syroco et al. (2019) PubMed 31216247: 'Repair or Observation of Resin Margin Defects: Clinical Trial After Five Years' https://pubmed.ncbi.nlm.nih.gov/31216247/