Skip to main content

Secondary caries: prevalence, characteristics, and approach



The objectives of this cross-sectional survey were to determine the prevalence of secondary caries (SC) in general population, to identify patient- and material-related factors which may affect the prevalence, and to describe some clinical characteristics of SC lesions.

Materials and methods

A total of 4036 restorations in 450 patients, who visited the university dental clinic for a regular (half) yearly checkup, were examined clinically (and radiographically) for the presence of SC. Clinical characteristics of the detected SC lesions (size, activity, and location) and the planned treatment were recorded. In addition, patients’ caries-risk status was assessed according to the modified “cariogram” model.


In total, 146 restorations were diagnosed with SC, which gives an overall prevalence of 3.6%. Restorative material, restoration class, patient’s caries risk, and smoking habits were shown to be important factors, as SC prevalence was significantly higher with composites, class II restorations, high-caries-risk patients, and smokers. Restorations’ gingival margins were most frequently affected by SC. The largest number of restorations with SC (72%) was scheduled for the replacement.


Prevalence of SC was higher with composite than with amalgam restorations, irrespective of the patient’s caries-risk status. Gingival margins of class II, including MOD restorations, seem to be the place of less resistance to SC development. Management of SC seems to place a considerable burden on the health care workforce and expenditure.

Clinical relevance

Secondary caries (SC) is considered to be the main cause of dental restoration failure and one of the biggest clinical challenges related to dental composites. Nevertheless, its prevalence in daily practice is still not clear, which impedes an accurate estimation of its impact on health care costs.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3


  1. Seemann R, Flury S, Pfefferkorn F, Lussi A, Noack MJ (2014) Restorative dentistry and restorative materials over the next 20 years: a Delphi survey. Dent Mater 30:442–448.

    Article  PubMed  Google Scholar 

  2. Mjor IA, Moorhead JE, Dahl JE (2000) Reasons for replacement of restorations in permanent teeth in general dental practice. Int Dent J 50:361–366

    Article  Google Scholar 

  3. Opdam NJ, Bronkhorst EM, Roeters JM, Loomans BA (2007) A retrospective clinical study on longevity of posterior composite and amalgam restorations. Dent Mater 23:2–8.

    Article  PubMed  Google Scholar 

  4. Palotie U, Vehkalahti MM (2012) Reasons for replacement of restorations: dentists' perceptions. Acta Odontol Scand 70:485–490.

    Article  PubMed  Google Scholar 

  5. Mjor IA (1997) The reasons for replacement and the age of failed restorations in general dental practice. Acta Odontol Scand 55:58–63

    Article  Google Scholar 

  6. Nuttall NM, Elderton RJ (1983) The nature of restorative dental treatment decisions. Br Dent J 154:363–365

    Article  Google Scholar 

  7. Qvist V (2008) Longevity of restorations: the “death spiral”. In: Ole Fejerskov EK (ed) Dental caries: the disease and its clinical management. Blackwell Munksgaard Ltd, Copenhagen, pp 444–455

    Google Scholar 

  8. Nedeljkovic I, Teughels W, De Munck J, Van Meerbeek B, Van Landuyt KL (2015) Is secondary caries with composites a material-based problem? Dent Mater 31:e247–e277.

    Article  PubMed  Google Scholar 

  9. Bernardo M, Luis H, Martin MD, Leroux BG, Rue T, Leitao J, DeRouen TA (2007) Survival and reasons for failure of amalgam versus composite posterior restorations placed in a randomized clinical trial. J Am Dent Assoc 138:775–783

    Article  Google Scholar 

  10. Soncini JA, Maserejian NN, Trachtenberg F, Tavares M, Hayes C (2007) The longevity of amalgam versus compomer/composite restorations in posterior primary and permanent teeth: findings from the New England Children’s Amalgam Trial. J Am Dent Assoc 138:763–772

    Article  Google Scholar 

  11. Kuper NK, Opdam NJ, Bronkhorst EM, Huysmans MC (2012) The influence of approximal restoration extension on the development of secondary caries. J Dent 40:241–247.

    Article  PubMed  Google Scholar 

  12. Nedeljkovic I, De Munck J, Slomka V, Van Meerbeek B, Teughels W, Van Landuyt KL (2016) Lack of buffering by composites promotes shift to more cariogenic bacteria. J Dent Res 95:875–881.

    Article  PubMed  Google Scholar 

  13. Imazato S (2003) Antibacterial properties of resin composites and dentin bonding systems. Dent Mater 19:449–457

    Article  Google Scholar 

  14. Chen L, Shen H, Suh BI (2012) Antibacterial dental restorative materials: a state-of-the-art review. Am J Dent 25:337–346

    PubMed  Google Scholar 

  15. Wang Z, Shen Y, Haapasalo M (2014) Dental materials with antibiofilm properties. Dent Mater 30:e1–e16.

    Article  PubMed  Google Scholar 

  16. Mjor IA (1998) The location of clinically diagnosed secondary caries. Quintessence Int 29:313–317

    PubMed  Google Scholar 

  17. Mjor IA (1985) Frequency of secondary caries at various anatomical locations. Oper Dent 10:88–92

    PubMed  Google Scholar 

  18. Mjor IA, Toffenetti F (2000) Secondary caries: a literature review with case reports. Quintessence Int 31:165–179

    PubMed  Google Scholar 

  19. Kanzow P, Hoffmann R, Tschammler C, Kruppa J, Rodig T, Wiegand A (2016) Attitudes, practice, and experience of German dentists regarding repair restorations. Clin Oral Investig 21:1087–1093.

    Article  PubMed  Google Scholar 

  20. Blum IR, Lynch CD, Wilson NH (2014) Factors influencing repair of dental restorations with resin composite. Clin Cosmet Investig Dent 6:81–87.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Demarco FF, Correa MB, Cenci MS, Moraes RR, Opdam NJ (2012) Longevity of posterior composite restorations: not only a matter of materials. Dent Mater 28:87–101.

    Article  PubMed  Google Scholar 

  22. Opdam NJ, Bronkhorst EM, Loomans BA, Huysmans MC (2010) 12-year survival of composite vs. amalgam restorations. J Dent Res 89:1063–1067.

    Article  PubMed  Google Scholar 

  23. Jepsen P, Johnsen SP, Gillman MW, Sorensen HT (2004) Interpretation of observational studies. Heart 90:956–960.

    Article  PubMed  PubMed Central  Google Scholar 

  24. European Guidelines on Radiation Protection in Dental Radiology, RP 136 (2004) Luxembourg

  25. Nyvad B, Machiulskiene V, Baelum V (1999) Reliability of a new caries diagnostic system differentiating between active and inactive caries lesions. Caries Res 33:252–260.

    Article  PubMed  Google Scholar 

  26. Bratthall D, Hansel Petersson G (2005) Cariogram--a multifactorial risk assessment model for a multifactorial disease. Community Dent Oral Epidemiol 33:256–264.

    Article  PubMed  Google Scholar 

  27. Meyer-Lueckel H, Paris S, Ekstrand KR (2013) Caries management science and clinical practice. Thieme, Stuttgart

    Book  Google Scholar 

  28. Selwitz RH, Ismail AI, Pitts NB (2007) Dental caries. Lancet 369:51–59.

    Article  PubMed  Google Scholar 

  29. Sunnegardh-Gronberg K, van Dijken JW, Funegard U, Lindberg A, Nilsson M (2009) Selection of dental materials and longevity of replaced restorations in public dental health clinics in northern Sweden. J Dent 37:673–678.

    Article  PubMed  Google Scholar 

  30. Gordan VV, Riley JL 3rd, Geraldeli S, Rindal DB, Qvist V, Fellows JL, Kellum HP, Gilbert GH, Dental Practice-Based Research Network Collaborative G (2012) Repair or replacement of defective restorations by dentists in The Dental Practice-Based Research Network. J Am Dent Assoc 143:593–601

    Article  Google Scholar 

  31. Eriksen HM, Bjertness E, Hansen BF (1986) Cross-sectional clinical study of quality of amalgam restorations, oral health and prevalence of recurrent caries. Community Dent Oral Epidemiol 14:15–18

    Article  Google Scholar 

  32. Opdam NJ, Bronkhorst EM, Cenci MS, Huysmans MC, Wilson NH (2011) Age of failed restorations: a deceptive longevity parameter. J Dent 39:225–230.

    Article  PubMed  Google Scholar 

  33. Sakki T, Knuuttila M (1996) Controlled study of the association of smoking with lactobacilli, mutans streptococci and yeasts in saliva. Eur J Oral Sci 104:619–622

    Article  Google Scholar 

  34. Axelsson P, Paulander J, Lindhe J (1998) Relationship between smoking and dental status in 35-, 50-, 65-, and 75-year-old individuals. J Clin Periodontol 25:297–305

    Article  Google Scholar 

  35. Benedetti G, Campus G, Strohmenger L, Lingstrom P (2013) Tobacco and dental caries: a systematic review. Acta Odontol Scand 71:363–371.

    Article  PubMed  Google Scholar 

  36. Francisconi LF, Graeff MS, Martins Lde M, Franco EB, Mondelli RF, Francisconi PA, Pereira JC (2009) The effects of occlusal loading on the margins of cervical restorations. J Am Dent Assoc 140:1275–1282

    Article  Google Scholar 

  37. Kuper NK, Opdam NJ, Bronkhorst EM, Ruben JL, Huysmans MC (2013) Hydrodynamic flow through loading and in vitro secondary caries development. J Dent Res 92:383–387.

    Article  PubMed  Google Scholar 

  38. Javidi H, Tickle M, Aggarwal VR (2015) Repair vs replacement of failed restorations in general dental practice: factors influencing treatment choices and outcomes. Br Dent J 218:E2.

    Article  PubMed  Google Scholar 

Download references


We would like to thank all clinical supervisors and master students who participated in this study, especially Leen Theys, Viviane Luyten, and Veerle Lemaitre, and GC Europe for providing Saliva-Check Buffer kit and Tri Plaque ID Gel.


This research was supported by the Research Foundation—Flanders (FWO) grant G.0884.13.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Kirsten L. Van Landuyt.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the Medical Ethics Committee, University Hospitals UZ Leuven (approved project S56046), and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Nedeljkovic, I., De Munck, J., Vanloy, A. et al. Secondary caries: prevalence, characteristics, and approach. Clin Oral Invest 24, 683–691 (2020).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Prevalence
  • Secondary caries
  • Recurrent caries
  • Caries risk
  • Dental composite
  • Dental amalgam