By Casey Rhines, D.D.S., CDA Editor
From the Autumn 2025 Journal of the Colorado Dental Association
Sitting across from each other in Panera at our quarterly meeting to plan the Journal’s articles, CDA Director of Communications, Becky O’Guin, and I discussed the lifespan of dental treatment. I was reminded of a post on Instagram by Dr. Kyle Stanley, also known as his social media alias “the Mentally Resilient Dentist,” about patient expectations for how long certain treatments should last. The post listed several medical procedures and their perceived longevity including a cochlear implant (10 years), pacemaker (5-10 years) and hip replacement (15 years) before discussing dental treatments:
Dental filling: forever
Dental crown: forever
Dental implant: forever
Denture: forever
Veneers: forever
Dr. Stanley’s cheeky post ponders where these expectations come from. Do patients expect more from dentists than physicians? Do we need to be better educators? Stanley’s content, which is designed for dentists, is captioned, “There’s something so different about how medical doctors set expectations and how dental professionals do it.” He proceeded to self-reflect how he too was bad at setting expectations with patients because he was afraid of them choosing not to do the treatment with him. Comparatively, I often hear patients discussing how they are gearing up to have a knee replacement redone or they try to time a facelift just right to only have to have it touched up once. But in my dental chair, the same people lament about how they had fillings when they were a child that had to be redone, and now they need crowns. To them, a marvelously individualistic tale about their “bad dental experiences”…to me, an average Wednesday afternoon.
An endodontist explained to a patient the risks and prognosis associated with a root canal. Appalled, the patient called wondering why we would want to treat this tooth endodontically when it had so many risks–her other root canal, she claimed, had never had any problems. We discussed how wonderful it was that her other tooth had no problems, but the same risk was always there. I’ve had similar casual conversations with my friends who wonder why they have such bad teeth that after getting a crown they needed a root canal later. I remember adjusting the occlusion on one of my crowns that was bothering her: “I swear I brush my teeth,” she said. We discussed how dental treatment needs to be revised (a key term physicians use regularly to refer to touch-ups after surgeries) and how all fillings, crowns, etc. have lifespans and how each time we have to treat a tooth, we lose more structure, demanding more involved treatments. I remember her asking me why no one had ever told her this. Was that true?
Patient education is one of the most important parts of our job. Between hygiene checks, the anxious patient who needs reassurance, and the block that hasn’t kicked in, spending time discussing how the treatment our patients need isn’t going to last forever can feel like time better spent placing a rubber dam to ensure it does last longer. Nevertheless, the time spent on this conversation will feel priceless when you avoid the conversation of a disappointed patient in pain because “you drilled on the tooth.”
I like to think most dentists do a good job at setting expectations when we know there could be complications or when patients ask the right questions. The problem is that we can do everything right and we are simply limited by the lifespan of dental materials and the oral hygiene of the patient. In addition, it is difficult for researchers to quantify how long certain procedures will last. Our student representative to the CDA board of trustees asked in an advanced treatment planning class the other day, “How long should we tell patients this will last?” The truth is, I don’t really know. We use a combination of our experience and the evidence within the literature to determine this. Here is a starting point:
- A 20-year retrospective study with a small sample size from 2017 of dental composites performed by one dentist had a mean survival rate of 11 years and 7 months; however, the widely accepted range found in an internet search of general dentists’ websites is 5-7 years.[i]
- All ceramic crowns (feldspathic and glass-ceramics) have a 91% success rate at 10 years, per a 2016 meta-analysis.[ii]
- A 2020 systematic review of endodontically-treated cracked posterior teeth was 82% after 1 year.[iii]
I’m sure many of our readers, who have more experience than I, have opinions and evidence of different numbers or even anecdotes that they have successfully used with patients. As always, I welcome your letters to the editor and look forward to more discussions so all our members can learn and continue to serve our patients better.
References
[i] Borgia E, Baron R, Borgia JL. Quality and Survival of Direct Light-Activated Composite Resin Restorations in Posterior Teeth: A 5- to 20-Year Retrospective Longitudinal Study. J Prosthodont. 2019 Jan;28(1):e195-e203. doi: 10.1111/jopr.12630. Epub 2017 May 17. PMID: 28513897.
[ii] Morimoto S, Rebello de Sampaio FB, Braga MM, Sesma N, Özcan M. Survival Rate of Resin and Ceramic Inlays, Onlays, and Overlays: A Systematic Review and Meta-analysis. J Dent Res. 2016 Aug;95(9):985-94. doi: 10.1177/0022034516652848. Epub 2016 Jun 10. PMID: 27287305.
[iii] Olivieri JG, Elmsmari F, Miró Q, Ruiz XF, Krell KV, García-Font M, Durán-Sindreu F. Outcome and Survival of Endodontically Treated Cracked Posterior Permanent Teeth: A Systematic Review and Meta-analysis. J Endod. 2020 Apr;46(4):455-463. doi: 10.1016/j.joen.2020.01.006. Epub 2020 Feb 21. PMID: 32094000.
