“Revision dentistry”: The next frontier in oral health

Dr Miguel Stanley

Mon. 7. July 2025

save

In medicine, it is widely accepted that medical implants and treatments require revision over time. In orthopaedic surgery, for example, joint replacements are routinely reassessed and replaced when necessary. Yet in dentistry, past dental work—whether direct restorations, ageing crowns or endodontically treated teeth—is rarely revisited unless it fails. This oversight may have profound consequences, contributing to chronic inflammation, systemic disease and deterioration of overall health. Medical implants and prostheses are not designed to last a lifetime.

For example, the average lifespan of a hip replacement is around 15–20 years, breast implants typically need replacement within ten to 15 years and a pacemaker’s battery lasts for about five to 15 years before requiring replacement. Even corneal transplants often last only ten to 15 years before deterioration occurs. These examples illustrate that the human body changes over time and so do the materials we implant into it.

The emerging field of what I like to call “revision dentistry” aims to bridge this gap. It calls for regular reassessment of existing dental work to identify potential hidden sources of inflammation, toxicity and bacterial load associated with the treatments and not only with teeth and gingivae that may be affecting overall health. This proactive approach aligns with advancements in integrative and preventive medicine, in which early detection and intervention are key to optimising long-term well-being.

The link between oral health and systemic inflammation

The connection between oral and systemic health is well documented, and periodontal disease has been linked to cardiovascular disease, diabetes and certain cancers. However, the discussion has largely ignored how ageing dental materials and poorly executed past treatments might be driving chronic inflammation and contributing to conditions like autoimmune disorders, neurological issues and metabolic dysfunction. The disconnect between doctors and dentists, combined with the lack of pain and of visible inflammation associated with many of these issues and the common misconception that dental work lasts forever, has created a critical gap in healthcare—one that leaves patients vulnerable to chronic, silent health risks. Some dental treatments can degrade over time, leaching harmful substances into the body. Additionally, improperly treated root canals can harbour residual bacteria, forming chronic low-grade infections that silently burden the immune system, and this can go unchecked for decades.

“Patients assume that their dental work is permanent, but nothing in dentistry lasts forever.”

Examples of overlooked risks include the following:

Metal hypersensitivity: Many patients unknowingly react to titanium alloys, mercury and nickel in dental work, triggering systemic inflammatory responses.
Oral galvanisation: When metals with different electrochemical potentials are present in the mouth, the saliva can act as an electrolyte and can create galvanic microcurrents between them, disrupting mitochondrial function and potentially affecting neurological health.
Contaminated implants and bone grafts: Studies have found that many commercially available implants contain surface impurities and that some grafting materials are not rigorously tested for immunogenicity.
Silent infections: CBCT imaging and microbial analysis reveal that many root canals that have undergone apparently successful treatment harbour bacterial biofilms that may contribute to systemic disease. It is important to note that a well-executed root canal therapy following the gold standard protocol, including the use of sterilised instruments, is a valid treatment. The problem lies in poor or incomplete execution of treatment or the use of subpar materials.

Why revision dentistry is essential

Patients assume that their dental work is permanent, but nothing in dentistry lasts forever. Materials degrade, restorations fail and ongoing research continues to expand our knowledge of biocompatibility, infection control and systemic health, enabling us to perform treatments that surpass past techniques.

Revision dentistry proposes:

routine assessment of old restorations for signs of corrosion, leakage and bacterial infiltration;
the use of advanced diagnostics like CBCT imaging, salivary biomarker testing and testing for systemic inflammation markers, such as CCL 5/RANTES and C-reactive protein;
improved protocols for replacing failing dental work with biocompatible materials that minimise toxicity and immune response; and
greater collaboration between dentists, physicians and functional medicine practitioners to ensure that oral health is integrated into overall healthcare.

A call to action for the dental industry

The challenge of implementing revision dentistry lies in awareness, accessibility and education. Many patients (and even some dentists) are unaware of the long-term risks of ageing dental materials. Additionally, insurance providers often classify revision procedures as elective or cosmetic, leaving patients with the financial burden.

“The future of dentistry is not just about aesthetics or function; it is about total-body health.”

To change this, we need:

greater patient education on the importance of routine reassessment of dental work;
standardised diagnostic protocols to detect failing restorations before they cause systemic health issues;
a push for insurance coverage of medically necessary dental revisions; and
expanded training and research on the connection between oral materials, inflammation and chronic disease.

The future of dentistry is integrative and proactive

Revision dentistry is more than a new concept; it is a necessary evolution in how we approach oral healthcare. By recognising the systemic implications of ageing dental work, we can shift dentistry from a reactive to a proactive model, preventing disease rather than just treating symptoms. If you are a dentist, consider incorporating biocompatibility testing, CBCT imaging and checking of systemic health markers into your assessments. You could also advise your patients about the longevity and safety of their existing dental work.

The future of dentistry is not just about aesthetics or function; it is about total-body health. The time for revision dentistry is now.

Editorial note:

This article was published in aligners—international magazine of aligner orthodontics vol. 4, issue 1/2025.