The article by David Bloom and Jay Padayachy, Vital guide to cosmetic dentistry (Vital summer 07 pages 15-22), raises a number of questions. The instance of endodontic retreatment (Figs 1 and 2) presumably includes the immediate post-operative radiograph since the periapical area is still present. The pulp chamber is empty. I could be more convinced of the success of the treatment if a follow-up radiograph showing resolution of the periapical area were shown, say a year after completion of the definitive coronal restoration.

Figures 5 and 6 show a number of heavily restored posterior teeth but it is wildly fanciful to imagine that these have failed. Most of them, particularly the premolars, look as if there would have been many years of service left. Any restoration could be described as ‘failing’ since all (including the mouthful of new composites) will fail eventually. A common reason for restoration replacement is secondary caries but no radiographic evidence of this was presented either before the wholesale destruction of the preoperative state or afterwards to show the quality of the work done. I wonder how many of those replacements will lead to further endodontic interventions which might not otherwise have been required.

I remain to be satisfied that the work carried out was necessary.