Subject: Preventive Resin Restorations
Reviewed: September 10, 2012
Important NoteThis Clinical Policy Bulletin expresses our determination of whether certain services or supplies are medically necessary. We have reached these conclusions based on a review of currently available clinical information including:
Aetna considers the placement of a preventive resin restoration (PRR) to be a treatment for caries found in the pits and fissures in a documented moderate to high caries risk patient. Aetna’s policy is that if decay is present on posterior permanent teeth and it extends into the dentin, the restoration is considered a posterior composite. If the decay (active cavitated lesion) does not extend into the dentin, it is considered a preventive resin restoration. The PRR procedure includes placement of a sealant in any radiating non-carious fissures or pits.
The preventive resin restoration (a combination of composites and/or sealants) is a treatment for caries found in the pits and fissures of posterior permanent teeth in a documented moderate to high caries risk patient when the carious lesion is isolated to the enamel. A patient's caries risk assessment may be evaluated and documented by a variety of methods. One such assessment tool can be found at Simple Steps.
An Aetna continuing education course is available for participating providers: Cariology CE Course.
The use of preventive resin restorations is generally governed by the desire to treat small lesions conservatively, and they are usually placed in the nonstress-bearing regions of the dentition.1
D1352 -- Preventive resin restoration in a moderate to high caries risk patient - permanent tooth
Revision DatesOriginal: December 29, 2008
The above policy is based on the following references:1Dorothy D. McComb, B.D.S., M.Sc.D., FRCD(C). NIH Consensus Development Conference on Caries. Copyright 2000 Regents of the University of Michigan. 2003.
Property of Aetna. All rights reserved. Dental Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical/dental advice. This Dental Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating health care professionals are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating health care professionals are solely responsible for medical/dental advice and treatment of members. This Clinical Policy Bulletin may be updated and, therefore, is subject to change.
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