Repair may increase survival of direct posterior restorations – A practice based study
Introduction
Placing dental restorations is core business for dentists all around the world. Dental restorations are most commonly placed due to caries or fracture [1], [2] and are often considered as ‘failed’ when a restoration does not meet certain standards that are designed by dental researchers and clinicians [3], [4], [5] or when a patient experiences problems with a restored tooth like pain, unpleasant esthetic appearance etc. In case a restoration has been considered as ‘failed’ and a restorative intervention is needed, there are two possible options. In some cases it is decided to remove the entire restoration which is defined as replacement. Alternatively, only a part of the restoration is removed or a preparation is ground next to a restoration including the outline of the existing restoration. In those cases, the restorative intervention includes an additional restoration, which is defined as repair [6].
Although repair was traditionally often considered as ‘bad dentistry’ and not done by all dentists [7], nowadays repair is more and more considered as state-of-art as it limits the size of the restorative intervention, reduces the risk for complications and limits the costs of the intervention [6], [8], [9]. For indirect restorations, Anusavice et al. [10] defined repaired restorations, as an example due to porcelain fracture or endodontic treatment access opening, not as failures but as survived restorations. Accordingly, an indirect restoration that is still in function without any intervention is considered as a success and only totally replaced restorations (including extractions) are considered as real failures.
For direct restorations, the difference between survival and success is not defined yet in clinical studies as in most longevity studies, any intervention on a direct restoration is considered as failure [11], [12], [13], [14]. Meanwhile, dentists are implementing the concept of repair more and more in their clinical practice [15] and modern dental schools are educating their undergraduates in repair techniques and indications [16], [17], [18], [19], [20].
Longevity of repair restorations, as expressed in the time between the repair restoration and the next intervention, is seldom investigated and includes several studies on interventions on restorations that are not failed yet (B scores for Ryge) [21], [22] showing good survival of small sized repairs. Two studies investigated actually failed restorations placed in some special general practices and demonstrated that repair can increase the longevity of dental restorations [23], [24] while at the same time the longevity of the repair restoration is less compared to the original restoration, depending from material and reason for repair [23].
Although from questionnaires it is known that dentists actually do repairs in their practices, the amount of repairs performed by general dental practitioners and the consequence for restoration survival is not known yet. The present study investigates among a group of general dental practitioners (GDPs) the amount of repairs and its consequences for longevity of class II restorations.
Section snippets
Study design, characteristics and participants
This retrospective practice-based study was developed at the Department of Preventive and Restorative Dentistry, Radboud University, Nijmegen, The Netherlands. The data set was based on dental records of patients attending regularly eleven general dental practices. To be included in the analysis, each dentist from a general dental practice should contribute with a minimum of 200 restorations. The research protocol of the present study was approved by the local Ethics Committee METC (CMO file
Results
In this retrospective practice-based study, the information was collected from 11 general dental practices, with 24 GDPs meeting the inclusion criteria of 200 contributing restorations. Data from 21,988 patients (10,652 male) with mean age of 38.2 (±14.8) years old were evaluated. A removable denture was present in 994 patients.
The analysis included 59,722 restorations (mean: 2.71 per patient) placed in premolars (28,883) and permanent molars (30,839). 112 restorations were placed in teeth with
Discussion
A total restoration replacement usually increases preparation size, risk for pulp complications and may lead to successive tooth loss in the future [25]. The main goal of Minimally Invasive Dentistry (MID) is to reduce potential adverse treatment effects for patients. Its current concepts support the practice of repair, instead of replacement for the treatment of defective, clinically unacceptable restorations, thereby reducing the risk of iatrogenic damage and treatment costs [26].
To our
Conclusions
The conclusion of this study is that repair can increase the survival of restorations, up to 50% reduction of AFR; dentists show a large variety in repair frequency and variation between dentists in AFRs was considerably. Molars, multi-surface restorations, presence of an endodontic treatment and a removable denture were identified as risk factors for failure.
Acknowledgments
The Department of Preventive and Restorative Dentistry, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands, and National Council for Scientific and Technological Development (CNPq – Brazil, Science without Borders, process n. 234539/2014-3) supported this work. This paper is based on a Post-Doctoral training (LC) staring in September/2015 up to August/2016 at Radboud University Nijmegen.
References (36)
- et al.
Longevity of posterior resin composite restorations in adults – a systematic review
J. Dent.
(2015) - et al.
Repair of restorations–criteria for decision making and clinical recommendations
Dent. Mater.
(2013) - et al.
Dental practice-based research network collaborative group, repair or replacement of defective restorations by dentists in the dental practice-based research network
J. Am. Dent. Assoc.
(2012) Standardizing failure, success, and survival decisions in clinical studies of ceramic and metal-ceramic fixed dental prostheses
Dent. Mater.
(2012)- et al.
Longevity of posterior resin composite restorations in permanent teeth in Public Dental Health Service: a prospective 8 years follow up
J. Dent.
(2013) - et al.
National dental practice-based research network collaborative group, repair or replacement of restorations: a prospective cohort study by dentists in the national dental practice-based research network
J. Am. Dent. Assoc.
(2015) - et al.
Repair or replacement of defective direct resin-based composite restorations: contemporary teaching in U.S. and Canadian dental schools
J. Am. Dent. Assoc.
(2012) - et al.
Can repair increase the longevity of composite resins? Results of a 10-year clinical trial
J. Dent.
(2015) - et al.
Longevity of repaired restorations: a practice based study
J. Dent.
(2012) - et al.
Longevity of posterior composite restorations: not only a matter of materials
Dent. Mater.
(2012)
Longevity of direct restorations in Dutch dental practices. Descriptive study out of a practice based research network
J. Dent.
22-Year clinical evaluation of the performance of two posterior composites with different filler characteristics
Dent. Mater.
Long-term evaluation of extensive restorations in permanent teeth
J. Dent.
Repair of defective composite restorations. A questionnaire study among dentists in the Public Dental Service in Norway
J. Dent.
Academy of operative dentistry european section, guidance on posterior resin composites: academy of operative dentistry – european section
J. Dent.
Longevity of posterior composite restorations: a systematic review and meta-analysis
J. Dent. Res.
Clinical criteria
Int. Dent. J.
FDI World Dental Federation: clinical criteria for the evaluation of direct and indirect restorations-update and clinical examples
Clin. Oral Investig.
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