Long-term costs of post-restorations: 7-year practice-based results from Germany

Single crown vs. composite for glass fiber post-retained restorations: An 8-year randomized clinical trial

OBJECTIVES

This study aimed to compare the success and survival rates of metal-ceramic crowns and composite resin restorations applied in root filled teeth that received a glass fiber post.

METHODS

A prospective, randomized controlled trial, with equivalent parallel groups was designed. Eighty-two teeth were randomly allocated to the metal-ceramic or composite resin groups. Multivariate Cox regression analysis with shared frailty for patients and Kaplan-Meier curves were performed using success and survival rates (p<0.05).

RESULTS

Seventy-five post-retained restorations (34 metal-ceramic crowns and 41 composite restorations) in 62 patients were analyzed. The median follow-up was 8.1 years [IQR 4.0-9.9]. Twenty-seven failures were observed. Twenty-two failures (81.5 %) were observed in the composite resin group, of which six (27.3 %) were not repairable. Five failures (18.5 %) were observed in the metal-ceramic crown group, of which three (66.6 %) were non-repairable. The cumulative success rate at 8 years was 85.0 % for crowns (AFR=1.31 %) and 43.2 % for composite resins (AFR=6.58 %), while the survival rate was 93.8 % for crowns (AFR=0.52 %) and 97.6 % for composite resins (AFR=0.20 %). Considering the success rates, adjusted multivariate Cox regression showed that composite resin had a Hazard Ratio of 5.07 (95 %CI, 1.99-12.89) greater than the metal-ceramic crown. No significant difference in the failure risk was observed when the survival rates were considered (HR=0.38, 95 %CI (0.10 - 1.44), p = 0.156). Co-variables did not affect the success and survival rates (p>0.05).

CONCLUSIONS

Metal-ceramic crowns showed a higher success rate than composite restorations. The survival rates were similar, but composite restorations presented a higher need for repairs.

CLINICAL SIGNIFICANCE

Post-retained composite restorations may need more reinterventions during the lifecycle, although more preservation of sound tooth structure is expected with a large restoration of resin post-and-core. These aspects have to be discussed with the patient for decision-making planning.

Characteristics of Spatial Changes in Molars and Alveolar Bone Resorption among Patients with Loss of Mandibular First Molars: A CBCT-Based Morphometric Study

OBJECTIVES

To investigate the characteristics of spatial changes in molars and alveolar bone resorption among patients with loss of mandibular first molars.

METHODS

A total of 42 CBCT scans of patients with missing mandibular first molars (3 males, 33 females) and 42 CBCT scans of control subjects without loss of mandibular first molars (9 males, 27 females) were evaluated in this cross-sectional study. All images were standardized using the mandibular posterior tooth plane with Invivo software. The following indices regarding alveolar bone morphology were measured, including alveolar bone height, bone width, mesiodistal and buccolingual angulation of molars, overeruption of maxillary first molars, bone defects, and the capability of molar mesialization.

RESULTS

The vertical alveolar bone height in the missing group was reduced by 1.42 ± 0.70 mm, 1.31 ± 0.68, and 1.46 ± 0.85 mm on the buccal, middle, and lingual side, respectively (no differences among the three sides; p > 0.05). Alveolar bone width was reduced the greatest at the buccal CEJ level and the least at the lingual apex level. Mandibular second molar mesial tipping (with mean of the mesiodistal angulation = 57.47 ± 10.34°) and lingual tipping (with mean of the buccolingual angulation = 71.75 ± 8.34°) were observed. The mesial and distal cusps of maxillary first molars were extruded by 1.37 mm and 0.85 mm, respectively. Buccal and lingual defects of alveolar bone occurred at the CEJ, mid-root, and apex levels. Through 3D simulation, the second molar cannot be successfully mesialized into the missing tooth position, and the difference between the available and required distances for mesialization was the greatest at the CEJ level. The duration of tooth loss was significantly correlated with the mesio-distal angulation (R = -0.726, p < 0.001), buccal-lingual angulation (R = -0.528, p < 0.001) and the extrusion of the maxillary first molar (R = -0.334, p < 0.05).

CONCLUSION

Both vertical and horizontal resorption of alveolar bone occurred. Mandibular second molars exhibit mesial and lingual tipping. Lingual root torque and uprighting of the second molars are needed for the success of molar protraction. Bone augmentation is indicated for severely resorbed alveolar bone.

Patterns of Post-Endodontic Restoration: A Nationwide Survey of Dentists in Turkey

Developments in materials and techniques, geographical locations, age, specialty, and affiliations of dental practitioners affect the preference of post-endodontic restoration. Thus, this survey aimed to evaluate the trends of dentists in Turkey in terms of post-endodontic restorations. An anonymous survey containing 10 questions regarding demographics, post-endodontic restoration patterns, and factors affecting restoration selection was electronically delivered to the dentists registered in the database of the Turkish Dental Association. The data were analyzed using by a chi-square test and ordinal logistic regression analysis. A total of 1093 surveys from 20,564 participants were collected with a response rate of 5.3%. Half of the participants (52%) preferred composite resins for post-endodontic restorations. Usage of posts was less prevalent amongst prosthodontists and dentists with clinical experience of more than 20 years compared to endodontists (p < 0.001) and dentists with clinical experience of less than 5 years (p = 0.004). More than half of the participants (56%) utilized fiber posts. Composite resins and fiber posts were the most common preferences in post-endodontic restoration. Endodontists had a higher tendency to use posts than prosthodontists and general dental practitioners.