Longevity of posterior restorations in primary teeth: Results from a paediatric dental clinic

Comparing modified USPHS and FDI criteria for the assessment of glass ionomer restorations in primary molars utilising clinical and photographic evaluation

PURPOSE

To compare the applicability of modified US Public Health Service (USPHS) and FDI criteria for evaluating glass ionomer cement (GIC) restorations in primary posterior teeth through digital image analysis.

METHODS

This comparative analytic study was conducted at the Children's Dental Clinic RSKGM FKG UI, involving 40 GIC restorations on lower first primary molars in children aged 4-9 years. After cleaning, the restorations were assessed clinically using modified USPHS and FDI criteria before taking digital images, then the collected images were re-evaluated using both sets of criteria, and the clinical assessment results were compared to the digital image assessment results.

RESULTS

Statistical analysis revealed significant differences between the clinical evaluation of GIC restorations in primary teeth and their corresponding digital photographs when using the modified USPHS criteria, and although the use of FDI criteria yielded different results, these differences were not statistically significant.

CONCLUSION

The assessment of GIC restorations through digital images aligns more closely with clinical assessments using the FDI criteria compared to the modified USPHS criteria.

Factors influencing the longevity of posterior composite restorations: A dental university clinic study

Objectives

This retrospective study aimed to assess the performance of posterior composite resin restorations (PCRRs) and evaluate the influence of patient-specific factors on restoration outcomes.

Methods

A total of 189 PCRRs were examined in 54 patients, with evaluations based on Modified USPHS criteria. Patient-specific factors were analyzed. Statistical analyses, including chi-square tests, independent samples t-tests, and ANOVA tests, were conducted.

Results

Patients aged over 50 exhibited higher DMFT averages and a higher rate of unsuccessful restorations. Despite higher DMFT scores in females, gender doesn't significantly impact restoration outcomes. Secondary caries correlated with.plaque scores, significantly affecting restoration survival. Marginal adaptation, retention deficiencies, and secondary caries were primary causes of failure. Multi-surface restorations faced higher failure risk due to elevated plaque scores. Class-V restorations showed a higher failure rate, challenging the number of surfaces and longevity correlation.

Conclusions

This study identified key factors influencing posterior composite resin restorations-(PCRRs) in patients over 50, including higher DMFT averages and more unsuccessful restorations. No significant difference was found between brushing; frequency and DMFT rates, possibly due to the absence of non-brushers. Secondary caries; correlated with elevated plaque scores, impacting restoration survival. Primary causes of; failure included marginal adaptation issues, retention deficiencies, and secondary caries, with multi-surface restorations facing a higher risk. However, tooth vitality, beverage and acidic food consumption, and oral hygiene habits did not significantly affect PCRR outcomes.

Clinical significance

Patient-specific factors significantly impact PCRRs' long-term performance. Dentists must tailor strategies, emphasizing regular monitoring and preventive measures for extended survival.

Clinical effectiveness of restorative materials for the restoration of carious primary teeth without pulp therapy: a systematic review

Purpose

To systematically search the available evidence and evaluate the clinical effectiveness of restorative materials for restoration of carious primary teeth. The findings aimed to support the European Academy of Paediatric Dentistry (EAPD) guidelines development.

Methods

Literature search was performed by searching 4 electronic databases for eligible randomised controlled clinical trials (RCTs) comparing restorative materials for the restoration of carious primary teeth up to December 28th, 2020. Quality assessment was performed with the revised Cochrane risk-of-bias tool for randomized trials (RoB 2).

Results

Of 1685 identified articles 29 RCTs were finally deemed as eligible for inclusion. Annual failure rates were: Amalgam 1–28%; atraumatic restorative treatment 1.2–37.1%; glass-ionomer cement (GIC) 7.6–16.6%, metal-reinforced GIC 29.9%, resin-modified GIC 1.9–16.9%, high-viscosity GIC 2.9–25.6%; glass carbomer ≤ 46.2%; compomer 0–14.7%; composite resin (CR) 0–19.5%, bulk-fill CR 0–16.9%; zirconia crowns 3.3%, composite strip crowns 15%, and preformed metal crowns (Hall-Technique) 3.1%. Secondary caries, poor marginal adaptation, loss of retention, and fracture of restoration were reported as reasons for failure. Four studies were evaluated at unclear and 25 at high risk of bias. Clinical and methodological heterogeneity, and the diversity of tested materials across included studies did not allow for meta-analyses.

Conclusions

Within the limitations of this systematic review, namely, the heterogeneity and the overall high risk of bias among included studies, clear recommendations based on solid evidence for the best restorative approach in primary teeth cannot be drawn. There is a need for future thoroughly implemented RCTs evaluating restorations in primary teeth to close this knowledge gap.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40368-022-00725-7.

Quality of approximal surfaces of posterior restorations in primary molars

PURPOSE

To evaluate the influence of the restorative material and matrix system on proximal contact tightness and morphological characteristics of class II restorations in primary molars.

METHODS

Occluso-mesial cavities in second primary artificial molars were randomly restored using different materials (Filtek Z500 or Filtek Bulk Fill composites or high-viscosity glass ionomer cement Ketac Universal) and different matrix system (Tofflemire, AutoMatrix, matrix band with ring, contoured sectional matrix) (n = 12). Proximal contact tightness was measured using a custom-made device in an Instron 3345, and proximal surface morphology and marginal adaptation were scored after digital scanning. Two-way ANOVA, Tukey and Fischer's exact tests were performed (P < 0.05).

RESULTS

Proximal contact tightness values were significantly influenced by the restorative material (P < 0.05), the matrix system (P < 0.001), and their interaction (P < 0.01). Both resin composites showed statistically differences in proximal shape according to the matrix used to restore and exhibited overhanging margins. Ketac Universal restorations showed similar morphology and gaps on the margins regardless of the matrix system.

CONCLUSIONS

Overall, both composite restorations achieved tighter proximal contact than those restored with the high-viscosity glass ionomer cement. None of the matrix systems tested provided a convex seamless proximal morphology.

Repair Bond Strength of High-viscosity Glass-ionomer Cements Using Resin Composite Bonded with Light- and Self-cured Adhesive Systems

CLINICAL RELEVANCE

High-viscosity glass-ionomer cements (HVGICs) used with atraumatic restorative treatment can be repaired with light- or self-cured adhesive systems; however, the repair bond strength of two-step, self-etching and one-step adhesives in the light-cure mode surpass one-step self-cure adhesives. Working on a feasible self-cure approach in the absence of such in rural areas as well as in war zones is of prime importance.

SUMMARY

Longevity of posterior composite restorations in children suffering from early childhood caries-results from a retrospective study

OBJECTIVES

This retrospective study aimed to evaluate health status as a new patient risk factor and analyze its influence on the survival of posterior composite restorations in patients with early childhood caries (ECC).

MATERIALS AND METHODS

Patients who received dental treatment of ECC under general anesthesia (GA) and attended at least one follow-up visit were included in this study. A total of 907 patient records were evaluated retrospectively through patient examination forms and panoramic radiographs. Kaplan-Meier survival probability analysis with log-rank test was used to assess the posterior composite restorations' longevity up to 24 months. Furthermore, risk factors were determined using Cox regression multivariate analysis.

RESULTS

A total of 5063 posterior composite restorations were assessed. Following the Cox regression analysis to determine the effect of risk factors on longevity of composite restorations, findings revealed that the survival probability of composite fillings was significantly lower in patients with systemic disease (p = 0.00). Filling materials were compared based on the survival probabilities and results were further discussed. There was no significant relationship between age, gender, and the survival of the restoration; however, the child's health status (p = 0.00) and caries risk status (p = 0.05) significantly affected survival. Moreover, the type of arch and pulp intervention influenced the restoration's survival.

CONCLUSION

Systemic disease has a detrimental influence over longevity of composite restorations. Therefore, considering the reduced survival rates of the composite restorations for children who have systemic disease, alternative non-invasive treatment options should be considered.

CLINICAL RELEVANCE

This study's novelty is the observation of drastically reduced survival of composite restorations in children with systemic disease.

Shortening of etching time of the dentin in primary teeth restorations: a randomized clinical trial

The aim of this study was to investigate the influence of shortening of etching time for dentin on the restoration survival after selective carious tissue removal in primary molars. This two-arm randomized clinical trial included sixty-two subjects (5-8 year-old) and 100 primary molars presenting moderate dentin carious lesions on occlusal surface. The sample was randomly assigned into groups previously to adhesive application (Adper Single Bond 2; 3M ESPE): etching time recommended by manufacturer (15 s) or reduced (7 s). Resin composite (Filtek Bulk Fill Posterior Restorative; 3M ESPE) was inserted in a single increment for all restorations. Restorations were evaluated at 1, 6, 12, and 18 months using FDI criteria. Survival estimates for restorations' longevity were evaluated with Kaplan-Meier method. Multivariate Cox regression analysis with shared frailty was used to assess the factors associated with failures (p < 0.05). The etching time did not influence the restorations' survival (HR 0.35 95%CI 0.11-1.12; p = 0.06). Mean estimated time of survival was 17.6 months (95%CI, 17.2-17.9). The survival rates at the 18-month follow-up were 75.7% and 91.4% (AFR: 16.9% and 5.7%) when primary dentin was acid etched for 15 and 7 s, respectively (log-rank p = 0.06). In conclusion, the etching time for dentin did not influence the clinical behavior of adhesives restorations. However, there was a tendency for better clinical outcome when using etching time of 7 s.

Influence of different clinical criteria on the decision to replace restorations in primary teeth

OBJECTIVES

This cross-sectional study is nested in a randomized clinical trial. It was designed to evaluate the influence of using two different clinical criteria to assess caries lesion around restorations on the decision to replace restorations in primary posterior teeth. Variables that might influence this decision were also considered.

METHODS

One trained and calibrated examiner assessed 550 restorations of 160 children (3-10 years old). Children were randomized to have their restorations evaluated and subsequently treated according to World Dental Federation (FDI) or Caries Associated with Restorations and Sealants (CARS) criteria. After reaching the treatment decision, the same examiner performed another evaluation using the other criteria. Spearman's correlation coefficients and 95 % confidence intervals (95 %CI) between the scores obtained with both criteria and respective treatment decisions were calculated. Poisson multilevel regression analysis were performed between the exploratory variables related to children, restored tooth and restoration assessment; the outcome variables were decisions related to restoration replacement, any operative intervention and presence of secondary caries.

RESULTS

The strongest correlation observed between the methods was for recurrence of caries. A total of 94 restorations (17.1 %) were indicated for replacement with FDI criteria and 30 (5.5 %) were indicated for replacement with CARS. Besides the diagnostic method used, number of decayed teeth and restorations with two and three restored surfaces were associated with the decision of replacement and presence of recurrent caries lesions.

CONCLUSIONS

The decision to replace posterior restorations in primary teeth is influenced by the criteria used for the restorations assessment and also by the children's caries experience and multisurface restorations. The restoration material did not influence the decision of restorations replacement.

CLINICAL SIGNIFICANCE

The decision to replace posterior restoration in primary teeth is strongly related to the evaluation method and not only by patients' risk factors.

Success rate of proximal tooth-coloured direct restorations in primary teeth at 24 months: a meta-analysis

The aim was to determine the survival of tooth-coloured restorative materials in proximal restorations of primary teeth at 24 months of follow-up and the influence of the following variables: use of coating, use of cavity conditioner, use of rubber dam isolation, the cavity form, the dentist's experience and the methodological characteristics of the studies. We conducted a search until May 2019, obtaining 16 articles from which 30 independent studies were extracted, which were considered as units of analysis. Four outcome measures were extracted from each study: retention, marginal integrity, anatomic form, and absence of recurrent caries. Separate meta-analyses were carried for each outcome and multiple meta-regression model was applied. The outcomes with the highest mean success rates were absence of recurrent caries and anatomic form. The type of material significantly influenced success rates. The best materials were resin-based material plus total-etching adhesion and resin-modified glass ionomer cement (RMGIC), and the worst high viscosity glass ionomer cement (HVGIC). Atraumatic restorative treatment (ART) had a lower success rate than the conventional cavity form. RMGIC had the best clinical performance and HVGIC the worst. The form of the cavity, blinding and the experience of the operator were the variables that influenced success rates. Proximal primary molar restorations should be performed with RMGIC as it combines good mechanical performance of the resins together with the prevention of secondary caries of glass ionomers.

Survival of composite restorations after selective or total caries removal in primary teeth and predictors of failures: A 36-months randomized controlled trial

OBJECTIVES

The aim of this study was to assess the survival of composite restorations after selective (SCR) or total caries removal (TCR) and determine predictors of failures after 36 months.

METHODS

120 teeth with deep occlusal or occlusal-proximal carious lesions were randomly divided into control (TCR; n = 54; 69% Class II) and test (SCR; n = 66; 63% Class II) groups. Clinical evaluation was applied using the USPHS criteria, and the presence of Charlie or Delta scores at the marginal integrity were considered as a failure.

RESULTS

The overall survival rate of restorations was 68% after 36 months, 81% for TCR and 57% for SCR (p = 0.004). The multivariable Cox Regression model demonstrated that restorations performed after SCR had 3.44 times greater probability of failure compared to TCR (p = 0.006). The other two predictors for failure of restorations were teeth with Class II cavities (hazard ratio = 3.3) and children with gingival bleeding over 20% (hazard ratio = 2.5).

CONCLUSIONS

Performing composite restorations after SCR in primary teeth had success rate significantly lower than restorations performed after TCR. Complex cavities and worst patient´s oral hygiene were found to be predictors of failure of restorations.

CLINICAL SIGNIFICANCE

Although SCR has been demonstrating high rates of pulp preservation, clinicians should consider that composite restorations fail in a higher frequency compared to TCR in primary teeth and, in some circumstances, may be preferable in terms of restoration longevity.

Long-term clinical performance of heat-cured high-viscosity glass ionomer class II restorations versus resin-based composites in primary molars: a randomized comparison trial

OBJECTIVE

To evaluate the long-term clinical performance of heat-cured high-viscosity glass ionomer (GIC) and posterior composite resin (CR) restorations in primary molars over a 3-year period.

METHODS

Photographs and radiographs of EQUIA GIC and Filtek™ P60 restorations were assessed. Study sample is comprised of healthy preschool/school children with proximal surface caries in primary molars.

RESULTS

70 GI restorations were placed in 45 patients (aged 78 months ± 25) and were evaluated at 33 months ± 7. 61 composite resin restorations were placed in 42 patients (age 82 months ± 19) and were evaluated at 39 months ± 13. GI restorations failure was 17.1%, a significantly greater rate compared with 4.9% in the CR group. GI failures were due to either significant loss of the restoration or to loss of marginal ridge integrity. CR failures were due to loss of marginal ridge integrity.

CONCLUSION

Both GI and CR restorations were clinically successful during a 3-year period. GI restorations may be considered as an intermediate-lasting restoration option for proximal lesions in primary molars, with 83% of the restorations functioning up to 36 months. CR restorations showed a higher success rate than GIC during the same period.

Qual material possui maior longevidade em molares decíduos: resina composta ou cimento de ionômero de vidro ? – Revisão sistemática da literatura

Introdução: Diversos materiais restauradores são indicados para a restauração de dentes decíduos posteriores, como amálgama, resina composta, cimento de ionômero de vidro convencional, cimento de ionômero de vidro modificado por resina e resinas compostas modificadas com poliácidos (compômeros). Entretanto, uma dúvida ainda persiste quanto ao desempenho clínico do cimento de ionômero de vidro, em decorrência de suas propriedades, para ser utilizado como material restaurador definitivo em molares decíduos. Objetivo: Realizar uma revisão sistemática da literatura acerca da taxa de sobrevivência de restaurações realizadas em molares decíduos utilizando resina composta e cimento de ionômero de vidro, buscando com base em evidências científicas, responder a PICO question: “Qual material possui maior longevidade em molares decíduos: resina composta ou cimento de ionômero de vidro?”. Material e métodos: Para este fim foram realizadas buscas em duas bases de dados, PubMed e Web of Science, utilizando uma estratégia de busca previamente determinada, para selecionar artigos de acordo com critérios de inclusão e exclusão criados para esse trabalho por dois examinadores calibrados. Resultados: A seleção dos artigos foi realizada de acordo com o fluxograma do PRISMA e foi criada uma tabela para avaliação qualitativa dos artigos selecionados. Foram encontrados 398 artigos na base de dados PubMed e 375 na Web of Science, sendo 153 coincidentes em ambas. Quarenta e seis artigos foram selecionados para leitura completa, dentre eles 42 foram excluídos, e quatro artigos foram incluídos para esta revisão. Conclusão: Após leitura crítica dos mesmos pode-se concluir que a resina composta demonstrou melhor desempenho clínico, ao longo do tempo, em molares decíduos comparados ao cimento de ionômero de vidro.

Survival, Reasons for Failure and Clinical Characteristics of Anterior/Posterior Composites: 8-Year Findings

This retrospective study aimed to compare the annual failure rate (AFR), reasons for failure and factors influencing survival of posterior and anterior composite restorations placed by undergraduate students. Composite restorations placed by undergraduate students were evaluated. The restorations should be in occlusion, with at least one adjacent tooth; and patients should have been present for check-up, with at least 1 annual recall. The investigation was performed in two separate analysis: 1) dental electronic records of 100 patients (n=333 restorations) were selected to assess factors influencing survival; 2) clinical evaluation of 30 patients by examining restorations (n=123) to assess clinical characteristics and failure type distribution. Data were subjected to Kaplan-Meier method, Log-rank test, Cox regression and Fisher's Exact test (p<0.05). After 8-year period, the AFR was 2.62%. There was difference between anterior and posterior restorations (p=0.005), with anterior showing a higher AFR. The patient caries-risk (p<0.001) and the number of surfaces restored (p=0.010) affected restoration survival. The superficial brightness (p=0.029), fracture (p=0.025) and retention (p=0.011) were clinical criteria with differences between anterior and posterior restorations. Income (p<0.001), caries activity (p<0.001), caries risk (p<0.001) and oclusal risk (p<0.001) also influenced on the restorations survival. After 8-year, the AFR of restorations placed by undergraduate students was acceptable and affected by patient risk factors and the position of the tooth in the arch: anterior restorations failed more than posterior.

Three-year clinical evaluation of high-viscosity glass ionomer restorations in non-carious cervical lesions: a randomised controlled split-mouth clinical trial

OBJECTIVE

To compare the 3-year clinical performance of high-viscosity glass ionomer restorations with that of composite restorations in non-carious cervical lesions (NCCLs).

MATERIALS AND METHODS

One hundred thirty-four NCCLs were randomised into two groups according to a split-mouth design. In the experimental group (Hv-GIC), lesions were restored with a high-viscosity glass ionomer (EQUIA Fil, GC), whereas a composite resin (G-aenial, GC) was applied in the control group (E&Ra/comp). All restorative materials were used according to the manufacturers' instructions. Clinical evaluations were performed after 1 week, 6 months, 1 year, 2 years, and 3 years using FDI (World Dental Federation) criteria. Data were analysed using Friedman's ANOVA and Mann-Whitney U tests (α = 0.05).

RESULTS

While retention rates of the Hv-GIC group were 98.5%, 96%, 91%, and 87% in respective evaluation periods, no retention loss was observed in the E&Ra/comp group at any time. There was a statistically significant difference between study groups regarding the retention criterion in both the second and third years (p = 0.008 and p = 0.003, respectively). Furthermore, there was a statistically significant difference between the groups in terms of surface lustre at the third-year recall, in favour of the E&Ra/comp group (p = 0.022).

CONCLUSIONS

The 3-year clinical performance of E&Ra/comp restorations in NCCLs was better than that of Hv-GIC restorations. The most common problems in Hv-GIC restorations were a loss of retention and reduction in surface lustre.

CLINICAL RELEVANCE

Although the 3-year clinical performance of Hv-GIC restorations in non-retentive lesions was acceptable, it was worse than in composites. The operator should consider the benefit/loss ratio of Hv-GIC when he/she decides to use this material in non-retentive cavities, especially those that are shallow.

Performance of resin composite restorations in the primary dentition: a retrospective university-based study

BACKGROUND

Limited data is available on variables influencing the survival of composite restorations in primary teeth.

AIM

This retrospective university-based study assessed the survival and risk factors associated with failures of resin composite restorations performed in primary teeth.

DESIGN

The sample was composed of 961 restorations from records of 337 patients (178 girls and 159 boys) attended in a university dental clinic. The restorations' longevity up to 48 months of follow-up was assessed using the Kaplan-Meier survival test. Multivariate Cox regression analysis with shared frailty was used to evaluate the factors associated with failures (P < 0.05).

RESULTS

Mean survival time was 41.5 months (95% CI: 39.7-43.3), with 70.6% of the restorations surviving after 48 months of evaluation. The overall annual failure rate up to 48 months follow-up was 8.3%. Restorations placed in lower arch had lower survival rate than those in upper arch (HR: 1.82, 95% CI: 1.02-3.28). Restorations involving two or more surfaces had more risk of failure than restorations placed in cavities involving only one surface (HR: 2.55 95% CI: 1.34- 4.83). Girls had less risk of failure in their restorations (HR: 0.43, 95% CI: 0.19-0.96).

CONCLUSION

Individual and dental variables such as gender, arch type and number of restored surfaces were associated with failure of composite restorations performed in children under daily life clinical environment.

Restorations in primary teeth: a systematic review on survival and reasons for failures

BACKGROUND

Several restorative materials with specific indications are used for filling cavities in primary teeth.

AIM

To systematically review the literature in order to investigate the longevity of primary teeth restorations and the reasons for failure.

DESIGN

Electronic databases were screened, and eligible studies were hand-searched to find longitudinal clinical studies evaluating the survival of restorations (class I, class II, and crown) placed with different materials in primary teeth with at least one year of follow-up.

RESULTS

Thirty-one studies were included, and a high bias risk was observed. Overall, 12,047 restorations were evaluated with 12.5% of failure rate. A high variation on annual failure rate (AFR) was detected (0-29.9%). Composite resin showed the lowest AFRs (1.7-12.9%). Stainless steel crowns (SSC) had the highest success rate (96.1%). Class I restorations and restorations placed using rubber dam presented better AFR. The main reason for failure observed was secondary caries (36.5%).

CONCLUSIONS

An elevated number of failures were observed due to recurrent caries, highlighting the need for professionals to work with a health-promoting approach. The high variation on failure rate among the materials can be due to children's behavior during the procedure, which demands short dental appointments and a controlled environment.

Survival of extensive restorations in primary molars: 15-year practice-based study

BACKGROUND

Caries decline in the western world is accompanied by strong polarization among children; 8% of Finnish 5-year-olds having 76% of untreated caries. This high caries risk group needs preventive and restorative strategies.

AIM

To explore survival of extensive restorations in primary molars.

DESIGN

This study was based on health records from 2002 to 2016 of children under 18 years.

RESULTS

Of severely affected primary molars (n = 1061), 41% were restored with preformed metal crowns (PMCs), 38% with glass-ionomer cement (GIC)/polyacid-modified resin composite (PAMRC)/resin-modified GIC (RMGIC), and 21% with resin composites (RC). Younger children (3-8) received 97% of the PMCs and 86% of GIC/PAMRC/RMGIC; older ones (≥9) 91% of the RC restorations. Neither amalgam nor indirect restorations were registered. General dentists (GDs) engaged in primary care restored with GIC/PAMRC/RMGIC (52%) or RC (48%). GDs in general anesthesia care service placed 66% and specializing/specialized dentists 31% of PMCs. PMCs had lower failure rate (1.4% vs 3.0%) than GIC/PAMRC/RMGIC (P = 0.001). Choosing PMCs reduced patient visits compared to other restorations (P < 0.001).

CONCLUSIONS

Severely affected primary molars of children at high caries risk are better managed, using PMCs to optimize the resources in public oral health services.

Survival and Associated Risk Factors of Selective Caries Removal Treatments in Primary Teeth: A Retrospective Study in a High Caries Risk Population

Objective: The aim of this retrospective study was to analyze the survival probability of selective caries removal (SCR) treatments in the primary teeth of children with high caries experience and factors potentially associated with treatment failure. Methods: The sample included SCR treatments conducted in anterior and posterior teeth without sedation or general anesthesia among children attending a university dental service. Kaplan-Meier survival analysis was used to estimate the longevity of restorations and multivariate Cox regression with shared frailty was used to assess risk factors. Results: A total of 284 SCR treatments in 88 children (aged 5.2 ± 1.91 years) with high caries experience (mean dmft/DMFT = 11.1 ± 5.04) were analyzed. The 3-year survival reached 48.8%, with an annual failure rate of 21.2%. Restorative failures (n = 60) were found more frequently compared to pulp complications (n = 12). SCR performed in anterior primary teeth were more prone to failure (hazard ratio = 3.6, 95% CI: 1.94; 6.71). Patients with a higher amount of visible plaque experienced more failures in SCR treatments (hazard ratio 3.0, 95% CI:1.27; 7.07). Conclusions: In this retrospective study, SCR showed restricted survival when compared to other prospective clinical trials. Patient-related factors, especially the young age and high caries experience of the children, may represent a challenge for restoration survival. Regardless of the caries removal technique or restorative material, cariogenic biofilm has a negative effect on the survival of restorations, probably by acting directly on material deterioration and, particularly, on the development of new caries lesions of rapid progression.

Survival and Factors Associated with Failure of Pulpectomies Performed in Primary Teeth by Dental Students

Abstract Although endodontic treatment is widely recommended for compromised dental pulp, there is no information regarding the factors associated with failures in primary teeth. The aim of this study was to evaluate the survival and factors associated with failure of pulpectomies performed in primary teeth by dental students. The sample comprised patients treated at a University Dental Service and required endodontic treatment in primary teeth. The study investigated treatment-related variables and patient factors potentially associated with treatment failure. Pulpectomy survival was analyzed by Kaplan-Meier estimator followed by log-rank test (p<0.05). The analysis included 81 pulpectomies performed in 62 children (5.6±1.5 years). The survival reached 62.9% up to 12 months follow-up. Most failures occurred in the first 3 months (p<0.001). Teeth with carious lesions at the start of treatment presented more failures than those with restorations or history of trauma (p=0.002). The survival of endodontically treated teeth restored with composite was higher than the ones filled with GIC (p=0.006). Pulpectomy performed in two or more sessions resulted in more failures (p=0.028). Patients presenting gingivitis had more failures in the endodontic treatment (p=0.022). The failures of root canal treatment in primary teeth were more prone to occur in a short time and when the treatment was performed in teeth presenting carious lesions. The use of composite instead of GIC increased the survival of pulpectomies. Repeated sessions for endodontic treatment and lack of oral hygiene habits had a negative effect on the results.

Influence of niobium pentoxide addition on the properties of glass ionomer cements

Objective: To determine the influence of niobium pentoxide (Nb₂O₅) addition on the physical and chemical properties of glass ionomer cements (GICs).

Materials and methods: Five, 10 or 20 wt.% of Nb₂O₅ were incorporated into commercial GICs (Maxxion R, Vitro Molar, Vitro Fil R) and one group of each GIC remained without Nb₂O₅ (control groups). The GICs were evaluated by Knoop hardness, compressive strength, acid erosion, particle size and radiopacity. Data were analyzed by two-way ANOVA followed by Tukey's test.

Results: The addition of 10% and 20% reduced the microhardness of two GICs (p < .05). Compressive strength showed no difference among groups (p > .05). Nb₂O₅ did not influence Maxxion R and Vitro Fil R regarding the acid erosion test (p > .05). Vitro Molar increased its acid erosion with 10% of Nb₂O₅ (p < .05). Maxxion R presented 15.78 μm, while Vitro Molar and Vitro Fil R showed 5.14 μm and 6.18 μm, respectively. As the Nb₂O₅ concentration increased, the radiopacity increased for all groups. Vitro Molar and Vitro Fil R did not present significant difference to at least 1 mm aluminum (p > .05).

Conclusion: The addition of 5 wt.% Nb₂O₅ did not affect the tested physical and chemical properties of the GICs and improved the radiopacity of one of the cements. These materials are therefore suitable for further testing of biomimetic remineralization properties.

Crown-Root Fractures in Primary Teeth: A Case Series Study of 28 Cases

Crown-root fractures in primary teeth are rare, with a wide variation of patterns that make diagnosis and treatment difficult. The aim of this study was to present a case series of crown-root fractures in primary teeth of children who attended a reference center. The study followed 28 cases of crown-root fractures in 26 children, representing 4% of the total number of attendees over 11 years of reference service at the Universidade Federal de Pelotas, Pelotas, Brazil. In most cases, the maxillary central incisors (85.7%) were involved. In the crown, 57.1% of the cases had a simple line of fracture, and 42.9% had multiple lines. Simple lines predominated in the root (89.3%). In cases with simple fracture lines in the crown, 37.6% underwent a total extraction, 31.2% required a partial extraction and 31.2% underwent pulpectomy. In most teeth with multiple lines of fractures in the crown, total extraction was performed (91.7%) All cases were followed-up until the eruption of the permanent successor tooth, and all patients had favorable outcomes.

Randomized controlled clinical trial of the 24-months survival of composite resin restorations after one-step incomplete and complete excavation on primary teeth

OBJECTIVE

This randomized clinical trial aimed to compare the 24-months survival of composite restorations in primary molars after partial caries removal (PCR) and total caries removal (TCR).

METHODS

Forty-eight children aged 3-8 years with at least one molar with a deep carious lesion were included (PCR; n=66; TCR; n=54). For PCR, excavation was stopped when dentine with a leathery consistency was achieved; in the TCR group, total absence of carious tissue was confirmed using a blunt-tipped probe. Pulpotomy was performed in cases of pulp exposure. Success was assessed by modified USPHS criteria with Alpha and Bravo scores recorded as success.

RESULTS

Pulp exposure occurred in 1 and 15 of the teeth treated with PCR and TCR respectively (p<0.01). The restorations survival rate after 24 months was 66% (PCR) and 86% (TCR) (p=0.03). When teeth that received pulpotomy were analyzed separately, the survival rate was 92% (p=0.09). PCR performed in occlusoproximal restorations demonstrated the lowest success rate (p=0.002). PCR increases 2.90 times the probability of having a restorative failure compared to TCR (p=0.03), after adjusting for cavity type. When pulp exposure and restoration failure were considered as the outcome, there was no significant difference between the two groups (p=0.10) with success rates of 64% (PCR) and 61% (TCR).

CONCLUSION

Collectively, deciduous teeth submitted to PCR prevented pulp exposure and, consequently, more invasive treatments; otherwise, PCR yielded lower longevity for composite restoration compared to TCR, suggesting that PCR restorations need to be followed over time, especially when multi-surface restorations are involved.

CLINICAL SIGNIFICANCE

Composite restorations on carious remaining tissue require monitoring over time, especially those performed in more than one surface. Even if the restorations present shortcomings over the time, the majority of them are subject to repair, allowing more conservative approaches for teeth with deep caries lesions.