Repair of defective composite restorations. A questionnaire study among dentists in the Public Dental Service in Norway

Clinical Decision-Making of Repair vs. Replacement of Defective Direct Dental Restorations: A Multinational Cross-Sectional Study With Meta-Analysis

OBJECTIVES

This web-based survey, conducted across multiple countries, sought to explore the factors that impact the decision-making of clinicians when it comes to managing defective direct restorations.

METHODS

A survey consisting of 14 questions was sent out to dentists in 21 countries through various online platforms. The survey consisted of two sections. The first contained five questions about demographic information, while the second involved eight clinical scenarios. In the second part, participants were tasked with deciding whether to repair or replace defective composite and amalgam restorations.

RESULTS

Three thousand six hundred eighty dental practitioners completed the survey. For composite restorations, repair was preferred in scenarios like partial loss or fracture (RR:0.72; 95% CI: 0.58, 0.89; p = 0.002), whereas replacement was favored for secondary caries (RR:2.43; 95% CI: 1.87, 3.16; p < 0.001) and open/defective margins (RR:3.93; 95% CI: 2.68, 5.76;p < 0.001). Amalgam restorations were mostly replaced across all scenarios. The main factors influencing decision-making were caries risk, restoration size, and patient oral hygiene. Substantial heterogeneity was observed across countries.

CONCLUSION

This study underscores the complexity of the decision-making process and the need for evidence-based guidelines to inform clinicians' decisions regarding restoration management. Patient-level factors predominantly influence decision-making, emphasizing the need for individualized approaches.

CLINICAL SIGNIFICANCE

The study reveals that the material type in the original restoration is a critical determinant, with composite restorations being repaired in specific scenarios, while amalgam restorations are consistently replaced across different countries. Key patient and tooth-level factors, such as high caries risk, poor oral hygiene, and restoration size, significantly impact clinicians' decisions, often favoring replacement over repair. These findings underscore the necessity for evidence-based guidelines to assist clinicians in making informed choices, ultimately enhancing the quality of patient care.

The current attitudes and practices of dentists in Australia towards composite repair: A cross-sectional survey study

BACKGROUND

Whether to replace or repair a composite restoration is controversial and varies among clinicians. This study was designed to collect information on the attitudes and practices of Australian dentists towards composite repair.

METHODS

An electronic 16-item questionnaire was distributed online on Australian clinicians' dental forum with a URL address and instructions on completing the survey. The questionnaire remained accessible for 2 months. The data collected were analysed statistically using descriptive, average rank, Pearson chi-square and Kruskal-Wallis tests at α = 0.05.

RESULTS

Repair of composite restorations was a widely accepted treatment modality among surveyed dentists. Despite this, approximately half of clinicians reported the prognosis of repaired restorations to be worse when compared to replacement. The most cited indications for repair were partial loss or fracture of the restoration, while the most common reason for repair was because this treatment modality was more conservative in terms of tooth structure removal. Most important patient factor influencing decision to repair composite restoration was caries risk of the patient (n = 50). Most significant situational factor to consider in decision whether to repair was previous (failed) attempts to repair (n = 74). The most important tooth level factor was the proximity of restoration to pulp (mean statistic rank 2.22). The most common composite surface treatment employed by participants bonding to old composite was acid etching (n = 87), and the main reason participants employed their chosen surface treatment was based on personal experience (n = 72).

CONCLUSION

The repair of composite restorations was a commonly performed procedure that is well accepted but may still be viewed as an inferior treatment to replacement by many Australian dentists. Most dentists agreed on indications for repair restorations and surface conditioning techniques, but there was wide variation in opinions overall. Due to the lack of high-quality evidence regarding composite repair techniques, dentists tend to rely on personal experience to guide their clinical decisions.

Five-year survival of class II restorations with and without base bulk-fill composite: a retrospective cohort study

OBJECTIVE

This study aimed to determine the survival of class II composite restorations in premolars and molars with and without base bulk-fill composite in general dental practice.

MATERIALS AND METHODS

We collected data from the electronic patient files of the Public Dental Services in the City of Oulu, Finland. The timespan of data collection was from August 15th, 2002, to August 9th, 2018. The data consisted of class II composite restorations both with and without base bulk-fill composite. We compared the survival of these restorations using Kaplan-Meier survival curves, the log-rank test, survival rates, and the Wilcoxon signed ranks test.

RESULTS

We observed 297 restorations in 96 patients. The five-year survival rates for restorations with and without base bulk-fill composite were comparable in premolars (77.5% and 77.4%, respectively) but different in molars (69.9% and 57.8%, respectively, p = 0.069). In molars, the restorations with base bulk-fill composite exhibited a higher survival rate in 14 patients, whereas in 11 patients the restorations without base bulk-fill composites exhibited a higher survival rate. In 24 patients the survival rates were similar for restorations with and without the base bulk-fill composite (p = 0.246).

CONCLUSIONS

The restorations with and without base bulk-fill composite had similar longevity.

CLINICAL RELEVANCE

Base bulk-fill composites are safe to use in general practice due to their similar survival rates compared to conventional composites.

Repair versus replacement of defective direct dental restorations: A multinational cross-sectional study with meta-analysis

OBJECTIVES

When dental practitioners encounter a defective restoration, they are faced with a crucial decision whether to repair or replace it. This study aims to explore international preferences for repair procedures and the clinical steps taken during the repair process.

METHOD

An 11-question survey was distributed to dentists across 21 countries via different platforms. The survey comprised two sections: the first included five questions aimed at gathering demographic information, while the second consisted of six questions focusing on participants' practices related to the repair of composite or amalgam restorations A meta-analysis was employed to ascertain the pooled odds ratio of repairing versus replacement. The statistical analysis was carried out using the RevMan 5.3 program and forest plots were generated using the same program to visualize the results.

RESULTS

The survey was completed by 3680 dental practitioners. The results indicated a strong tendency to repair defective composite restorations (OR: 14.23; 95 % CI: 7.40, 27.35, p < 0.001). In terms of amalgam, there was a significant tendency to replace the restorations (OR: 0.19; 95 % CI: 0.12, 0.30, p < 0.001). When repairing restorations, the most common protocols were etching with orthophosphoric acid and creating an enamel bevel, regardless of the restorative material used.

CONCLUSION

The findings of this study indicate that there exists a knowledge gap among dental practitioners regarding restoration repair. It is imperative that dental practitioners receive proper education and training on restoration repair, to ensure the usage of adequate protocols and restoration survival.

CLINICAL SIGNIFICANCE

A significant portion of dental practitioners lack the necessary knowledge and education required for the repair of restorations. Therefore, it is imperative to establish guidelines aimed at enhancing the management of defective restorations, along with protocols for clinical interventions. This includes the incorporation of proper courses in undergraduate, graduate, and continuing education programs.

Repairability of aged dimethacrylate-free ORMOCER-based dental composite resins with different surface roughening methods and intermediate materials

STATEMENT OF PROBLEM

The repair of damaged composite resin restorations has been recommended as a conservative treatment option. However, a reliable protocol for repairing ORMOCER-based restorations is lacking.

PURPOSE

The purpose of this in vitro study was to investigate the effect of different surface roughening methods, repair composite resins, and intermediate materials on the repair bond strength of a dimethacrylate-free ORMOCER-based composite resin.

MATERIAL AND METHODS

Cylindrical composite resin specimens (Admira Fusion) were roughened by using hydrofluoric acid (HF) or a diamond rotary instrument. In both groups, 4 types of intermediate materials were used (Monobond-S, Clearfil SE bond [second bottle], Clearfil Universal bond, GC Composite Primer), and then half of the specimens were repaired with a similar composite resin, and the other half with dimethacrylate composite resin (Clearfil-APX). The specimens (n=20) were then subjected to repair bond strength and failure mode evaluation. The data were analyzed by using the Weibull test, 3-way and 1-way ANOVA, and the Tukey honestly significant difference (HSD) test (α=.05).

RESULTS

All variables, including the surface roughening method, intermediate material, and repair composite resin, had a significant effect on repair bond strength (P<.001). The lowest repair bond strength values were obtained in the group roughened with HF, prepared with Monobond-S, and repaired with Admira Fusion, and the highest values were obtained in the group roughened with a rotary instrument, prepared with GC Composite Primer, and repaired with Clearfil APX (P<.05). All experimental groups had a lower bond strength than the cohesive and control groups (P<.05). In all experimental groups, the predominant failure modes were adhesive and mixed.

CONCLUSIONS

The use of a diamond rotary instrument was a more reliable method of creating roughness, and different intermediate materials based on the clinical situation can be used to repair dimethacrylate-free ORMOCER-based composite resin with similar or different composite resins. However, in general, the highest repair bond strengths were achieved with Clearfil APX-repaired specimens.

EVIDENCE-PRACTICE GAP IN TREATMENT DECISIONS ABOUT DEFECTIVE COMPOSITE AND AMALGAM RESTORATIONS AMONG BRAZILIAN DENTISTS

Better understanding of dentists' decision-making about defective restorations is needed to close the evidence-practice gap (EPG). Aim: this study aimed to quantify the EPG about defective restorations and identify dentist factors associated with this EPG. Methods: 216 dentists from São Paulo State, Brazil, completed a questionnaire about three clinical case scenarios involving defective composite restorations with cementum-dentin margins (case 1) and enamel margins (case 2), and an amalgam (case 3) restoration. Dentists were asked what treatment, if any, they would recommend, including preventive treatment, polishing, re-surfacing, or repairing the restoration, or replacing the entire restoration. Replacing the entire restoration in any of these three scenarios was classified as inconsistent with the evidence, comprising an EPG. Bivariate analyses using Chi-square, ANOVA, or multiple comparison tests were performed (p<.05). Results: for defective composite restorations, 49% and 55% of dentists chose to replace the entire restoration for cases 1 and 2, respectively. Twenty-nine percent of dentists chose to replace the entire amalgam restoration. Dentists were significantly more likely to choose to replace the defective amalgam restoration than the composite restoration with a defect at the cementum-dentin margins or the enamel margins (both at p < .001). Female dentists were more likely to choose a conservative treatment than male dentists for cases 1 (p=.034) and 2 (p=.009). Dentists with a higher percentage of patients interested in individualized caries prevention were also more conservative in case 1 (p=.045). Conclusion: a substantial EPG regarding treatment decisions for defective restorations exists, especially for composite restorations. This study adds to the international evidence that an EPG exists in this clinical area and that global strategies need to be developed to close the gap.

Procedure time and filling quality for bulk-fill base and conventional incremental composite techniques-A randomised controlled in vitro trial

OBJECTIVES

The aims of this randomised controlled laboratory trial were to determine the procedure time and immediate quality (surface porosity and marginal gaps) of fillings placed using the bulk-fill base technique and the conventional incremental technique in simulated clinical settings.

METHODS

Forty-two dentists and dental students were randomly allocated to use either the bulk-fill base technique or the conventional incremental technique to fill an identical class II disto-occlusal cavity in a maxillary left first molar typodont tooth. We recorded the time the participants used to fill the cavity and evaluated the surface porosity and marginal gaps on the approximal surfaces of the fillings using a stereomicroscope and specific probes according to the FDI criteria for restoration evaluation. Data were analysed using the Mann-Whitney U, Kruskal-Wallis, and chi-square tests.

RESULTS

The median time ± interquartile range was 186 ± 80 s for the bulk-fill base technique and 463 ± 156 s for the conventional incremental technique (p < 0.001). The quality of the fillings was better for the bulk-fill base technique than for the conventional incremental technique (X2 = 9.5, p = 0.002). Neither operator experience nor the usual technique of choice were associated with the procedure time or the quality of the fillings.

CONCLUSIONS

Compared to the conventional incremental technique, the use of the bulk-fill base technique shortened the time to fill a cavity by 59.8 % or 4 min and 36 s, and it improved the immediate surface and marginal quality of the fillings, regardless of the operator's experience or technique preference.

CLINICAL SIGNIFICANCE

The use of the bulk-fill base technique instead of the conventional incremental technique leads to significant time-savings when placing large class II composite fillings. Additionally, the use of the bulk-fill base technique instead of the conventional incremental technique improves the immediate quality of large class II composite fillings.

Flexural Strength of Conventional or Bulk-fill Resin Composite Repaired with High- or Low-viscosity Restorative Materials

OBJECTIVE

To evaluate the flexural strength of two types of high-viscosity resin composites (conventional or bulk-fill) that were repaired with either high-viscosity composites (conventional or bulk-fill) or low-viscosity composites (conventional or bulk-fill) of the same manufacturer (3M Oral Care, St Paul, MN, USA).

METHODS AND MATERIALS

Specimens (25 mm × 2 mm × 2 mm) of both conventional nanofilled resin (Filtek Z350XT), and bulk-fill nanofilled resin (Filtek One Bulk Fill) were prepared. After fracture of the specimens in the 3-point bending test (initial), half of the specimens were repaired immediately afterwards (24 hours), and the other half were repaired after 6 months of storage in distilled water. Repairs were performed with (n=15) high-viscosity resin composites (Filtek Z350XT, Filtek One Bulk Fill), or their low-viscosity versions (Filtek Supreme XT Flow, Filtek Bulk Fill Flowable Restorative). The repair was performed by roughening the surface and applying phosphoric acid, silane, and adhesive. The bending test (results reported in MPa) was performed in a universal testing machine, and the fracture pattern was determined. Data were evaluated by generalized linear models, chi-square test and the Fisher exact test (α=0.05).

RESULTS

There was no significant difference between the former pair of high-viscosity resins in terms of initial flexural strength (p=0.42). The repairs performed with low-viscosity resin composites after 24 hours or 6 months obtained higher MPa values compared with those using high-viscosity composites (p=0.0006). There was a significant decrease in MPa values when the repair was performed after 24 hours and an increase after 6 months, regardless of the material (p<0.0001). After 6 months, fractures involving the old (conventional) resin were more frequent in the repair performed with bulk-fill resin composites compared with the conventional composites (p=0.02).

CONCLUSIONS

Considering the tested products, the material to be repaired did not influence the flexural strength of the repair composite; however, the use of the low-viscosity resin composites resulted in greater flexural strength of the repaired material. The repair of the aged composite resulted in an increase in its flexural strength, regardless of the material repaired or used to perform the repair.

Methods of Primary Clinical Prevention of Dental Caries in the Adult Patient: An Integrative Review

AIM

Preventive approaches to oral health diseases, mainly dental caries, require individual and collective policies. Thus, this review was conducted to identify the primary prevention methods of dental caries in adults to improve oral health at the clinical and community levels.

METHODS

This review followed the PICO strategy with the research question: "What are the methods of primary prevention of dental caries, in adults, for improving and maintaining oral health integrating clinical and community-based strategies?" Electronic screening was carried out by two independent reviewers in five databases (MedLine/PubMed, SciELO, Web of Science, Cochrane Library, and LILACS) to find relevant publications between 2015-2022. We applied eligibility criteria for selection of the articles. The following MeSH terms were used: "Primary Prevention"; "Adult"; "Oral Health"; "Dental Caries"; "Fluorides, Topical"; "Fluoride Varnishes"; "Pit and Fissure Sealants"; "Preventive Dentistry". Although the term "Prevention strategy" is not a MeSH descriptor, several correlated terms appeared and were used in the search engines: "Preventative Care", "Disease Prevention, Primary", and "Prevention, Primary". The tool provided by the JBI organization (Joanna Briggs Institute) was used to assess the quality of the included studies.

RESULTS

Nine studies were included. Overall, it was found that the main primary prevention methods applied in dentistry in adults are the application of pit and fissure sealants, topical application of fluoride performed in the dental clinic, use of fluoridated toothpaste, mouthwash with chlorhexidine at home, use of xylitol, the recommendation for regular appointments with the dentist, and the need to inform patients about the saliva buffer capacity and adoption of a non-cariogenic diet. For that purpose, preventive policies should be taken to prevent dental caries. These include three major challenges: providing the adult population with more knowledge regarding their oral health, empowering patients through adopting healthy lifestyles, and developing new preventive strategies and awareness campaigns aimed at the adult population to promote proper oral health habits.

CONCLUSIONS

A small number of studies were found whose participants were adult patients. There was some consistency regarding primary prevention methods in our studies. However, good quality randomized control studies are still required to define the best intervention strategies for adult caries prevention.

Direct restorations and enhanced caries prevention among 20- to 60-year-olds attending Helsinki City Public Dental Service - a register-based observation

OBJECTIVE

Our retrospective register-based observational study evaluated age-specific aspects and changes in volume and content of direct restorative procedures, pulp cappings and enhanced caries prevention measures given to adults.

METHODS

Data included all treatments provided for 20- to 60-year-olds visiting the Helsinki City Public Dental Service (PDS) in 2012 and 2017. For both years, the data were aggregated into 5-year age groups. Data included means of DMFT indices, number and size of direct restorations, number of specific codes for pulp cappings and enhanced prevention.

RESULTS

Around half of all patients received restorations, 39,820 (50.9%) in 2012 and 43,392 (45.9%) in 2017. The greatest increase in DMFT means by age cohort was found for the 2012 age cohort of 25- to 29-year-olds and the smallest for the 2012 age cohort of 45- to 49-year-olds. In each same-age group and each age cohort, the enhanced prevention in 2017 was less frequent than in 2012. The proportion of two-surface restorations accounted for 44.7% of procedures in 2012 and 45.9% in 2017, followed by an increasing proportion of one-surface restorations, from 28.3% in 2012 to 32.9% in 2017. Associations between restoration size and age group were highly significant (p < .001).

CONCLUSIONS

The volume of direct restorative procedures and enhanced prevention measures were strongly age-dependent. Restorative treatment procedures were more frequent in older age groups than in younger age groups, and vice versa for enhanced prevention and pulp cappings. The magnitude of restorative treatment decreased slowly from 2012 to 2017, and overall enhanced preventive treatment was limited.

How French dentists manage defective restorations: Evidence from ReCOL the French dental practice-based research network--A survey study

OBJECTIVES

The objective of this study was to describe the knowledge, opinions and practices about the defective restoration (DR) management of French general dental practitioners (GDPs).

METHODS

A cross-sectional, online survey-based study was carried out amongst 378 GDPs - members of the dental practice-based research network in France (ReCOL). Bivariate comparisons were made using Fisher's exact test to assess the association of the respondent characteristics (age, gender…) with the decision to repair DRs, and responses to clinical cases.

RESULTS

The response rate was 82.9%. 50.4% of the respondents declared they at least sometimes consider DRs repair in their clinical practice instead of DRs total replacement. For the 89.8% who at least rarely repaired DRs, the main characteristic determining the therapeutic strategy was the defect size (71%, mainly inclined to repair small defects), followed by the defect type (marginal defect or crack for more than 60% of the respondents) and the material of initial restoration (composite for 63.5%). When shown clinical photographs illustrating DRs, most of respondents proposed a replacement with inlay/onlay or crown.

CONCLUSIONS

This study indicates that a significant proportion of French GDPs do not make sufficient use of DR repair on a routine basis. A lack of knowledge of the concept seems to explain at least part of this situation. Collective and individual efforts from the profession are still needed to promote DR repair and therefore more often apply MinimalIntervention Dentistry.

CLINICAL SIGNIFICANCE

This survey shows that MID is not yet sufficiently used in routine practice in France regarding DR management. Further efforts (continuing education toward MID, public funding revaluation for MID strategies…) are needed to help GDPs to implement MID into everyday practice.

Effect of Different Surface Treatments on the Long-Term Repair Bond Strength of Aged Methacrylate-Based Resin Composite Restorations: A Systematic Review and Network Meta-analysis

This systematic review and network meta-analysis is aimed at investigating the effect of common surface treatments on the long-term repair bond strength of aged resin composite restorations and to rank and compare these surface treatments. In vitro studies evaluating the methacrylate-based resin composites subjected to rigorous aging protocols before and after being repaired with a new composite were included. A frequentist network meta-analysis was carried out using a random effects model. P scores were used to rank the efficacy of the surface treatments. Also, the global and node-split inconsistencies were evaluated. Web of Science, PubMed/Medline, Scopus, and Embase databases were searched until July 07, 2022. Twenty-six studies were included in the meta-analysis. The results showed that the application of silane and a total-etch (shear MD 32.35 MPa, 95% CI: 18.25 to 46.40, P score 0.95; tensile MD 33.25 MPa, 95% CI: 25.07 to 41.44; P score 0.77) or a self-etch (shear MD 38.87 MPa, 95% CI: 21.60 to 56.14, P score 0.99; tensile MD 32.52 MPa, 95% CI: 23.74 to 41.29; P score 0.73) adhesion protocol subsequent to the roughening with diamond bur produced the highest (micro)tensile and (micro)shear bond strengths compared to diamond bur alone as the control group. There was no difference between self- and total-etch adhesive protocols. Mechanical surface treatments yielded greater bond strength when used alongside the chemical adhesive agents. Further, it is possible to achieve acceptable repair bond strength using common dental clinic equipment. Therefore, clinicians could consider repairing old resin composites rather than replacing them.

Age-related variation in volume and content of restorative private dental care for adults in Finland in 2012-2017: A nationwide register-based observation

OBJECTIVES

This study assessed age-related variation in the volume and content of restorative dental care performed by private dentists for adults in Finland in 2012-2017.

METHODS

This retrospective register-based observational study utilized the Social Insurance database of private dental services in 2012 and 2017, including all patients. The data were aggregated into 5-year age groups for 20-89-year-olds; those aged 90+ formed one group. A patient was one who had received at least one treatment, and a restoration patient one who received at least one restoration (direct/indirect), excluding prosthetic crowns. Attendance rate was the proportion of the population treated. Volume of restorative treatment was the proportion of restoration patients among all patients using private dental services. Content of restorative treatment was described as the number of teeth receiving restoration and the size of restoration (number of surfaces restored). Correlation coefficient demonstrated associations between age groups and numbers of restorations.

RESULTS

Rate of restoration patients was 64.8 % in 2012 and 61.1 % in 2017, the rate for individuals aged under 80 years in each calendar year being smaller than in previous years. Mean number of restorations received per patient was 1.59 in 2012 and 1.42 in 2017, increasing with age (r = 0.85 in 2012; r = 0.95 in 2017). Small restorations dominated; one to two surfaces were covered in 72.3 % and 75.5 % of restorations in 2012 and 2017, respectively.

CONCLUSIONS

Volume and content of restorative dental care for adults vary by age and have decreased slightly over time.

CLINICAL SIGNIFICANCE

Restorative treatments are a prominent part of dental care for adults. This paper sheds light on the entity of restorative dental care for adults visiting private dentists. Variation in restoration volume and content is shown according to patient's age group, and changes are assessed across six years.

Type and time of first re-intervention of posterior restorations - 13-year scenario at the public dental service

Objectives: We investigated the first re-interventions of two- and three-surface direct restorations on posterior teeth, specifically noting the type and time of the first re-intervention.Materials and methods: In 2002, altogether 5542 posterior two- and three-surface composite and amalgam restorations were done for 3051 patients aged 25-30 years at Helsinki City Public Dental Service (PDS). Based on electronic patient records, we analysed all restorations (n = 2445) having re-intervention during a 13-year follow-up. We recorded the type of tooth, restoration size, and type of first re-intervention. The time to re-intervention was the interval between the date of the placement of restoration at the year 2002 and its first re-intervention.Results: Restorative treatment was the most common (77.9%) first re-intervention, followed by endodontics (11.5%), extractions (5.2%), and other (5.4%). Males, more frequently than females, had extraction or endodontics as first re-intervention. The average time to re-intervention was 5.7 years (SD 3.8; median 5.2). Both median and mean times were shortest for cases involving endodontics or extractions.Conclusions: For the majority of two- and three-surface posterior restorations, the first re-intervention is restorative (replacement or repair of restoration). The shortest time to re-intervention is for restorations that have endodontics or extraction as the first re-intervention.

METHODS FOR CARIES PREVENTION IN ADULTS AMONG DENTISTS FROM A BRAZILIAN COMMUNITY: Adult' caries prevention among Brazilian dentists

Little is known about dental practice patterns of caries prevention in adults among Brazilian dentists.

OBJECTIVE

To quantify procedures used for caries prevention for adult patients among dentists from a Brazilian community.

METHODS

Dentists (n=197) who reported that at least 10% of their patients are more than 18 years old participated in the first Brazilian study that used a translated version of the "Assessment of Caries Diagnosis and Caries Treatment" from the U.S. National Dental Practice-Based Research Network. A questionnaire about characteristics of their practice and patient population were also completed by the dentists. Generalized linear regression models and a hierarchal clustering procedure were used (p<0.05).

RESULTS

In-office fluoride application was the preventive method most often reported. The main predictors for recommending some preventive agent were: female dentist (dental sealant; in-office fluoride; non-prescription fluoride) and percentage of patients interested in caries prevention (dental sealant; in-office fluoride; non-prescription fluoride). Other predictors included private practice (dental sealant), percentage of patients 65 years or older (in-office fluoride), graduation from a private dental school (non-prescription fluoride), years since dental school graduation (chlorhexidine rinse) and using a preventive method (recommending sealant/fluoride/chlorhexidine rinse/sugarless, xylitol gum). Cluster analysis showed that dentists in the largest subgroup seldom used any of the preventive agents.

CONCLUSION

Dentists most often reported in-office fluoride as a method for caries prevention in adults. Some practitioner, practice and patients' characteristics were positively associated with more-frequent use of a preventive agent.

Impact of aesthetic component of dental health on the quality of life of young patients

Aim. To study the impact of the aesthetic component of dental health on the quality of life of young patients. Methods. 83 subjects with violation of the aesthetics of hard tissues of the anterior group of teeth were examined and treated. Assessment of stability of composite restorations with materials of Russian and foreign production was carried out according to Ryge criteria. A brief questionnaire (the world health organization quality of life WHOQOL-BREF) was used to assess the quality of life. Results. With the material Filtek Z550 violation of surface preservation occurred in 6 (15.8%) out of 38 men and only 1 (2.2%) out of 45 women (p=0.026). With Estelux NK material the violation of the seal surface preservation occurred in 5 (13.2%) out of 38 men and 2 (4.4%) out of 45 women, the findings are not statistically significant (p=0.15). The total index of quality of life in men and women significantly improved 6 months after the restoration and amounted to 88.7±5.4 points (p=0.024) and 88.4±7.3 (p=0.034), respectively, compared to test results prior to treatment. Stability of the quality of the restoration according to Ryge criteria of both photocomposite materials (Estelux NK and Filtek Z550) had no significant differences, therefore, the domestic material Estelux NK, taking into account its financial availability, can be recommended for aesthetic dental rehabilitation of young patients. Conclusion. Restoration of the aesthetic optimum of men and women of young age leads to a subjective improvement of psychological comfort and objective increase of self-perception indices.

Repair bond strength of nanohybrid composite resins with a universal adhesive

Objective: To investigate the repair bond strength of fresh and aged nanohybrid and hybrid composite resins using a universal adhesive (UA).

Materials and methods: Fresh and aged substrates were prepared using two nanohybrid (Venus Pearl, Heraus Kulzer; Filtek Supreme XTE, 3 M ESPE) and one hybrid (Z100, 3 M ESPE) composite resin, and randomly assigned to different surface treatments: (1) no treatment (control), (2) surface roughening with 320-grit (SR), (3) SR + UA (iBOND, Heraus Kulzer), (4) SR + Silane (Signum, Ceramic Bond I, Heraeus Kulzer) + UA, (5) SR + Sandblasting (CoJet, 3 M ESPE) + Silane + UA. After surface treatment, fresh composite resin was added to the substrates at 2 mm layer increments to a height of 5 mm, and light cured. Restored specimens were water-stored for 24 h and sectioned to obtain 1.0 × 1.0 mm beams (n = 12), and were either water-stored for 24 h at 37 °C, or water-stored for 24 h, and then thermocycled for 6000 cycles before microtensile bond strength (µTBS) testing. Data were analyzed with ANOVA and Tukey’s HSD tests (p = .05).

Results: Combined treatment of SR, sandblasting, silane and UA provided repair bond strength values comparable to the cohesive strength of each tested resin material (p < .05). Thermocycling significantly reduced the cohesive strength of the composite resins upto 65% (p < .05). Repair bond strengths of UA-treated groups were more stable under thermocycling.

Conclusions: Universal adhesive application is a reliable method for composite repair. Sandblasting and silane application slightly increases the repair strength for all substrate types.

Understanding the management and teaching of dental restoration repair: Systematic review and meta-analysis of surveys

OBJECTIVES

Repair instead of complete replacement is recommended to manage partially defective restorations. It is unclear if and why such treatment is taught at dental schools or practiced by dentists. We aimed to identify barriers and facilitators for repairs using a systematic review and meta- and qualitative analysis.

SOURCES

Electronic databases (PubMed, CENTRAL, Embase, PsycINFO) were searched.

STUDY SELECTION

Quantitative studies reporting on the proportion of (1) dentists stating to perform repairs, (2) dental schools teaching repairs, (3) failed restorations having been repaired were included. We also included qualitative studies on barriers/facilitators for repairs. Random-effects meta-analyses, meta-regression and a thematic analysis using the theoretical domains framework were conducted.

DATA

401 articles were assessed and 29, mainly quantitative, studies included. 7228 dentists and 276 dental schools had been surveyed, and treatment data of 30,172 restorations evaluated. The mean (95% CI) proportion of dentists stating to perform repairs was 71.5% (49.7-86.4%). 83.3% (73.6-90.0%) of dental schools taught repairs. 31.3% (26.3-36.7%) of failed restorations had been repaired. More recent studies reported significantly more dentists to repair restorations (p=0.004). Employment in public health practices and being the dentist who placed the original restoration were facilitators for repairs. Amalgam restorations were repaired less often, and financial aspects and regulations came as barriers.

CONCLUSIONS

While most dentists state to perform repairs and the vast majority of dental schools teach repairs, the proportion of truly repaired restorations was low. A number of interventions to implement repair in dental practice can be deduced from our findings.

CLINICAL SIGNIFICANCE

Partially defective restorations are common in dental practice. While repairs are taught and dentists are aware of the recommendation towards repairs, the actually performed proportion of repairs seems low.

Effect of curing and silanizing on composite repair bond strength using an improved micro-tensile test method

Objectives: To evaluate the micro-tensile repair bond strength between aged and new composite, using silane and adhesives that were cured or left uncured when new composite was placed.

Methods: Eighty Filtek Supreme XLT composite blocks and four control blocks were stored in water for two weeks and thermo-cycled. Sandpaper ground, etched and rinsed specimens were divided into two experimental groups: A, no further treatment and B, the surface was coated with bis-silane. Each group was divided into subgroups: (1) Adper Scotchbond Multi-Purpose, (2) Adper Scotchbond Multi-Purpose adhesive, (3) Adper Scotchbond Universal, (4) Clearfil SE Bond and (5) One Step Plus. For each adhesive group, the adhesive was (a) cured according to manufacturer’s instructions or (b) not cured before repair. The substrate blocks were repaired with Filtek Supreme XLT. After aging, they were serially sectioned, producing 1.1 × 1.1 mm square test rods. The rods were prepared for tensile testing and tensile strength calculated at fracture. Type of fracture was examined under microscope.

Results: Leaving the adhesive uncured prior to composite repair placement increased the mean tensile values statistically significant for all adhesives tested, with or without silane pretreatment. Silane surface treatment improved significantly (p < 0.001) tensile strength values for all adhesives, both for the cured and uncured groups. The mean strength of the control composite was higher than the strongest repair strength (p < 0.001).

Conclusions: Application of freshly made silane and a thin bonding layer, rendered higher tensile bond strength. Not curing the adhesive before composite placement increased the tensile bond strength.