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Hatipoğlu Ö, Martins JFB, Karobari MI, Taha N, Aldhelai TA, Ayyad DM, Madfa AA, Martin-Biedma B, Fernandez R, Omarova BA, Yi LW, Alfirjani S, Lehmann A, Sugumaran S, Petridis X, Krmek SJ, Wahjuningrum DA, Iqbal A, Abidin IZ, Intriago DMG, Elhamouly Y, Palma PJ, Hatipoğlu FP. Repair versus Replacement of Defective Direct Dental Restorations: A Multinational Cross-sectional Study with Meta-Analysis. J Dent 2024:105096. [PMID: 38796090 DOI: 10.1016/j.jdent.2024.105096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/22/2024] [Accepted: 05/22/2024] [Indexed: 05/28/2024] Open
Abstract
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.
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Affiliation(s)
- Ömer Hatipoğlu
- Department of Restorative Dentistry, Nigde Omer Halisdemir University, Turkey.
| | | | - Mohmed Isaqali Karobari
- Dental Research Unit, Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu 600077, India.
| | - Nessrin Taha
- Department of Conservative Dentistry Jordan University of Science and Technology Irbid.
| | | | - Daoud M Ayyad
- Head of the Endodontics Department faculty of dentistry, AL-QUDS University.
| | - Ahmed A Madfa
- Department of Restorative Dental Science, Collage of Dentistry, University of Ha'il, Ha'il, Saudi Arabia.
| | | | - Rafael Fernandez
- Endodontist, associate professor from endodontic department at CES University, Medellín.
| | - Bakhyt A Omarova
- S. D. Asfendiyarov Kazakh National Medical University, Dentistry School, Departement of Therapeutic Dentistry. Kazakhstan, Almaty.
| | - Lim Wen Yi
- Department of Restorative Dentistry, National Dental Centre Singapore.
| | - Suha Alfirjani
- Department of Conservative Dentistry and Endodontics, University of Benghazi.
| | | | - Surendar Sugumaran
- Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hospitals Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India.
| | - Xenos Petridis
- Department of Endodontics, Section of Dental Pathology and Therapeutics, School of Dentistry, National and Kapodistrian University of Athens, Greece.
| | - Silvana Jukić Krmek
- Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb, Gundulićeva 5, 10000 Zagreb, Croatia.
| | | | - Azhar Iqbal
- Department of Operative Dentistry & Endodontics, Frontier Medical and Dental College, Abbottabad, Pakistan.
| | - Imran Zainal Abidin
- Department of Restorative Dentistry International Islamic University Malaysia.
| | | | - Yasmine Elhamouly
- Department of Pediatric and Community Dentistry Faculty of Dentistry, Pharos University in Alexandria, Egypt.
| | - Paulo Jorge Palma
- Center for Innovation and Research in Oral Sciences (CIROS), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal.
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da Silva Tagliaferro EP, Riley JL, Gilbert GH, da Silva SRC, Rosell FL, Junior AV, Gordan VV. EVIDENCE-PRACTICE GAP IN TREATMENT DECISIONS ABOUT DEFECTIVE COMPOSITE AND AMALGAM RESTORATIONS AMONG BRAZILIAN DENTISTS. BRAZILIAN JOURNAL OF ORAL SCIENCES 2023; 22:e231640. [PMID: 38077621 PMCID: PMC10702847 DOI: 10.20396/bjos.v22i00.8671640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024] Open
Abstract
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.
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Affiliation(s)
- Elaine Pereira da Silva Tagliaferro
- Department of Community Dentistry, São Paulo State University (Unesp), School of Dentistry, Araraquara, Rua Humaitá, 1680, Centro - 14801-903 - Araraquara, SP, Brazil
| | - Joseph L Riley
- University of Florida College of Dentistry, Director, Pain Clinical Research Unit, UF CTSI, South Atlantic Region, Dental Practice-based Research Network, Clinical and Translational Research Building (CTRB), Room 2227, 2004 Mowry Road, Box 100404, Gainesville, FL 32610-0404, The United States of America
| | - Gregg H Gilbert
- Department of Clinical & Community Sciences, Room SDB 109, School of Dentistry, University of Alabama at Birmingham, 1720 Second Avenue South, Birmingham, AL 35294-0007, The United States of America
| | - Silvio Rocha Correa da Silva
- Department of Community Dentistry, São Paulo State University (Unesp), School of Dentistry, Araraquara, Rua Humaitá, 1680, Centro - 14801-903 - Araraquara, SP, Brazil
| | - Fernanda Lopez Rosell
- Department of Community Dentistry, São Paulo State University (Unesp), School of Dentistry, Araraquara, Rua Humaitá, 1680, Centro - 14801-903 - Araraquara, SP, Brazil
| | - Aylton Valsecki Junior
- Department of Community Dentistry, São Paulo State University (Unesp), School of Dentistry, Araraquara, Rua Humaitá, 1680, Centro - 14801-903 - Araraquara, SP, Brazil
| | - Valeria Veiga Gordan
- University of Florida, College of Dentistry, Room D9-6 P.O. Box 100415, Gainesville, FL 32610-0415, The United States of America
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Spaveras A, Antoniadou M. Awareness of Students and Dentists on Sustainability Issues, Safety of Use and Disposal of Dental Amalgam. Dent J (Basel) 2023; 11:dj11010021. [PMID: 36661558 PMCID: PMC9857391 DOI: 10.3390/dj11010021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023] Open
Abstract
Among the pillars of sustainability in health care units is environmental protection. Although an EU-wide dental amalgam phase-out legislation exists, quantities of this material are still to be found in the market, dental offices or in the mouths of patients. The purpose of this study is to record the views of dentists and dental students in Greece regarding the use and safety of dental amalgam for people and the environment as well as their attitudes towards its restriction and disposal. MATERIALS AND METHODS Two different questionnaires, through Google forms, were filled by each group. Descriptive statistics were used to describe the variables. The chi-square test or the chi-square test with Yates correction was used to examine potential differences per group (p-value = 0.05). Overall, 564 people participated in this study; 462 (81.9%) dentists (N1) and 102 (18.1%) dental students (N2). RESULTS Both groups agreed that they no longer use dental amalgam often. Dentists (39.8%) and students (36.4%) consider amalgam to have a moderate burden on the environment. This answer differed significantly per year of profession and year of undergraduate studies, respectively, with dentists from 6-25 years in the profession and 4th-year students, being the least aware on the environmental footprint of dental amalgam. Further, professionals (70%) and students (60%) believe that dental amalgam has a hazardous impact on patient's health, at all or to a small extent. For staff health, dentists reported at a moderate degree dangerous impact (32.9%) while students (36.4%), respectively. The impact on patients and staff health, were found to differ significantly per region of practicing dentistry for both groups. Finally, there were suggestions made from both groups about the necessity of information sharing on amalgam and mercury safety and the impact on the environment at the level of professional organizations. CONCLUSIONS Students, younger dentists and those living in non-urban regions seem to be more sensitive to the environmental impact of amalgam use, disposal, and health of people. Environmental issues should be addressed thoroughly by professional organizations, enhancing relevant activities for all people involved.
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Mocquot C, Vergnes JN, Julien L, Volgenant C, de Soet H, Seux D, Muller-Bolla M, Kopperud SE, Staxrud F, Grosgogeat B, Doméjean S. How French dentists manage defective restorations: Evidence from ReCOL the French dental practice-based research network--A survey study. J Dent 2022; 125:104244. [PMID: 35914571 DOI: 10.1016/j.jdent.2022.104244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 10/16/2022] Open
Abstract
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.
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Affiliation(s)
- Caroline Mocquot
- Université Lyon 1, Université de Lyon1, UMR CNRS 5615, Laboratoire des Multimatériaux et Interfaces, Villeurbanne F-69622, France; Université Paris Cité, Faculté dentaire, Hôpital Rothschild, Assistance Publique-Hôpitaux de Paris, France
| | - Jean-Noël Vergnes
- CHU Toulouse, Service d'Odontologie, Toulouse, France; Université Paul Sabatier, UFR d'Odontologie, Toulouse, France; Division of Oral Health and Society, McGill University, Montreal, Quebec, Canada
| | | | - Catherine Volgenant
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands
| | - Hans de Soet
- Department of Preventive Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands
| | - Dominique Seux
- Université Lyon 1, Université de Lyon1, UMR CNRS 5615, Laboratoire des Multimatériaux et Interfaces, Villeurbanne F-69622, France
| | - Michèle Muller-Bolla
- UFR d'Odontologie, Service d'Odontologie pédiatrique, Université Côte d'Azur, CHUN, F-06357 Nice, UR4462-URB2i Université de Paris, Montrouge F-92120, France
| | | | - Frode Staxrud
- Nordic Institute of Dental Materials (NIOM), Oslo, Norway
| | - Brigitte Grosgogeat
- Université Lyon 1, Université de Lyon1, UMR CNRS 5615, Laboratoire des Multimatériaux et Interfaces, Villeurbanne F-69622, France; Univ Lyon, Université Claude Bernard Lyon 1, Faculté d'Odontologie, Lyon, France; Hospices civils de Lyon, Service d'Odontologie, Lyon, France
| | - Sophie Doméjean
- CHU Estaing, Service d'Odontologie, Clermont-Ferrand, France; Université Clermont Auvergne, UFR d'Odontologie, Clermont-Ferrand, France; Centre de Recherche en Odontologie Clinique EA 4847, Clermont-Ferrand, France.
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Kattan W, Urquhart O, Comnick C, McQuistan MR, Guzmán-Armstrong S, Kolker J, Teixeira EC. Repair versus replacement of defective direct restorations: A cross-sectional study among US dentists. J Am Dent Assoc 2021; 152:927-935. [PMID: 34489065 DOI: 10.1016/j.adaj.2021.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 05/06/2021] [Accepted: 05/24/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Repair increases the longevity of restorations and is well-accepted by patients. In this study, the authors assessed the acceptance of dental restoration repair by dentists and determined the main variables of repair versus replacement of defective restorations. METHODS A 15-item questionnaire was developed and distributed electronically to the American Dental Association Clinical Evaluators panel members (n = 785) during a 2-week period in 2019. Descriptive, bivariate, and multivariable analyses were conducted. RESULTS Of the 387 respondents, 83.7% stated that they repair defective restorations, and 16% stated that they always replace them. Reasons to forego a restoration repair among dentists who perform repairs included defect size and carious lesion extension (42%) and negative personal experience or lack of success (37.9%). However, the latter was considerably higher for dentists who do not perform repairs (60.7%). The most commonly cited patient-related reason and tooth condition to repair restorations were limited patient finances (67%) and noncarious marginal defects (86%), respectively. Neither sex nor age group was significantly associated with the practice of restoration repair (P = .925 and P = .369, respectively). However, sole proprietors were more likely to perform repairs than those in an employee, associate, or contractor practice setting (P = .008). The most significant reason to forego restoration was negative experience or lack of success (P = .002). CONCLUSIONS Restoration repair is considered a treatment option for managing defective restorations. Negative personal experience or lack of success and practice setting influenced the dentists' decision to repair or replace a defective restoration. PRACTICAL IMPLICATIONS Understanding dentists' clinical challenges and practice environment is necessary when advocating for this approach.
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Abstract
Purpose of Review Defective dental restorations are amongst the most common encounters in general dental practice. Replacement of defective restorations is often costly and commonly results in the sacrifice of sound tooth structure, thereby compromising the vitality of the dental pulp, potentially resulting in the acceleration of the restoration cycle and premature loss of the restored tooth. With advances in adhesive dentistry, ‘reparative dentistry’ is becoming an important area of minimally invasive dentistry. This article highlights the detrimental biological effects of restoration replacement and provides an overview of current knowledge and understanding of restoration repair as a safe and effective alternative approach to replacement. Recent Findings The literature reviewed showed that a growing body of evidence from clinical studies indicates that repaired restorations have similar survival outcomes in patients with low and medium caries risk compared to replaced restorations and are clinically acceptable over a 12-year follow-up of clinical service. Teeth with repaired restorations are less likely to require aggressive interventions such as endodontic treatment or extraction compared to those with replaced restorations. Summary Repair options should be carried out wherever possible as minimally interventional procedures in order to increase the longevity of the remaining part of the restoration and the restored tooth unit. Restoration replacement should be considered as the last resort when there are no other viable alternatives.
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Affiliation(s)
- Igor Robert Blum
- 1King's College Hospital & King's College London Dental Institute, Division of Primary Dental Care and Maurice Wohl Dental Centre, Department of Restorative Dentistry, University of London, Bessemer Road, Denmark Hill, London, SE5 9RS UK
| | - Mutlu Özcan
- 2Division of Dental Materials, Center for Dental and Oral Medicine, Clinic for Fixed and Removable Prosthodontics and Dental Materials Science, University of Zurich, Zurich, Switzerland
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Kanzow P, Wiegand A, Göstemeyer G, Schwendicke F. Understanding the management and teaching of dental restoration repair: Systematic review and meta-analysis of surveys. J Dent 2017; 69:1-21. [PMID: 28943362 DOI: 10.1016/j.jdent.2017.09.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 09/19/2017] [Accepted: 09/20/2017] [Indexed: 11/28/2022] Open
Abstract
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.
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Affiliation(s)
- Philipp Kanzow
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Germany; Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Germany.
| | - Annette Wiegand
- Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Germany
| | - Gerd Göstemeyer
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Germany
| | - Falk Schwendicke
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Germany
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