Dental restorations for oral rehabilitation – testing of laboratory properties versus clinical performance for clinical decision making

The survival and clinical performance of anterior composite resin restorations and posterior indirect and cast restorations used to treat generalised tooth wear

Objective To evaluate the survival and clinical performance of restorative materials used in the rehabilitation of generalised severe tooth wear within a UK NHS postgraduate teaching hospital.Methods The clinical performance of 527 restorations on 20 patients with generalised severe tooth wear was reviewed after a mean period of five years. Anterior teeth were restored with direct composite resin and posterior teeth with indirect restorations. The study used the modified United States Public Health Service criteria for restoration assessment. Survival of the restorations was analysed using Kaplan-Meier survival curves, the log-rank test and the Cox proportional hazards regression analysis.Results The sample included 20 participants: 13 men and 7 women, with a median age of 51.8 years (range: 33-73 years). The median survival time for all restorations was 11.3 years when major failures were considered and 5.9 years for restorations when all types of failure were considered. A median survival time of 5.9 years for composite resin restorations and over seven years for cast restorations was found when considering all failures. Composite resin restorations commonly failed as a result of fracture, wear and marginal discolouration. Factors significantly influencing restoration survival were the material used, aetiology, incisal relationship and tooth location. The biological complications associated with this treatment regime were rare. Patient satisfaction remained generally high, with greatest dissatisfaction related to treatment time.Conclusions The use of anterior composite resin with posterior indirect restorations to treat generalised severe tooth wear is a viable treatment modality with very few major complications.

Clinical evaluation of lithium disilicate versus indirect resin composite partial posterior restorations - A 7.8-year retrospective study

OBJECTIVE

To evaluate retrospectively the longevity of lithium disilicate ceramic (LidiSi) vs. laboratory-processed resin-based composite (RBC) inlay/onlay/overlay restorations and risk factors associated with restoration deficiencies and failures.

METHODS

Patients (n = 91) receiving LidiSi (73.1%) and RBC (36.9%) inlays/onlays/overlays between 2007 and 2017 were selected. The restorations were evaluated using the modified U.S. Public Health Service criteria. The survival of the restorations was analyzed using the Kaplan-Meier method and log rank test. Factors affecting the occurrence of deficiencies were examined by logistic regression analysis. This was performed with the use of the Generalized Estimating Equation model including Repeated measurements (GEER), with the consideration that the same patient had several teeth in the sample. Risk estimation was conducted for each evaluated criterion (p < 0.05).

RESULTS

The survival of LidiSi and RBC restorations were 96.8% and 84.9%, respectively after a mean observation period of 7.8 ± 3.3 years. The annual failure rate was 0.2% for LidiSi and 1.0% for RBC. The probability of survival was above 98% for both restorations in the first 6 years, however, it dropped to 60% for RBC by the end of the 15th year. For both materials the reasons for failure included secondary caries, restoration fracture, and endodontic complication. In addition, LidiSi also failed due to tooth fracture, while RBC due to marginal gap formation and loss of retention. Among the evaluated risk factors, material of restoration (OR=6.8, CI95%:3.1-14.9), oral hygiene (OR=8.0, CI95%: 2.9-22.1], and bruxism (OR=1.9, CI95%: 1.1-3.3) showed a significant impact on the evaluated criteria.

SIGNIFICANCE

LidiSi and RBC restorations showed similarly excellent 6-year survival, however, in the long term significantly more failures should be expected for RBCs.

Dental Implant Treatment in Bruxers: A Case Report and Literature Review

This case report presents a literature review and a case report of a full-mouth implant rehabilitation for a 65-year-old woman with a history of Bruxism. The patient's oral condition showed dentition with severe occlusal wear, extensive dental work, and missing teeth replaced with bridges and implants. The existing dental work was failing due to recurrent caries and the mechanical failure of long-span bridges. The unique aspect of the treatment presented in this report is the management of existing osseointegrated implants of different systems with different platform designs, which adds to the treatment's complexity. The existing implants were incorporated into the planned treatment, and other implants were added to support maxillary zirconia and mandibular hybrid full-arch prostheses. After 2 years of function, extensive wear was evident on the milled acrylic, even though an occlusal guard was used. New acrylic teeth were processed using the same milled titanium bar of the mandibular hybrid prosthesis, and the occlusal surfaces of the acrylic teeth were protected with gold onlays. The patient is seen regularly for maintenance every 6 months with no further complications. Careful evaluation, planning, and treatment execution are paramount in managing patients with a history of bruxism. Patients should be prepared and informed about possible mechanical failure and seen regularly for maintenance.

A NARRATIVE REVIEW ON THE OVERLOOKED ASPECTS OF dPROs IN CONNECTION WITH DENTAL MATERIALS

OBJECTIVE

Dentists use a large number of dental materials to treat patients, mainly for pain relief, improved oral function, and orofacial appearance purposes. These materials supposably have been clinically tested and registered before launching onto the market. In terms of clinical testing, despite various objective and subjective assessments that could be done, the dentist-centred outcomes and regulatory body requirements might not fully reflect the perspective of the patient. Thus, dental-patient reported outcomes (dPROs) might be useful in providing valuable self-perceived feedback to stakeholders across a long period of time about the materials... performances.

METHODS AND RESULTS

This narrative review evaluated various assessment dPROs tools and their applications to contemporary dental materials, trying to link up basic materials science and biomechanics with the patients... reported outcomes.

CONCLUSIONS

dPROs can eventually form a basis of value-based dentistry for dental materials that would be of importance in terms of research, regulatory and safety.

Evaluation of the failure modes and load-bearing capacity of different surface-treated polyether ether ketone copings veneered with lithium di-silicate compared to polyether ether ketone copings veneered with composite: An in vitro study

Aims:

The purpose of this study is to compare and evaluate the failure modes and load-bearing capacity of different surface-treated polyether ether ketone (PEEK) copings when veneered with lithium di-silicate with that of PEEK veneered with composite.

Settings and Design:

In vitro; comparative study.

Materials and Methods:

Congruently anatomically shaped single unit PEEK copings (n = 40) were fabricated by scanning a prepared typodont tooth. The PEEK copings were subdivided among four groups (n = 10/group). Among all, one group of PEEK coping was veneered with Urethane dimethacrylate (UDMA)-based composite and other groups were veneered with lithium-di-silicate after different surface treatment on peek copings, i.e., (i) composite veneered PEEK fixed dental prosthesis (FDP) (control group: Group PC), (ii) lithium di-silicate veneered PEEK FDP (no surface treatment: Group PCeN), (iii) lithium di-silicate veneered PEEK FDP (sandblasting with 50 μm alumina: Group PCeS), and (iv) lithium di-silicate veneered PEEK FDP (chemical etching with 98% sulfuric acid: Group PCeE). The load-bearing capacity of all specimens was assessed using a universal test machine. All the samples were loaded till the cracking point and load at that point and failure modes were noted down.

Statistical Analysis Used:

One-way ANOVA and post hoc Tukey tests.

Results:

The highest load-bearing capacity was recorded for lithium di-silicate veneered PEEK copings which were chemically etched with 98% sulfuric acid (Group PCeE: 1040.25 ± 77.46) followed by Group PCeS (1017.20 ± 53.70), then Group PC (965 ± 51.57) and least was for Group PCeN (933 ± 97.54). There was a significant reduction in mean load-bearing capacity in Group PCeN (P < 0.05).

Conclusions:

Veneering of PEEK with pressed lithium di-silicate seems to be a viable clinical option in terms of adequate load-bearing capacity. Lithium di-silicate veneered PEEK FDPs were successful against physiological occlusal forces and are a suitable material for FDPs.

Influence of Ceramic and Substrate Types on the Microleakage of Aged Porcelain Laminate Veneers

Objective

To evaluate the effects of the type of ceramic, and the influence of the type of cervical substrate on the microleakage of aged Porcelain laminate veneers (PLVs).

Materials and Methods

A total of 48 sound human maxillary premolars were divided randomly into two groups (n=24), Group A: lithium disilicate PLVs; Group B: zirconia reinforced lithium silicate PLVs. The groups were further subdivided into four subgroups (n=12): (A1, B1): finishing line placed in Class V composite filling; (A2, B2): finishing line placed in sound enamel. In subgroups A1 and B1 standardized Class V cavities were prepared and restored with nanocomposite. Standardized PLVs tooth preparation was done for the specimens in all subgroups. Cementation of PLVs was done with a light cured resin cement and specimens were stored in distilled water for 2 weeks. Mechanical load cycling (45,000 cycle, 49 N at 2.5 Hz) and thermocycling procedure (500 cycles, 5–55°C) were done. A microleakage test was done with dye penetration (2% methylene blue) and the microleakage percentage was recorded and calculated using a stereomicroscope and ImageJ program.

Results

Means of microleakage percentage of the subgroups were: A1 (6.6075%), A2 (4.6058%), B1 (7.3158%), and B2 (6.105%), Two-way ANOVA showed a significant effect of ceramic type and cervical composite substrate. According to samples t-test, subgroup A2 was significantly lower than A1 and B2, while subgroup B2 was significantly lower than B1. A P-value≤0.05 was considered as statistically significant.

Conclusion

The type of ceramic and the type of substrate both affects PLV microleakage. Lithium disilicate PLVs had significantly lower microleakage compared to zirconia reinforced lithium silicate PLVs. Teeth with cervical composite substrate had a significantly higher microleakage compared to teeth with enamel substrate.

Fatigue behavior and damage modes of high performance poly-ether-ketone-ketone PEKK bilayered crowns

OBJECTIVES

To evaluate and compare the fatigue behavior (fatigue limit and fatigue life) and damage modes of high-performance poly-ether-ketone-ketone (PEKK), zirconia and alloy bilayered crowns.

MATERIALS AND METHODS

A total of 110 crowns (n = 50 for fatigue limit and n = 60 for fatigue life) were fabricated and used in this study. Pekkton® ivory discs, yttrium stabilized zirconia blanks and NiCr casting alloy were used to produce the respective PEKK, zirconia and alloy copings for crown fabrication. The prepared crowns were veneered with composite resin and subjected to fatigue tests. The fatigue limit was evaluated using the staircase method and the fatigue life of the samples was evaluated by subjecting the crowns to a load lower than the fatigue limit of that particular group, and also with an intermediate load of 522 N. A graphical plot was generated from the shape parameter (β) and life parameter (α) values obtained through the Weibull analysis method. Kruskal-Wallis and Mann-Whitney tests were applied to determine the significance differences in the recorded fracture mode between the study groups. The damage modes of the samples were assessed using Burke's classification.

RESULTS

The recorded fatigue limits of the groups were 442.8 ± 42.1 N, 608.7 ± 7.6 N, and 790.4 ± 29.2 N for zirconia, NiCr and PEKK, respectively. A significant difference in the fatigue limit of the groups was observed (p < 0.05). PEKK samples demonstrated the highest survival cycles of 1,170,000 and the lowest survival cycles was observed with zirconia samples at 100,000 under 522 N loading. The fracture modes in PEKK samples were largely distributed between code 1 and 2 whereas the fracture modes in NiCr group was distributed between code 1 and 4 and YZ crowns exhibited more of code 5 fractures. The difference in fracture modes among the groups was statistically significant (p < 0.05).

CONCLUSION

The PEKK group demonstrated better results compared to zirconia and NiCr based crowns. The PEKK group demonstrated high fatigue limit and survived the highest fatigue life cycles among the tested groups.

Clinical comparison of various esthetic restorative options for coronal build-up of primary anterior teeth

Background:

This study was designed to compare the clinical performance of composite, strip crowns, biological restoration, and composite with stainless steel band when used for the coronal build-up of anterior teeth.

Materials and Methods:

A total of 20 patients aged 3-6 years presenting with mutilated primary anterior teeth due to caries or trauma were selected for the study using randomized simple sampling. A total of 52 primary anterior teeth were randomly divided into four equal groups having 13 teeth in each group. Teeth in Group I were restored with composite, in Group II with strip crowns, in Group III with biologic restoration and with stainless steel band reinforced composite in group IV. The restorations were evaluated for color match, retention, surface texture, and anatomic form according to Ryge's Direct (US Public Health Service) evaluation criteria at baseline (immediate postoperative), after 48 h, 3, 6, and 9 months. The data obtained were statistically analyzed using Chi-square test, and level of significance, that is, P value was determined.

Results:

At baseline, none of the groups showed any color changes. Other than Group III all other groups showed highly significant changes (P < 0.05) in color after 3 months. Loss of retention was seen in both Groups I and IV after 3 months. After 6 months, retention loss was seen in all the groups except Group II, in which loss was seen after 9 months (P > 0.05). Deterioration in surface texture was exhibited maximum by restorations in Group IV followed by Group I at 3 months. Whereas, no surface changes were seen in Group II and III. Only Group I and IV showed discontinuity in anatomic form after 3 months. After 6 months, except in Group II, discontinuity in anatomic form was observed in all the groups. Discontinuity in anatomic form was seen in all the 4 groups after 9 months although the difference was not significant (P > 0.05).

Conclusion:

Biological restoration was found to be most satisfying esthetically owing to color compatibility with the patient's tooth. Thus, it has a great potential to be used as esthetic restorative option in primary anteriors.

Esthetic Prosthetic Restorations: Reliability and Effects on Antagonist Dentition

Recent advances in ceramics have greatly improved the functional and esthetic properties of restorative materials. New materials offer an esthetic and functional oral rehabilitation, however their impact on opposing teeth is not welldocumented. Peer-reviewed articles published till December 2014 were identified through Pubmed (Medline and Elsevier). Scientifically, there are several methods of measuring the wear process of natural dentition which enhances the comparison of the complicated results. This paper presents an overview of the newly used prosthetic materials and their implication on antagonist teeth or prostheses, especially emphasizing the behavior of zirconia restorations.

What constitutes an ideal dental restorative material?

Intense environmental concerns recently have prompted dentistry to evaluate the performance and environmental impact of existing restoration materials. Doing so entices us to explore the 'what if?' innovation in materials science to create more ideal restorative materials. Articulating a specification for our design and evaluation methods is proving to be more complicated than originally anticipated. Challenges exist not only in specifying how the material should be manipulated and perform clinically but also in understanding and incorporating implications of the skill of the operator placing the restoration, economic considerations, expectations patients have for their investment, cost-effectiveness, influences of the health care system on how and for whom restorations are to be placed, and global challenges that limit the types of materials available in different areas of the world. The quandary is to find ways to actively engage multiple stakeholders to agree on priorities and future actions to focus future directions on the creation of more ideal restorative materials that can be available throughout the world.

Dentists' restorative decision-making and implications for an 'amalgamless' profession. Part 1: a review

The Minamata Convention has agreed to a worldwide reduction and ultimate elimination in the production and use of mercury containing products. This will have implications for the practice of dentistry. Australian organizations' pronouncements on the issue are limited and research examining the Australian context dated. The restoration of teeth with direct materials has changed significantly since the 1980s. Up to this time amalgam was the material of choice for direct posterior restorations. Its properties and guidelines for placement were, and remain, well established. Resin composite has replaced amalgam as the material of choice in many clinical situations. Despite inherent clinical disadvantages compared to amalgam, there continues to be a shift toward greater use of resin composite. There is consensus worldwide that the restoration of posterior teeth using resin composite now exceeds that of amalgam. The reasons for this are reviewed in this article along with current evidence and commentary relating to direct restorative and evidence-based decision-making, minimally invasive approaches, and approaches to education. The implications for these in an 'amalgamless' profession are identified.

In vitro evaluation of the fracture resistance and microleakage of porcelain laminate veneers bonded to teeth with composite fillings after cyclic loading

PURPOSE

There is insufficient data regarding the durability of porcelain laminate veneers bonded to existing composite fillings. The aim of the present study was to evaluate the fracture resistance and microleakage of porcelain laminate veneers bonded to teeth with existing composite fillings.

MATERIALS AND METHODS

Thirty maxillary central incisors were divided into three groups (for each group, n=10): intact teeth (NP), teeth with class III composite fillings (C3) and teeth with class IV cavities (C4). Porcelain laminate veneers were made using IPS-Empress ceramic and bonded with Panavia F2 resin cement. The microleakage of all of the specimens was tested before and after cyclic loading (1 × 10⁶ cycles, 1.2 Hz). The fracture resistance values (N) were measured using a universal testing machine, and the mode of failure was also examined. The statistical analyses were performed using one-way ANOVA and Tukey post hoc tests (α=.05).

RESULTS

There was a significant difference in the mean microleakage of group C4 compared with group NT (P=.013). There was no significant difference in the fracture loads among the groups.

CONCLUSION

The microleakage and failure loads of porcelain laminate veneers bonded to intact teeth and teeth with standard class III composite fillings were not significantly different.

The zirconia ceramic: strengths and weaknesses

Metal ceramic restorations were considered the gold standard as reliable materials. Increasing demand for esthetics supported the commercialization of new metal free restorations. A growing demand is rising for zirconia prostheses. Peer-reviewed articles published till July 2013 were identified through a Medline (Pubmed and Elsevier). Emphasizing was made on zirconia properties and applications. Zirconia materials are able to withstand posterior physiologic loads. Although zirconia cores are considered as reliable materials, these restorations are not problem free.

Self-adhesive resin cements: a new perspective in luting technology

Many materials are available for the fabrication of indirect restorations such as, metal alloys, resin-based composites and ceramics. Resin cements have long been valued as luting agents for indirect restorations because of their high retentive strength, resistance to wear, and low solubility. However, one of the common discouraging factors regarding their chairside use is the need of multiple-steps (etching, drying, priming and luting) for bonding. Thus the current impetus is towards the use of self-adhesive cements that require no etching, priming or bonding agents to bond to the tooth surface. Their increased popularity can be judged by the commercial availability of more than a dozen self-adhesive resin products/brands, in a short span of time. This article reviews the composition, physical and biological properties, adhesion characteristics and clinical performance of self-adhesive (resin) cements.

CLINICAL RELEVANCE

Self-adhesive resin cements are dual-cured and adhere to tooth structure without the requirement of a separate etching step and application of an adhesive/bonding agent.

Priorities for future innovation, research, and advocacy in dental restorative materials

Innovations in materials science, both within and outside of dentistry, open opportunities for the development of exciting direct restorative materials. From rich dialog among experts from dental and non-dental academic institutions and industry, as well as those from policy, research funding, and professional organizations, we learned that capitalizing on these opportunities is multifactorial and far from straightforward. Beginning from the point when a restoration is needed, what materials, delivery systems, and skills are needed to best serve the most people throughout the world's widely varied economic and infrastructure systems? New research is a critical element in progress. Effective advocacy can influence funding and drives change in practice and policy. Here we articulate both research and advocacy priorities, with the intention of focusing the energy and expertise of our best scientists on making a difference, bringing new innovations to improve oral health.

Twenty years of research on mineral trioxide aggregate: a scientometric report

INTRODUCTION

Mineral trioxide aggregate (MTA) has been suggested for root-end filling, vital pulp therapy, apical plug, perforations repair, and root canal filling. Since the introduction of MTA in 1993, many studies about this material have been published. The aim of this survey was to illustrate statistical information about published articles in PubMed-index journals vis-à-vis the various aspects of this biomaterial.

MATERIAL AND METHODS

A PubMed search was performed to retrieve the relative articles from 1993 to August 2012. The data of each article including publication year, journal name, number of authors, first author name, affiliations and study design were recorded. Citation of each article till 2009 was obtained from Scopus and Google scholar databases. Data were analyzed to determine the related scientometric indicators.

RESULTS

In total, 1027 articles were found in PubMed-indexed journals which show considerable increase from 2 papers in 1993 to 139 in 2011. While ~62% of articles had no level of evidence, only ~5% could be classified as having the highest level of evidence (LOE1); however, the majority of LOE1 articles originated from Iran (~1%: n=10). Journal of Endodontics, as the top rank journal, published 31.7% of MTA related articles. The majority of articles were four-authored (19.6%). Most of the articles originated from USA (21.9%), Brazil (18.5%) and Iran (8.76%). The average number of citation for the top ten articles from Scopus was 231.

CONCLUSION

This data demonstrates that during the past two decades, research on this novel endodontic biomaterial had a rapid positive trend especially during the last 5 years. Further high-level evidence articles for the various clinical applications of MTA would result in superior clinical decision making and stronger scientific-based endodontic practice.

Predicting clinical biological responses to dental materials

OBJECTIVES

Methods used to measure and predict clinical biological responses to dental materials remain controversial, confusing, and to some extent, unsuccessful. The current paper reviews significant issues surrounding how we assess the biological safety of materials, with a historical summary and critical look at the biocompatibility literature. The review frames these issues from a U.S. perspective to some degree, but emphasizes their global nature and universal importance.

METHODS

The PubMed database and information from the U.S. Food and Drug Administration, International Standards Organization, and American National Standards Institute were searched for prominent literature addressing the definition of biocompatibility, types of biological tests employed, regulatory and standardization issues, and how biological tests are used together to establish the biological safety of materials. The search encompassed articles published in English from approximately 1965-2011. The review does not comprehensively review the literature, but highlights significant issues that confront the field.

RESULTS

Years ago, tests for biological safety sought to establish material inertness as the measure of safety, a criterion that is now deemed naive; the definition of biocompatibility has broadened along with the roles for materials in patient oral health care. Controversies persist about how in vitro or animal tests should be used to evaluate the biological safety of materials for clinical use. Controlled clinical trials remain the single best measure of the clinical response to materials, but even these tests have significant limitations and are less useful to identify mechanisms that shape material performance. Practice-based research networks and practitioner databases are emerging as important supplements to controlled clinical trials, but their final utility remains to be determined.

SIGNIFICANCE

Today we ask materials to play increasingly sophisticated structural and therapeutic roles in patient treatment. To accommodate these roles, strategies to assess, predict, and monitor material safety need to evolve. This evolution will be driven not only by researchers and manufacturers, but also by patients and practitioners, who want to use novel materials in new ways to treat oral disease.

Loading Standardization of Postendodontic Restorations In Vitro: Impact of Restorative Stage, Static Loading, and Dynamic Loading

Objective

The load capability of post-restored endodontically treated teeth (ETT) can be determined at different restorative stages. It was the aim of this study to compare the load capability of ETT at these stages.

Materials and Methods

Maxillary central incisors were divided into 4 groups (n=10) and endodontically treated. Specimens were restored with: (I) only glass fiber posts (GFP); (II) GFP and composite build-up with 2 mm ferrule; (III and IV) with additional adhesively luted all-ceramic crowns. Group (I) to (III) were statically loaded, and group (IV) was exposed to thermomechanical loading (TML) and subsequent static loading.

Results

The lowest median load level of 73 N was determined for group (I). The maximum median load value of 331 N was found for group (III). The comparison of Fmax [N] of group (I), (II) and (III) revealed significant differences between the groups (p&lt;0.001). The specimens of group (IV) failed at significantly lower load values (p&lt;0.005) as similarly restored specimens of group (III) which were only statically loaded. The stage of restoration and TML loading prior to static loading had a significant impact on fracture patterns (p=0.006).

Conclusion

Every additional restorative step torwards a final crown-restored ETT significantly increased the load capability. TML prior to load-to-fracture testing of the complete restorative complex, ie. post, core and crown, significantly decreased maximum load capability.

Restoration of posterior teeth in clinical practice: evidence base for choosing amalgam versus composite

This article reviews the current use of amalgam versus resin composite in posterior restorations and the evidence-base for choosing between these two treatment options. While much research has been published on the issue of the clinical use of amalgam versus resin composite, there are several issues that limit the true evidence-base on the subject. Furthermore, while the majority of published studies on posterior composites would seem to indicate equivalent clinical performance of resin composite to amalgam restorations, the studies that should be weighted much more heavily (randomized controlled trials) do not support the slant of the rest of the literature. As part of an evidence-based approach to private practice, clinicians need to be aware of the levels of evidence in the literature and need to properly inform patients of the true clinical outcomes that are associated with the use of amalgam versus resin composite for posterior restorations, so that patients are themselves making informed decisions about their dental care.

Rehabilitation of the worn dentition

The purpose of this review was to evaluate the literature on the rehabilitation of tooth wear, with some pertinent historical, epidemiological and aetiological aspects of tooth wear provided as background information. In historical skull material, extensive tooth wear, assumed to be the result of coarser diets, was found even in relatively young individuals. Such wear is seldom seen in current populations. Although many of the factors associated with extensive tooth wear in historical material are no longer present or prevalent, new risk factors have emerged. In the young individual, the literature points to a global rise in soft drink consumption as the most significant factor in the development of tooth wear through dental erosion. Among older individuals, lifestyle changes and chronic diseases that are controlled with medications that may, in turn, result in regurgitation and/or dry mouth, are possible reasons amongst others for the widespread clinical impression of an increasing prevalence of tooth wear. The aetiology of tooth wear is multifactorial and the role of bruxism is not known. Clinical controlled trials of restorative and prosthodontic approaches for the range of clinical conditions that wear can give rise to, are limited in number and quality. Equally, the striking lack of evidence regarding the long-term outcomes of treatment methods and materials calls for caution in clinical decision-making. Notwithstanding these observations, clinicians have provided and continue to provide rehabilitative strategies for managing their patients' worn dentitions that range traditionally from extensive prosthodontics to an increasing reliance on adhesive techniques.

Finnish dentists' perceptions of the longevity of direct dental restorations

OBJECTIVES

To evaluate Finnish dentists' perceptions of the longevity of direct dental restorations; to assess the possible impacts of dentists' characteristics on these perceptions; and to compare the present longevity estimates with those of recent European reports.

METHODS

A questionnaire to 592 general practitioners, systematically sampled from the Finnish Dental Association's membership list, was posted in April 2004 and data collection was finished by the end of June. The question "In general, what is your estimate for the mean age of restoration in permanent teeth?" pointed restorations: Class II and MOD composites and amalgam in a posterior tooth and Class III composites in an incisor. Dentists' gender, main work, and year of graduation served as background information. Of the 339 (57%) respondents, only public and private dentists were included; 11 were excluded. Three studies fulfilled the inclusion criteria for recent reports on restoration longevity. Statistical evaluation was by one-way ANOVA, with p=0.05 as the level of significance.

RESULTS

The mean of the estimates for all types of composite was 9.0 years (SD 3.6; 95% CI 8.6-9.3) and 18.7 years for amalgam (SD 7.3; 95% CI 18.0-19.5). Male dentists gave longer estimates than female dentists for posterior composites, but shorter estimates for amalgam. Compared to public dentists, private dentists gave longer estimates for posterior composites. All estimates were longer than those reported in the recent literature.

CONCLUSION

Dentists' perceptions of posterior composite longevity are significantly longer among males than among females and among private than public sector dentists, and exceed the median longevity reported in recent studies.