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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

A comparison between clinical and digital images with various resolutions to evaluate glass ionomer cement restoration on primary teeth

Introduction

Dental photography has increasingly been used in practice. One of the purposes of dental photography is for treatment evaluation. Notably, photo resolution affects a picture's quality. Glass ionomer cement (GIC) restorations are frequently used on pediatric teeth and must be evaluated periodically. In this digital era, digital photos can be used to evaluate restorations. The evaluation of restorations using FDI criteria is typically effective in clinical uses.

Objective

This study aims to compare differences in digital photo resolution and clinical results to evaluate GIC restoration in primary teeth.

Materials and methods

Forty mandibular primary first molars from 31 pediatric patients aged 4 to 9 years from Universitas Indonesia dental hospital were included in this study. All teeth were examined and clinically evaluated, and photos were taken using a DSLR camera with low resolution (8 MP), medium resolution (15 MP), and high resolution (32 MP). The photos were then evaluated. Clinical GIC restorations and digital photographs were evaluated using FDI criteria. All of the collected data were analyzed using a Pearson's chi-square categorical comparative test with a significance level of p < 0.05.

Result

Based on the comparative test, there were no statistically significant differences in the clinical groups with low resolution, medium resolution, and high resolution for evaluating GIC restorations in primary teeth.

Conclusion

Digital photography can be used to support the evaluation of restoration status. Digital photos can indicate the clinical state of GIC restorations. This study recommends using digital photos between low and medium resolution (8-15.3 MP) as media in dental practices to evaluate GIC restorations in primary teeth, comparable to smartphone cameras or pocket cameras.

Dental students' ability to judge the quality of composite restorations' exemplars depicted in photographs and their impact on preclinical skills

INTRODUCTION

Assessing exemplars as a formative activity is thought to promote students' learning. This study aimed to investigate dental students' ability to judge the quality of composite restorations' exemplars depicted in photographs and their impact on students' preclinical skills.

MATERIALS AND METHODS

In a non-randomised controlled crossover trial with two intervention arms, 92 undergraduates in their first preclinical course self-enrolled in into the intervention group (A1-INT) or control group (B1-CT). The intervention group assessed photographic images of composite restorations before restoring an ivorine premolar with composite while the control group restored the same tooth without assessing the photographic exemplars. Intervention and control groups were swapped 3 days later in a second iteration (B2-INT, A2-CT). Data were analysed in SPSS® version 27 using nonparametric tests.

RESULTS

Students who did not complete all activities in the study were excluded. Therefore, 57 out of the 92 student participants were included in the study analysis. No significant differences were observed between intervention and control groups' ability to assess quality of photographic exemplars or restoring a tooth in both iterations.

CONCLUSION

Students were able to identify the quality of composite restorations in photographic exemplars. It appears that assessing photographic exemplars did not have an immediate impact on students' ability to restore a tooth with composite.

Development of clinical criteria for the evaluation of indirect restorations

OBJECTIVE

To propose the development and validation of criteria for evaluating the clinical performance of indirect restorations, considering the variables related to the operator, material, and/or patient.

MATERIALS AND METHODS

The experimental design of this study was divided into three stages. Stage 1: development of the new criteria items by specialists in Prosthodontics. Step 2: creation of the criteria, named UERJ criteria, with the description of the parameters that indicate the quality of the restoration, the possible associated complications, and a detailed description of each classification. As well as the development of a form of variables. Step 3: validation of the UERJ criteria.

RESULTS

Cohen's Kappa statistic registered for both intra- and inter-examiner agreements a coefficient >0.91 with a p-value <0.0001. The validity of the UERJ criteria was evaluated by tests of sensitivity (0.96) and specificity (0.91) and had a satisfactory accuracy (92.7%), a positive (10.99), and negative (0.05) likelihood ratio and high values predictive variables, with positive (PPV) 0.84 (high specificity) and negative (VPN) 0.98 (high sensitivity), with a confidence interval of 95%.

CONCLUSION

The UERJ criteria is a valid instrument for evaluating the clinical performance of indirect restorations.

CLINICAL SIGNIFICANCE

The UERJ criteria, developed exclusively for the analysis of indirect restorations, elucidates the details necessary to identify the causes of failures and complications of these restorations.

Comparison between intraoral scanning and direct visual analysis for the assessment of developmental defects of enamel

OBJECTIVE

To compare direct visual analysis (DVA) and intraoral scanning (IOS) for the assessment of developmental defects of the enamel (DDE).

METHODS

Thirty-nine extracted permanent human teeth with DDE were selected by an experienced examiner and digitised using IOS. The scanning was recorded using the OBS Studio software parallel to the IOS software to obtain a coloured high-definition MP4 file of the process. Two other experienced, blinded, and calibrated examiners randomly analysed the same teeth through DVA and IOS. A third examiner resolved any disagreements between the two examiners. Descriptive statistics were used to analyse the frequencies of the scores. Cohen's kappa test was used to determine whether the DVA scores were different from those assigned using IOS. Spearman's test was used to verify non-random examiner errors. The Chi-square test was used to compare score frequencies. Statistical significance was set at p <0.05.

RESULTS

Scores indicating more severe and extended DDE (p <0.05) were more frequently assigned with IOS than with DVA (IOS: 25.64%, 25.64%, 38.46%, and 35.90% between one-third to two-third of the lingual, occlusal, mesial, and distal surfaces, respectively; vs. DVA: 10.26%, 7.69%, 15.38%, and 10.26% for the respective aforementioned tooth surfaces). Contrarily, 'no visible enamel defect' was significantly less assigned for IOS than for DVA (IOS: 15.38%, 43.59%, 35.90%, 15.38%, and 17.95% for buccal, lingual, occlusal, mesial, and distal surfaces, respectively; vs. DVA: 38.46%, 66.67%, 56.41%, 51.28%, and 43.59% for the respective aforementioned tooth surfaces). Kappa agreement ranged from fair to moderate when comparing DVA and IOS; the correlation between both methods was positive, indicating that the examiners assigned the scores properly and the differences arose from employing different methods.

CONCLUSION

The assessment of DDE differed depending on the method used. IOS scores indicated more severe and extended DDE than DVA scores. Clinical investigation is the next step in validating the use of IOS for DDE diagnosis.

CLINICAL SIGNIFICANCE

This study showed that DDE can be assessed differently using IOS. It is clinically relevant as it directly affects the determination of the severity of the defect and dental treatment planning.

Evaluation of the marginal adaptation and gingival status of full-crown restorations using an intraoral camera

Objective

The purpose of this study was to compare the usefulness of intraoral photographs, acquired with a household intraoral camera operating in conventional, calibrated, and polarized modes, with clinical examinations for assessing the marginal adaptation and gingival status of full-crown restorations.

Methods

Clinical examinations were performed by a prosthodontist who classified the marginal adaptation of full-crown restorations according to FDI World Dental Federation criteria, and a periodontal expert who classified gingival status according to the Modified Gingival Index (MGI). The margins and gingival status of the conventional, calibration, and polarization groups of full-crown restorations were independently assessed by three evaluators who obtained photographs using an intraoral camera. Cases where at least two of three assessors were in agreement were analyzed using Cohen’s kappa coefficient and the chi-square test, and the sensitivity and specificity were calculated.

Results

The conventional, calibration, and polarization groups differed significantly in marginal and gingival status of full-crown restorations. In the calibration group, there was good agreement between the camera-based and oral clinical examinations in terms of the gingival status of full-crown restorations (kappa = 0.945), with 100% sensitivity and 91.67% specificity; this was also the case in the polarization group with respect to the margins of full-crown restorations (kappa = 0.917, sensitivity = 97.22%, specificity = 94.44%).

Conclusions

An intraoral camera with black and white calibrated images is useful to assess the gingival status of full-crown restorations. Polarization mode can be used to assess the marginal adaptation of full-crown restorations. The camera is a feasible and valid diagnostic aid.

Evaluation of direct restorations using the revised FDI criteria: results from a reliability study

Objectives

The purpose of this in vitro reliability study was to determine the intra- and inter-examiner agreement of the revised FDI criteria including the categories “fracture of material and retention” (F1) and “caries at restoration margin” (B1).

Materials and methods

Forty-nine photographs of direct tooth-coloured posterior (n = 25) and anterior (n = 24) restorations with common deficiencies were included. Ten dental experts repeated the assessment in three blinded rounds. Later, the experts re-evaluated together all photographs and agreed on a reference standard. Statistical analysis included the calculation of Cohen’s (Cκ), Fleiss’ (Fκ), and weighted Kappa (wκ), the development of a logistic regression with a backward elimination model and Bland/Altman plots.

Results

Intra- and inter-examiner reliability exhibited mostly moderate to substantial Cκ, Fκ, and wκ values for posterior restorations (e.g. Intra: F1 Cκ = 0.57, wκ = 0.74; B1 Cκ = 0.57, wκ = 0.73/Inter F1 Fκ = 0.32, wκ = 0.53; B1 Fκ = 0.41, wκ = 0.64) and anterior restorations (e.g. Intra F1 Cκ = 0.63, wκ = 0.76; B1 Cκ = 0.48, wκ = 0.68/Inter F1 Fκ = 0.42, wκ = 0.57; B1 Fκ = 0.40, wκ = 0.51). Logistic regression analyses revealed significant differences between the evaluation rounds, examiners, categories, and tooth type. Both the intra- and inter-examiner reliability increased along with the evaluation rounds. The overall agreement was higher for anterior restorations compared to posterior restorations.

Conclusions

The overall reliability of the revised FDI criteria set was found to be moderate to substantial.

Clinical relevance

If properly trained, the revised FDI criteria set are a valid tool to evaluate direct and indirect restorations in a standardized way. However, training and calibration are needed to ensure reliable application.

Remote assessment of DMFT and number of implants with intraoral digital photography in an elderly patient population – a comparative study

Objectives

This comparative study aimed to evaluate intraoral digital photography (IODP) as assessment-tool for DMFT and number of implants (IMPL) compared to clinical diagnosis (CLIN) in an elderly population with high restorative status. Secondary research questions were whether an additional evaluation of panoramic radiographs (PAN-X) or raters’ clinical experience influence the agreement.

Methods

Fifty patients (70.98±7.60 years) were enrolled for standardized CLIN and IODP. The clinical reference examiner and ten blinded raters evaluated the photographs without and with a PAN-X regarding DMFT and IMPL. CLIN were used as reference standard and differences to IODP and IODP-PAN-X findings were analysed descriptively. To assess intra-rater agreement, pairwise Gwet’s AC1s of the three diagnostic methods CLIN, IODP and IODP+PAN-X were calculated.

Results

Compared to a DMFT of 22.10±3.75 (CLIN), blinded raters evaluated a DMFT of 21.54±3.40 (IODP) and 22.12±3.45 (IODP+PAN-X). Mean values for “Decayed” were 0.18±0.52 (CLIN), 0.45±0.46 (IODP) and 0.48±0.47 (IODP-PAN-X), while 11.02±5.97 (CLIN), 10.66±5.78 (IODP) and 10.93±5.91 (IODP+PAN-X) were determined for “Missing” and 10.90±5.61 (CLIN), 10.43±4.85 (IODP) and 10.71±5.11 (IODP+PAN-X) for “Filled”. IMPL were 0.78±2.04 (CLIN), 0.58±1.43 (IODP), 0.78±2.04 (IODP+PAN-X). Gwet’s AC1 using the mode of the blinded raters’ assessment of "Decayed", "Missing" and IMPL compared to CLIN ranged from 0.81 to 0.89 (IODP) and 0.87 to 1.00 (IODP+PAN-X), while for "Filled" and DMFT they were 0.29 and 0.36 (IODP) as well as 0.33 and 0.36 (IODP+PAN-X), respectively. Clinical experience did not influence the agreement.

Conclusions

Assessment of “Decayed”, “Missing” and IMPL by IODP showed almost perfect agreement, whereas of “Filled” and DMFT revealed fair to moderate agreement with clinical findings. Additional PAN-X-evaluation increased agreement compared to IODP-diagnostics alone. IODP for the assessment of DMFT and IMPL might be a suitable method in large-scale epidemiological studies, considering high agreement in total values and miscellaneous agreement at patient-level.

Clinical decision-making in anterior resin composite restorations: a multicenter evaluation

OBJECTIVE

This study investigated whether a sample of anterior resin composite restorations could be differently evaluated in different centers of evaluation by clinical and lay evaluators.

METHODS

Anterior resin composite restorations on high-quality intraoral digital photography were evaluated using FDI criteria (1-5 score) by pairs of clinical and lay evaluators in Brazil (BR), France (FR), Peru (PE), and the United States of America (USA). Scores were allocated as maintenance (1, 2, 3), repair (4) and replacement (5) when comparing clinical evaluators and, as acceptable (1, 2, 3) and unacceptable (4, 5) when comparing clinical vs. lay evaluators and lay vs. lay evaluators. The Chi-square test compared the frequencies of scores among the centers.

RESULTS

The frequencies of maintaining, repairing, or replacing anterior resin composite restorations given by clinical evaluators varied depending on the evaluation center. BR and PE showed the highest frequencies for repair and replacement, while FR and USA showed the highest frequencies for maintenance. The comparison of frequencies of anterior resin composite restorations accepted or unaccepted by the clinical vs lay evaluators in the same centers showed a significantly higher frequency of acceptable dental restorations coming from clinical evaluators. Comparison between lay evaluators from different centers showed significant higher frequency of unacceptable dental restorations by BR, compared to other centers.

CONCLUSIONS

In the evaluation of anterior resin composite restorations, the maintenance, repair, or replacement trends can vary among different centers. The unacceptable rate came more frequently from lay than from clinical evaluators. Lay evaluators from different centers differed significantly.

CLINICAL SIGNIFICANCE

Clinical and lay evaluators in distant evaluation centers can present different trends when assessing anterior resin composite restoration. Multicenter evaluations can help to understand such differences and it is important because clinical decision-making based on scientific evidence comes from clinical studies done in different research centers.

Radiopacity of resin-based CAD/CAM blocks assessed by areal grayscale pixel value measurement

PURPOSE

This study assessed radiopacity of resin-based computer-aided-design/computer-aided-manufacturing (CAD/CAM) materials by areal grayscale pixel value measurement.

METHODS

Radiopacities of six resin-based CAD/CAM block materials and resin composite were evaluated and compared to that of enamel and dentin. Specimens of 1-mm thickness were placed on photostimulable phosphor plate and irradiated with digital x-ray unit. On the radiographic image, regions of interests were determined for each specimen and areal grayscale pixel values were measured. Elemental analysis was performed with energy-dispersive x-ray spectroscopy (EDS) on field emission scanning electron microscope (FESEM) images of the specimens. Data were analyzed statistically (α = 0.05).

RESULTS

Radiopacity values of the restorative materials were significantly different from each other (P < 0.05). Radiopacity values of two resin-based CAD/CAM materials were significantly lower than that of dentin (P < 0.05). All tested restorative materials contain zirconium, three materials contain barium, and only resin composite contains lanthanum.

CONCLUSION

Four CAD/CAM materials with higher amounts of zirconia or barium (>18%) had radiopacity values significantly higher than the dentin; while two materials with lower amounts of zirconia (<4%) and/or no-barium, had radiopacity values significantly lower than the dentin. EDS analysis suggests materials containing elements with higher atom numbers such as zirconia and barium could exhibit higher radiopacity.

Prospective clinical evaluation of 765 partial glass-ceramic posterior restorations luted using photo-polymerized resin composite in conjunction with immediate dentin sealing

Objectives

To evaluate the clinical performance of partial glass-ceramic (IPS e.max Press) posterior restorations.

Materials and methods

A total of 765 restorations in 158 patients were placed between 2008 and 2018 and evaluated in a prospective study during regular dental care visits between 2015 and 2018. The restorations were luted with a conventional photo-polymerized resin composite (HFO) in conjunction with an Immediate Dentin Sealing procedure (IDS). Intra-oral photographs and radiographs were made and evaluated using USPHS criteria.

Results

The mean observation time was 53.3 months (range 3–113 months). Three absolute failures occurred (tooth fractures, n = 2; apical re-infection, n = 1) all leading to the loss of the restored tooth. Repairable and salvageable failures occurred in 9 teeth (endodontic complications, n = 7; secondary caries, n = 1; debonding, n = 1). The survival and success rates according to Kaplan-Meier after 5 years cumulated to 99.6% and 98.6%, respectively. Location (premolar/molar and mandibula/maxilla), pre-restorative endodontic status (vital/devitalised) and extension of the indirect ceramic restoration (number of sides and cusps involved) did not significantly affect the cumulative success rate (log rank test, p > 0.05). The condition of the vast majority of the restorations remained unaffected for 5 years.

Conclusions

Partial glass-ceramic posterior restorations (pressed lithium disilicate (IPS e.max press, Ivoclar Vivadent) luted by means of a conventional photo-polymerized resin composite in conjunction with the use of an IDS procedure have an excellent medium-term prognosis.

Clinical relevance

Partial glass-ceramic posterior restorations can be considered as a highly reliable treatment option. Location and extension of the restoration and pre-restorative endodontic status do not affect success rate.

Digital photography vs. clinical assessment of resin composite restorations

PURPOSE

To compare direct clinical and indirect digital photographic assessment of resin composite restorations. Ninety-two posterior resin composite restorations were classified using World Dental Federation (FDI) criteria by two different clinical examiners (C1 and C2). In the same appointment of clinical assessment, intraoral high-quality digital photographs were taken and posteriorly two different digital examiners (D1 and D2) classified the images of each restoration. Restorations of each patient were assessed once by C1 and C2 independently. D1 and D2 assessed the digital images from different locations and in different time. Data were analyzed using the Cohen's kappa coefficient, Kruskal-Wallis non-parametric test and Dunn's multiple shared test, with 95% confidence. Agreement levels varied from very good (0.81-1.00) to fair (0.21-0.40). Statistically significant differences (p < 0.05) between assessments were found for surface lustre, staining, color match and translucency, esthetic anatomical form, fracture of material and retention and marginal adaptation. The classification of the resin composite restorations varied significantly according to clinical or high-quality digital photographic assessments. Overall, clinical assessment detected more demand for repair or replacement.

Optical Evaluation of Enamel Microleakage with One-Step Self-Etch Adhesives

OBJECTIVE

In this in vitro study, cross-polarization optical coherence tomography (CP-OCT) was used to evaluate microleakage in dental composite restorations bonded to enamel with two types of one-step self-etching (SE) adhesives.

BACKGROUND DATA

One-step SE adhesives were proposed to simplify bonding of composite restorations. However, bonding of these simplified adhesive to dental enamel is still questionable. OCT is a promising diagnostic tool that allows micron-scale imaging of biological tissues and structures.

METHODS

Class-V cavities (4-mm diameter × 1-mm depth) were prepared on the labial surfaces of extracted human anterior teeth with margins and floor located in enamel. The cavities were then divided into two groups (n = 5) and restored with either Tetric N-Bond Universal (Ivoclar Vivadent, Liechtenstein) or Palfique Bond (Tokuyama Dental Corporation, Japan), followed by Estelite Flow Quick flowable composite (Tokuyama Dental Corporation). After storage in 100% humidity for 24 h, specimens were immersed in ammoniacal silver nitrate solution for another 24 h. Later, they were rinsed and immersed in photo-developing solution under fluorescent light for 8 h. CP-OCT at 1310 nm center wavelength was used to scan seven two-dimensional cross-sectional images from each specimen. Each cross-sectional image was analyzed using ImageJ software to quantify interfacial microleakage at the cavity floor.

RESULTS

Student's t-test showed significant difference between the tested adhesives (p < 0.05). Palfique Bond adhesive presented inferior interfacial adaptation as it obtained higher values of floor microleakage compared to Tetric N-Bond Universal adhesive group.

CONCLUSIONS

CP-OCT enabled nondestructive quantitative assessment of microleakage in enamel dental restorations.

Clinical Performance of Composite Restorations with Resin-modified Glass Ionomer Lining in Root Surface Carious Lesions

Objective: The purpose of this study was to evaluate the clinical performance of composite restorations in root surface carious lesions with or without resin-modified glass ionomer lining.

Methods and Materials: The sample consisted of 25 female and 14 male patients. A maximum of four lesions were included for each patient. After caries removal, the depth, length, and width of the cavity were measured. Lesions in the same patient were randomly divided into two groups, and the dentin surfaces were either lined with resin-modified glass ionomer liner (Glass Liner II) or left as they were. Self-etch adhesive (All Bond SE) was applied and cured for 20 seconds. All cavities were restored with nanohybrid anterior composite resin (Clearfil Majesty Esthetic). Two experienced clinicians evaluated the marginal adaptation (retention) rate, anatomic form, secondary caries, sensitivity, and marginal staining of restorations at the end of the first week and at six, 12, and 18 months posttreatment. The data were statistically analyzed using the Chi-square and two-way repeated measures tests.

Results: At the end of 18 months, a total of five lined and three unlined restorations were lost. There was no significant relationship between marginal adaptation and cavity lining at six, 12, and 18 months (p&gt;0.05). Although marginal stainings of restorations were mostly localized, the total number of localized or generalized discolored restorations increased with time (p&lt;0.001). There was a statistically significant relationship between marginal staining and smoking (p&gt;0.05). There was no significant relationship between marginal staining and frequency of toothbrushing at six, 12, and 18 months (p=0.286, p=0.098, and p=0.408, respectively).

Conclusion: Within the limitations of this study, both restorative applications were accepted as clinically appropriate.

Consistency and standardization of color in medical imaging: a consensus report

This article summarizes the consensus reached at the Summit on Color in Medical Imaging held at the Food and Drug Administration (FDA) on May 8-9, 2013, co-sponsored by the FDA and ICC (International Color Consortium). The purpose of the meeting was to gather information on how color is currently handled by medical imaging systems to identify areas where there is a need for improvement, to define objective requirements, and to facilitate consensus development of best practices. Participants were asked to identify areas of concern and unmet needs. This summary documents the topics that were discussed at the meeting and recommendations that were made by the participants. Key areas identified where improvements in color would provide immediate tangible benefits were those of digital microscopy, telemedicine, medical photography (particularly ophthalmic and dental photography), and display calibration. Work in these and other related areas has been started within several professional groups, including the creation of the ICC Medical Imaging Working Group.

Caries removal in deciduous teeth using an Er:YAG laser: a randomized split-mouth clinical trial

OBJECTIVES

The aim of the present clinical randomized split-mouth study was to evaluate the effectiveness and efficiency of an Er:YAG laser for caries removal in primary molars, microbiological dentin analysis, and clinical restorations after 1 year in 29 children.

MATERIALS AND METHODS

The children's teeth were randomized into two groups: (I) an Er:YAG laser group and (II) a bur preparation group. The efficiency of the treatments (the time necessary for the removal of carious tissue) was evaluated based on the time spent on caries removal in the deciduous molars. The effectiveness (caries removal capacity) of the caries removal was determined by means of a blind test in which the examiner performed a tactile and visual examination of the dentin. Microbiological analysis was performed by counting the Streptococcus mutans and Lactobacillus sp in the remaining dentin. Clinical analysis of restorations was performed using the USPHS method in combination with photographs of restored teeth, 7 days after the restorative procedure and again after 1 year. All cavities were restored with the Adper Single Bond 2/Filtek Z350 system. The obtained data were analyzed with a significance level of 5 %.

RESULTS

The Er:YAG laser was less effective and had the same efficacy as bur preparation during caries removal at the pulpal wall of deciduous molars. In the surrounding walls, bur preparation was the more effective method. Regardless of the method employed, the affected dentin in the pulpal wall had similar amounts of S. mutans and Lactobacillus sp. The restorations were clinically accepted by the USPHS method over a 1-year period.

CONCLUSION

It can be concluded that caries removal with an Er:YAG laser has no influence on the clinical behavior of restorations.

CLINICAL RELEVANCE

Irradiation with an Er:YAG laser is appropriate for caries removal in primary teeth.

Can repair increase the longevity of composite resins? Results of a 10-year clinical trial

OBJECTIVES

The aim of this double-blind clinical trial was to assess the longevity of repairs to localized clinical defects in composite resin restorations that were initially planned to be treated with a restoration replacement.

METHODS

Twenty-eight patients aged 18-80 years old with 50 composite resin restorations (CR) were recruited. The restorations with localized, marginal, anatomical deficiencies and/or secondary caries adjacent to CR that were "clinically judged" to be suitable for repair or replacement according to the USPHS criteria were randomly assigned to Repair (n=25) or Replacement (n=25) groups, and the quality of the restorations was scored according to the modified USPHS criteria. The restorations were blind and two examiners scored them at baseline (Cohen Kappa agreement score 0.74) and at ten years (Cohen Kappa agreement score 0.87) restorations. Wilcoxon tests were performed for comparisons within the same group (95% CI), and Friedman tests were utilized for multiple comparisons between the different years within each group.

RESULTS

Over the decade, the two groups behaved similarly on the parameters of marginal adaptation (MA) (p>0.05), secondary caries (SC) (p>0.05), anatomy (A) (p<0.05), and colour (C) (p>0.05).

CONCLUSIONS

Given that the MA, SC, A and C parameters behaved similarly in both groups, the repair of composite resins should be elected when clinically indicated, because it is a minimally invasive treatment that can consistently increase the longevity of restorations.

CLINICAL SIGNIFICANCE

The repair of defective composite resins as an alternative treatment to increase their longevity proved to be a safe and effective treatment in the long term.