Criteria for the Replacement of Restorations: Academy of Operative Dentistry European Section

Multifactorial Contributors to the Longevity of Dental Restorations: An Integrated Review of Related Factors

PURPOSE

This integrated review aims to identify and analyze the multifactorial contributors to the longevity of direct restorations, focusing on tooth-, patient-, and dentist-related factors.

MATERIALS AND METHODS

A search of the literature was performed using an electronic database, PubMed/Medline, Web of Science, and Scopus, on papers published between 1980 and 2024. The titles and abstracts of papers that evaluated aspects categorized into tooth-related, patient-related, and dentist-related factors influencing restoration failure were selected and screened. Full-text assessments were conducted, and the extracted data were compiled, summarized, and synthesized. The reference lists of the collected papers were also screened, and relevant citations were included in this review. Data were gathered from clinical and laboratorial studies, systematic reviews, and meta-analyses to provide a comprehensive understanding of restoration longevity.

RESULTS

Among the tooth-related factors, multiple-surface restorations, deep margins, tooth location, and tooth vitality significantly impact restoration survival. Patient-related factors such as medical conditions, risk predictors of caries, age, sex, parafunctional habits, smoking, periodontal health, number of restorations, and socioeconomic status all play crucial roles. Regarding dentist-related factors, the decision-making process, age, experience, and dentist manual dexterity are vital aspects. Furthermore, the technique used, including isolation methods for moisture control, as well as the type of dental practice (large group vs. small practice), notably influenced the restoration survival.

CONCLUSIONS

The longevity of dental restorations is influenced by a complex interplay of tooth-related, patient-related, and dentist-related factors. Strategies to improve restoration outcomes should consider all these multifactorial contributors. Continuing professional education, diligent patient guidance on the factors that influence restoration survival, careful material selection and restorative technique, and tailored individual treatment are crucial factors to reduce failure rates and improve the lifespan of restorations.

Interdisciplinary Delphi study by PROSEC North America: Recommendations on single indirect restorations made from ceramic and nonmetallic biomaterials for posterior teeth

OBJECTIVE

This article puts forward consensus recommendations from PROSEC North America regarding single indirect restorations made from ceramic and nonmetallic biomaterials in posterior teeth.

OVERVIEW

The consensus process involved a multidisciplinary panel and three consensus workshops. A systematic literature review was conducted across five databases to gather evidence. The recommendations, informed by findings from systematic reviews and formulated based on a two-phase e-Delphi survey, emphasize a comprehensive treatment strategy that includes noninvasive measures alongside restorative interventions for managing dental caries and tooth wear. The recommendations advocate for selecting between direct and indirect restorations on a case-by-case basis, favoring inlays and onlays over crowns to align with minimally invasive dentistry principles. The recommendations highlight the critical role of selecting restorative biomaterials based on clinical performance, esthetic properties, and adherence to manufacturer guidelines. They emphasize the importance of precision in restorative procedures, including tooth preparation, impression taking, contamination control, and luting. Regular follow-up and maintenance tailored to individual patient needs are crucial for the longevity of ceramic and nonmetallic restorations.

CONCLUSIONS

These PROSEC recommendations provide a framework for dental practitioners to deliver high-quality restorative care, advocating for personalized treatment planning and minimally invasive approaches to optimize oral health outcomes.

CLINICAL SIGNIFICANCE

The PROSEC North America recommendations highlight the importance of minimally invasive techniques in posterior tooth restorations using ceramic and non-metallic biomaterials. These principles prioritize tooth structure conservation and personalized treatment planning, essential for enhancing clinical outcomes and long-term oral health.

Diagnostic Strategies for Restorations Management: A 70-Month RCT

We aimed to evaluate the impact of 2 visual diagnostic strategies for assessing secondary caries and managing permanent posterior restorations on long-term survival. We conducted a diagnostic cluster-randomized clinical trial with 2 parallel groups using different diagnostic strategies: (C+AS) based on caries assessment, marginal adaptation, and marginal staining aspects of the FDI (World Dental Federation) criteria and (C) based on caries assessment using the Caries Associated with Restorations or Sealants (CARS) criteria described by the International Caries Detection and Assessment System (ICDAS). The treatment for the restoration was conducted based on the decision made following the allocated diagnostic strategy. The restorations were then clinically reevaluated for up to 71 mo. The primary outcome was restoration failure (including tooth-level failure: pain, endodontic treatment, and extraction). Cox regression analyses with shared frailty were conducted in the intention-to-treat population, and hazard ratios (HRs) and 95% confidence intervals (95% CIs) were derived. We included 727 restorations from 185 participants and reassessed 502 (69.1%) restorations during follow-up. The evaluations occurred between 6 and 71 mo. At baseline, C led to almost 4 times fewer interventions compared with the C+AS strategy. A total of 371 restorations were assessed in the C group, from which 31 (8.4%) were repaired or replaced. In contrast, the C+AS group had 356 restorations assessed, from which 113 (31.7%) were repaired or replaced. During follow-up, 34 (9.2%) failures were detected in the restorations allocated to the C group and 30 (8.4%) allocated to the C+AS group in the intention-to-treat population, with no significant difference between the groups (HR = 0.83; 95% CI = 0.51 to 1.38; P = 0.435, C+AS as reference). In conclusion, a diagnostic strategy focusing on marginal defects results in more initial interventions but does not improve longevity over the caries-focused strategy, suggesting the need for more conservative approaches.

5.5-year-survival of CAD/CAM resin-based composite restorations in severe tooth wear patients

OBJECTIVES

Aim of this prospective study was to assess full mouth rehabilitation of severe tooth wear patients using minimally invasive CAD/CAM resin-based composite (RBC) restorations and direct veneers by evaluating restoration survival up to 5.5-years.

METHODS

Twenty-two patients with generalized severe tooth wear with functional and/or esthetic problems were included. Following minimally invasive preparation, CAD/CAM RBC restorations (LAVA Ultimate,3M) were adhesively luted, direct RBC veneers (Filtek Supreme XTE, 3M) were applied in the aesthetic region. Patients were recalled after 1m,1y,3y,5y and seen in between recalls by their general dentists or at the clinical study center if complaints occurred. Failures were categorized as F1 (severe deficiencies requiring replacement/extraction), F2 (localized deficiencies requiring re-cementation/repair) and F3 (small chippings requiring refurbishment/monitoring). Survival of indirect restorations was evaluated using lifetables and Kaplan-Meier-graphs, distinguishing between failure categories and tooth type (front teeth=FT, premolars=PM, molars=M). F1 + F2 and F1 + F2 + F3 failures were analyzed using Cox regression on the variables tooth type/ location, age, gender and VDO increase (p < 0.05).

RESULTS

568 indirect restorations and 200 direct veneers in 21 patients evaluated for up to 5.5-years. For indirect restorations, 96 failures were recorded (F1:6;F2:41;F3:49) and annual failure rates were 0.29%(FT), 1.56%(PM), 2.93%(M) for F1 +F2 and 0.53%(FT), 2.42%(PM), 6.11%(M) for F1 + F2 + F3. Reasons for failure were chipping fracture (48), adhesive fracture (32), complete debonding (7), caries (4), endodontic treatment (1) and reasons unknown (documentation general dentists, 4). Molar tooth type had a statistically significantly increased probability of failure compared with front teeth and premolars for F1 + F2 + F3 (p < 0.006). Direct veneer restorations showed 18 failures (F1:2;F2:9;F3:7).

SIGNIFICANCE

Minimally invasive CAD/CAM RBC restorations combined with direct RBC veneers showed an acceptable clinical mid-term survival for restorative rehabilitation of severely worn dentitions.

Organization for Caries Research-European Federation of Conservative Dentistry Consensus Report on Clinical Recommendations for Caries Diagnosis Paper II: Caries Lesion Activity and Progression Assessment

INTRODUCTION

This consensus paper provides recommendations for oral health professionals on why and how to assess caries activity and progression with special respect to the site of a lesion.

METHODS

An expert panel was nominated by the executive councils of the European Organization for Caries Research (ORCA) and the European Federation of Conservative Dentistry (EFCD). The steering committee built three working groups that were asked to provide recommendations on (1) caries detection and diagnostic methods, (2) caries activity and progression assessment, and (3) obtain individualized caries diagnoses. The experts of work group 2 phrased and agreed on provisional general and specific recommendations on caries lesion activity and progression, based on a review of the current literature. These recommendations were then discussed and refined in a consensus workshop followed by an anonymous Delphi survey to determine the agreement on each recommendation.

RESULTS

The expert panel agreed on general (n = 7) and specific recommendations (n = 6). The specific recommendations cover coronal caries on pits and fissures, smooth surfaces, proximal surfaces, as well as root caries and secondary caries/caries adjacent to restorations and sealants. 3/13 recommendations yielded perfect agreement.

CONCLUSION

The most suitable method for lesion activity assessment is the visual-tactile method. No single clinical characteristic is indicative of lesion activity; instead, lesion activity assessment is based on assessing and weighing several clinical signs. The recall intervals for visual and radiographic examination need to be adjusted to the presence of active caries lesions and recent caries progression rates. Modifications should be based on individual patient characteristics.

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.

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.

Compomers for the restorative treatment of dental caries in primary teeth: An umbrella review

OBJECTIVES

This umbrella review comprehensively appraised the evidence on the use of compomers in comparison to other dental filling materials for restorative treatment of decayed primary teeth.

DATA

The literature search was conducted based on the question: "Is the use of compomers as a dental filling material more successful in the restorative treatment of decayed primary teeth than other dental filling materials?" No language restriction was applied and systematic reviews published up to May 2023 were included. The ROBIS tool was used to assess the methodological quality of the included systematic reviews. Data were extracted for narrative synthesis, considering the restoration failure/success outcomes.

SEARCH

Online search was conducted in three databases (PubMed/Medline, Embase and Cochrane library).

STUDY SELECTION

The electronic search yielded a total of 779 publications. Finally, 18 systematic reviews were included in this umbrella review. Four systematic reviews presented a low risk of bias, 11 presented an unclear risk of bias and three presented a high risk of bias. Most systematic reviews presenting low risk of bias reported no difference in the success rates of compomers compared to other dental filling materials used for restoration of decayed primary teeth. Studies that found a significant difference or that made clear recommendations towards the use of compomers were commonly rated with a high risk of bias.

CONCLUSION

Compomers are similar to other dental filling materials for the placement of direct restorations in primary teeth.

CLINICAL SIGNIFICANCE

The results of this umbrella review indicate a similar clinical performance of compomers compared to other materials containing a resin component for direct restoration in primary teeth. Therefore, the choice of restorative material will depend on multiple factors, such as clinician's skills/preferences, patients' wishes, costs, and cavity type/location.

Revised FDI criteria for evaluating direct and indirect dental restorations-recommendations for its clinical use, interpretation, and reporting

OBJECTIVES

The FDI criteria for the evaluation of direct and indirect dental restorations were first published in 2007 and updated in 2010. Meanwhile, their scientific use increased steadily, but several questions from users justified some clarification and improvement of the living document.

MATERIALS AND METHODS

An expert panel (N = 10) initiated the revision and consensus process that included a kick-off workshop and multiple online meetings by using the Delphi method. During and after each round of discussion, all opinions were collected, and the aggregated summary was presented to the experts aiming to adjust the wording of the criteria as precisely as possible. Finally, the expert panel agreed on the revision.

RESULTS

Some categories were redefined, ambiguities were cleared, and the descriptions of all scores were harmonized to cross-link different clinical situations with possible management strategies: reviewing/monitoring (score 1-4), refurbishment/reseal (score 3), repair (score 4), and replacement (score 5). Functional properties (domain F: fracture of material and retention, marginal adaptation, proximal contact, form and contour, occlusion and wear) were now placed at the beginning followed by biological (domain B: caries at restoration margin, hard tissue defects, postoperative hypersensitivity) and aesthetic characteristics (domain A: surface luster and texture, marginal staining, color match).

CONCLUSION

The most frequently used eleven categories of the FDI criteria set were revised for better understanding and handling.

CLINICAL RELEVANCE

The improved description and structuring of the criteria may help to standardize the evaluation of direct and indirect restorations and may enhance their acceptance by researchers, teachers, and dental practitioners.

Management Thresholds for Molars With Occlusal Noncavitated Caries Lesions

AIM

There is sparse research on the effect of factors related to the dentist and patient in the caries management decision-making process. This in vitro study explored the influence of factors related to dentists and patients on the management decision of occlusal noncavitated caries lesions in children.

MATERIALS AND METHODS

Five investigators in the specialties of dental public health (DPH), paediatric, prosthetic, and operative dentistry and a general dentist (GDP) participated in this study. Initially, the investigators were asked to independently assess the occlusal surfaces of 175 noncavitated permanent molars and choose a management recommendation using 2 caries risk patients' scenarios. After 1 month, investigators were trained and calibrated to use the International Caries Detection and Assessment System (ICDAS) scoring system. Then, they examined the same teeth, recorded the highest/worst ICDAS score, and chose a management recommendation. Two weeks later, the investigators repeated the teeth examination using magnification loupes and again chose a management recommendation. The teeth were sectioned to study the relationship between the presence of caries and the management recommendations.

RESULTS

For the low- and the high-caries risk scenarios, ICDAS training increased the operative intervention by 20% to 27% and 14% to 22%, respectively, for both the GDP and the paediatric dentist (P < .0001). For the low-caries risk scenario, using the magnifying loupes increased the operative recommendations for the DPH, GDP, and the operative dentist by 5% to 23% (P < .05). Compared to the low-caries risk scenario, teeth for patients with high caries risk received more surgical interventions (9%-30%) at all examination conditions for the GDP and the paediatric and operative dentists (P < .0001).

CONCLUSIONS

For occlusal noncavitated caries lesions, enhancing dentists' caries detection skills had a significant impact on decisions of surgical intervention. This also influenced the appropriateness of the treatment recommended for the different caries risk groups.

Longevity of composite restorations is definitely not only about materials

OBJECTIVES

This review study provides an overview of factors that influence the longevity of all types of direct resin composite restorations.

METHODS

A systematic search was performed in PubMed, Scopus, and Web of Science databases for articles reporting data from primary longitudinal clinical studies on composite longevity published 2011-2021. Prospective or retrospective studies with restorations in permanent dentition, with follow-up periods of at least 5 years were included.

RESULTS

In total, 33 articles were included with different study designs, practice settings, datasets, countries of origin, and sample sizes. Annual failure rates of restorations ranged from 0.08% to 6.3%. Survival rates varied between 23% and 97.7%, success rates varied between 43.4% and 98.7%. Secondary caries, fractures, and esthetic compromise were main reasons for failures. Risk factors for reduced restoration durability included patient-level factors (e.g., caries risk, parafunctional habits, number of check-ups per year, socioeconomic status), dentist factors (different operators, operator's experience), and tooth/restoration factors (endodontic treatment, type of tooth, number of restored surfaces). Patient gender and the composite used generally did not influence durability.

SIGNIFICANCE

A number of risk factors are involved in the longevity of composite restorations. Differences between composites play a minor role in durability, assuming that materials and techniques are properly applied by dentists. Patient factors play a major role in longevity. The decision-making process implemented by dentists relative to the diagnosis of aging or failed restorations may also affect the longevity of restorations. Clinicians should treat patients comprehensively and promote a healthy lifestyle to ensure longevity.

Reframing perceptions in operative dentistry relating evidence-based dentistry and clinical decision making: a cross-sectional study among Jordanian dentists

BACKGROUND

The aim of the current study was to investigate current dental practice in operative dentistry in Jordan, and the relationship between evidence-based dentistry in caries research and decision making in clinical practice in operative dentistry.

MATERIALS AND METHODS

This cross-sectional study was conducted through a survey of dentists in Jordan. The survey aimed to explore the degree of knowledge and practice of evidence-based dentistry in caries research the dentists possess regarding clinical decision making in operative dentistry. The sample size was composed of (5811) dentists whom registered in Jordan Dental Association database. Descriptive statistics were generated and Chi-square test was used to examine associations between the different variables and the significance level was set at P < 0.05.

RESULTS

4000 responses were collected from the web-survey, response rate (68.83%). Nearly half of the surveyed dentists focus on the chief complaint of their patients (n = 2032, 50.8%) rather than doing full mouth assessment. Nearly two-thirds of dentists (n = 2608, 65.2%) treat lesions confined to enamel with operative treatment. Half of dentists use operative treatment when asked about the routine management of radiographically detected proximal caries confined to enamel. When treating incipient lesions, the majority (n = 3220, 80.5%) use preventive treatment. Three-quarters of dentists (n = 2992, 74.8%) treat deep dentinal caries by removing just the soft infected carious dentin, and treated old failed restorations with replacement.

CONCLUSION

In operative dentistry, the evidence-based research is not implemented clinically. To optimize relationship between evidence-based dentistry and clinical decision-making, dental curriculum has to be updated and modified constantly.

Repair of Dental Restorations: A 10-year Retrospective Analysis of Clinical Data

OBJECTIVES

This study collected and analyzed clinical data regarding the repair of dental restorations in patients treated in the clinics of a dental school over 10 years.

METHODS AND MATERIALS

Data related to repair procedures for permanent tooth restorations were extracted from the digital dental records system and filtered according to year (January 1, 2008, to December 31, 2017), age (<30, 30-60, >60), tooth group, and dental surfaces. Data were analyzed with descriptive statistics in terms of the absolute and relative frequency, and chi-square tests (95% confidence) were used to compare the frequency of repairs between years, age, tooth, and dental surfaces.

RESULTS

A total of 48,915 dental records were accessed by searching for general restorative procedures, of which 1,408 were repairs of dental restorations on permanent teeth. The number of repairs per year increased over the period assessed, and there was a significant increase in the years 2016 and 2017. Individuals aged between 30 and 60 years received the largest number of repairs, with significantly more repairs than the other groups. Regarding the tooth group and surface, the canines and the incisal and lingual surfaces received the least number of repairs.

CONCLUSIONS

The number of repairs increased over the study period. When comparing frequencies between groups, those belonging to the 30- to 60-years of age group received more repairs; the least repaired surfaces were the lingual and the incisal.

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.

The Diagnostic Relevance and Interfaces Covered by Mach Band Effect in Dentistry: An Analysis of the Literature

This work surveyed how the Mach band effect was mentioned in the dental literature and provided a qualitative assessment of diagnostic relevance and interfaces covered. PubMed, Scopus, and Google Scholar were queried in mid-Jan 2022. The search string was (“mach band effect” OR “mach effect”) AND (dental OR oral OR tooth OR teeth OR maxillofacial OR orofacial). All publications returned by the searches were screened. Exclusion criteria included irrelevance (e.g., dealing with “Mach effect” that was non-radiographic or non-dental) and not written in English. Reference lists of returned publications were manually searched to identify potentially missed papers. For each included publication, the following parameters were recorded: any presentation of radiographic images showing a Mach band effect, direct investigation of the effect, relevance to which structural interfaces, diagnostic relevance, and in which parts of the publication Mach band effect was mentioned. Seventy-seven publications were included and analyzed. The majority of the publications mentioned the Mach band effect in the Discussion section about its diagnostic relevance to caries detection at the enamel-dentinal junction and the interface between restorative material and tooth structure. Eight of them presented radiographic images showing a Mach band effect. Three of them investigated the Mach band effect. Dental publications seldom covered the Mach band effect. When they covered it, most of them only mentioned it in the Discussion section without actually investigating it.

Comparison of two clinical approaches based on visual criteria for secondary caries assessments and treatment decisions in permanent posterior teeth

Background

This cross-sectional study aimed to compare two clinical approaches based on visual criteria for secondary caries assessments and treatment decisions in permanent posterior teeth.

Methods

The two clinical visual criteria tested for the assessments of restored teeth were: FDI criteria—based on the caries presence, marginal adaptation and staining criteria, adapted from the FDI (International Dental Federation) criteria and CARS criteria—"Caries Associated with Restorations or Sealants" (CARS) criteria described by the International Caries Classification and Management System. Adults were randomized according to the criteria. One calibrated examiner assessed the restorations and assigned the treatment according to the criteria. The primary outcome was replacement indication.

Results

A total of 185 patients were included, totalling 718 restorations. The strongest correlation founded between the methods was for the presence of caries lesions (Rho = 0.829). A moderate correlation (Rho = 0.420) was founded between the treatment decisions proposed by the CARS and by the FDI criteria. The multilevel regression analysis showed that the FDI criteria indicated five times more replacements when compared to the CARS (< 0.001). Also, using the FDI criteria restorations were 2.7 times more related to caries around restorations (p < 0.001) compared to the other criterion.

Conclusions

The visual criteria used on the restoration's assessment directly influences the treatment decision to intervene or not on the restoration. The use of a minimally invasive based approach for assessing secondary caries may prevent overtreatment.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02112-6.

Survival analysis of crown margin repair: A retrospective study in a dental school setting

BACKGROUND

Repairing crowns with defective margins is minimally invasive and cost-effective compared with replacement. The authors' objectives were to examine the survival trajectory of crown margin repairs and to determine the factors associated with survival.

METHODS

Records of adult patients from January 2008 through August 2019 were reviewed for crown margin repairs completed at University of Iowa College of Dentistry. A total of 1,002 crown margin repairs were found. Each repair was followed through the end of study in 2019 or until an event (for example, additional repair, endodontic treatment, crown replacement, or extraction). A Cox proportional hazards model was used to study the relationship between selected covariates and time to event.

RESULTS

During the follow-up period, 32.8% of the repairs needed reintervention. In the final model, repair material was the only significant covariate. No difference was found between the survival of repairs done with resin-modified glass ionomer and amalgam. However, the repairs done with resin-based composite and conventional glass ionomer were more likely (1.5 times: 95% CI, 1.02 to 2.10 times; and 2 times: 95% CI, 1.40 to 2.73 times, respectively) to need reintervention than were those done with amalgam.

CONCLUSIONS

Median survival time of crown margin repairs was 5.1 years (95% CI, 4.48 to 5.72 years). Median survival times for amalgam, resin-modified glass ionomer, resin-based composite, and glass ionomer repair materials were 5.7 years (95% CI, 4.80 to 6.25 years), 5.3 years (95% CI, 4.73 to 6.34 years), 3.2 years (95% CI, 2.51 to 6.19 years), and 3.0 years (95% CI, 2.53 to 3.62 years), respectively.

PRACTICAL IMPLICATIONS

When considering crown margin repairs, resin-modified glass ionomer or amalgam is preferable to resin-based composite or glass ionomer.

Overtreatment in Restorative Dentistry: Decision Making by Last-Year Dental Students

To evaluate the tendency for overdiagnosis and overtreatment upon different clinical situations among last-year students from the degree in dentistry from Valencia University (Spain) during the 2018-2019 course. A questionnaire consisting of 10 case exemplifications examining the diagnosis, treatment, and clinician's attitude towards different common clinical situations regarding restorative dentistry was designed. Fifty-two students were surveyed, from whom 42 completed the questionnaire (80.77%). Data were analyzed descriptively. A total of 58.8% of the students correctly identified an early carious lesion in the occlusal surface of a molar, while 63.2% would perform unnecessary complementary tests for its diagnosis. The treatment for carious lesions in different evolutive phases with a vital pulp was correct between 51.2 and 92.7% of the cases. The treatment for irreversible pulp pathology and the restoration of the tooth with root canal treatment were adequately selected in 56.1% and 78.3% of the cases, respectively. For the repair of a faulty restoration, an overtreatment was proposed by 87.8% of the students. A tendency to perform unnecessary complementary tests for caries diagnosis was observed. Treatment caries proposals were in accordance with available evidence in the majority of the cases. Students tended to overtreat defective restorations and would perform unnecessary treatments in medically compromised patients.

Antimicrobial properties of dental cements modified with zein-coated magnesium oxide nanoparticles

The aim of this study was to test the antimicrobial properties of dental cements modified with magnesium oxide (MgO) nanoparticles. Zein-modified MgO nanoparticles (zMgO) in concentrations (0.0, 0.3, 0.5, and 1.0%) were mixed with dental cements (Fuji II, Rely X Temp E, Ionoglass Cem, Es Temp NE, and System P link). Eight discs were fabricated from each zMgO-cement pair for a total of 32 specimens for each cement. Characterization of the dental cements incorporating zMgO was done by X-ray Diffraction (XRD) and Field Emission Scanning Electron Microscopy (FESEM). The antimicrobial properties of the mixtures were tested using direct contact and agar diffusion assays against Streptococcus mutans, Staphylococcus aureus, Enterococcus faecalis, and Candida albicans. Data was analyzed using two-way analysis of variance and LSD post hoc test at 0.05 significance level. XRD spectra showed sharp peaks of zMgO indicating its high crystalline nature, while the amorphous dental cements with zMgO had broad peaks. FESEM analysis showed a uniform distribution of the zMgO nanoparticles in the cement. There were significant inhibition zone values associated with all concentrations of zMgO-cement mixtures tested compared to controls (p < 0.001) with a dose-response recorded only with Fuji II. Optical density values were significantly lower in zMgO groups compared to controls for all microorganisms. The effect was most prominent with Rely X against C. albicans and S. aureus. Dental cements containing zMgO showed significant antimicrobial properties that were dependent on the specific initial cement substrate.

•

Antimicrobial nanoparticles (NPs) are widely used in dental materials to improve their biological properties.

•

Magnesium Oxide (MgO) NPs are novel antimicrobial agents.

•

Incorporation of MgO NPs in dental cements aids in minimizing bacterial colonization at the restoration margin.

•

Zein polymer facilitates the dispersion of MgO NPs and avoid its agglomeration.

•

Zein polymer effectively enhances the performance of MgO NPs.

Needs for re-intervention on restored teeth in adults: a practice-based study

OBJECTIVES

Evaluate the need for re-intervention on dental coronal restorations in adults seen in a network of general dental practitioners (ReCOL).  MATERIALS AND METHODS: This observational, cross-sectional, multicenter study involved 40 practitioners and 400 patients. Coronal restoration failures (needing re-intervention for unsatisfactory outcomes) were assessed with a simplified rating scale of seven criteria from the FDI World Dental Federation. The oral health status, the risk factors, and Oral Health Impact Profile-14 were also examined. Previous restoration characteristics (extent, technique, material) were analyzed according to the need for re-intervention (yes/no), the age group, and the risk profile. Qualitative variables were compared between "re-intervention" and "no re-intervention" group using Fisher exact test.

RESULTS

The need for re-intervention was estimated at 74% (95% CI: 70; 79); it increased with age (49 to 90%), unfavorable risk profile (82 vs. 62%), and extent of the filling (32, 39, 44, and 44% on 1, 2, 3 surfaces, and crowns, respectively). More posterior than anterior teeth were restored (median per patient: 6 vs. 1) or needed re-intervention (median per patient: 1 vs. 0).

CONCLUSIONS

The needs for re-intervention in adults are still high within a context of ever-changing materials and techniques, simplified and rationalized decision-makings, and demands for patient involvement.

CLINICAL RELEVANCE

Meeting these needs requires the following: (i) consensus definitions and assessment methods for "failure" and (ii) reliable feedbacks on materials, procedures, and satisfaction. Building large and detailed databases fed by networks of motivated practitioners will help analyzing complex success/failure data by artificial intelligence and guiding treatment and research.

Study protocol for a diagnostic randomized clinical trial to evaluate the effect of the use of two clinical criteria in the assessment of caries lesions around restorations in adults: the Caries Cognition and Identification in Adults (CaCIA) trial

Background

The assessment of restored teeth in dentistry remains a challenge, mainly related to the detection of caries around restorations. There is a diversity of clinical criteria available to assess the caries lesions, resulting in differences in the dentists’ diagnosis and treatment decisions. In addition, there is a lack of evidence regarding the best criteria to detect caries lesions around the restorations. Thus, the present protocol aims to evaluate the effect of using 2 visual criteria to assess restored teeth on the outcomes related to oral health in adults.

Methods

The design protocol of the Caries Cognition and Identification in Adults trial correspond to a triple-blind randomized, controlled clinical trial with parallel-groups. Two groups will be compared: patients who will receive the diagnosis and treatment decision according to FDI (World Dental Federation) criteria—FDI group; and patients who will receive diagnosis and treatment decision according to the “Caries Associated with Restorations or Sealants” criteria defined by the International Caries Classification and Management System (ICCMS group). The participants will be followed up after 6, 12, 18, 24, and 60 months, and the restoration failure will be the primary outcome. The analysis will be conducted through Cox regression with shared frailty. The impact of oral health on quality of life and the cost-effectiveness of the methods used will be the secondary outcomes. Two-tailed analyzes will be used, considering a level of significance of 5%.

Discussion

This is the first clinical trial to assess the effect of using two visual methods to detect caries lesions around restorations on the outcomes related to oral health in adults. The findings of this study will define what is the best diagnostic strategy for the assessment of caries around restorations in permanent teeth.

Trial registration NCT03108586 (registered 11 April 2017).

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

CLINICAL SIGNIFICANCE

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

Does use of silane-containing universal adhesive eliminate the need for silane application in direct composite repair?

This in vitro study aimed to evaluate the effect of a silane-containing universal adhesive used with or without a silane agent on the repair bond strength between aged and new composites. Forty nanohybrid composite resin blocks were stored in distilled water for 14 d and thermo-cycled. Sandpaper ground, etched, and rinsed speciments were randomly assigned into four experimental groups: silane + two-step etch-and-rinse adhesive system, two-step etch-and-rinse adhesive system, silane + silane-containing universal adhesive system, and silane-containing universal adhesive system. Blocks were repaired using the same composite. After 24 h of water storage, the blocks were sectioned and bonded sticks were submitted to microtensile testing. Ten unaged, non-repaired composite blocks were used as a reference group to evaluate the cohesive strength of the composite. Two-way ANOVA and Tukey's tests were used to analyze average µTBS. One-way ANOVA and Dunnet post-hoc tests were used to compare the cohesive strength values and bond strength obtained in the repaired groups (α = 0.05). The µTBS values were higher for the silane-containing universal adhesive compared to the two-step etch-and-rinse adhesive system (p = 0.002). Silane application improved the repair bond strength (p = 0.03). The repair bond strength ranged from 39.3 to 65.8% of the cohesive strength of the reference group. Using universal silane-containing adhesive improved the repair bond strength of composite resin compared to two-step etch-and-rinse adhesive. However, it still required prior application of a silane agent for best direct composite resin repair outcomes.

Fluorescence-aided Composite Removal in Directly Restored Permanent Posterior Teeth

AIM

The aim of this study was to quantitatively compare conventional composite removal and composite removal supported by the fluorescence-aided identification technique (FIT) regarding the completeness, selectivity, and duration of the procedure in directly restored permanent posterior teeth.

METHODS AND MATERIALS

Two operators removed standardized direct class II composite restorations (n=32 per operator) in human tooth models under simulated clinical conditions. According to a randomized allocation scheme, removal was performed with either the conventional technique (contra-angle handpiece) or supported by FIT. The duration of each removal procedure was recorded. The completeness and selectivity were volumetrically assessed through superimposition of three-dimensional surface scans. Statistical significance was tested by examining the overlap of 95% confidence intervals (CI). Multiple comparison was performed with Tukey tests for each variable.

RESULTS

Compared with the conventional technique, composite removal with FIT was faster (329 seconds [95% confidence interval (CI): 268-390 seconds] vs 179 seconds [95% CI: 150-208 seconds]), generated less tooth substance loss (4.53 mm³ [95% CI: 3.77-5.30 mm³] vs 2.77 mm³ [95% CI: 2.11-3.43 mm³]), and left behind less composite residue (1.58 mm³ [95% CI: 1.23-1.94 mm³] vs 0.53 mm³ [95% CI: 0.39-0.67 mm³]).

CONCLUSION

Within the limitations of this in vitro study, FIT facilitated the selective and expeditious removal of tooth-colored composites in directly restored posterior teeth.

Impact of a diagnostic workshop on undergraduate teaching-learning process for the diagnosis and management of tooth restorations-A randomised controlled study

OBJECTIVE

The aim of this study was to investigate the impact of a diagnostic workshop on undergraduate teaching-learning process for the diagnosis and management of tooth restorations.

METHODS

The first stage of the study was a randomised controlled study with two parallel groups: lecture (L) and lecture coupled with a diagnostic workshop (LW). A pool of cases of tooth restorations including secondary caries and marginal defects was used for training. Theoretical knowledge, perception about the activity and practical abilities were evaluated. The second stage of the study assessed students' theoretical knowledge retention six months following intervention. All students included in the first stage of the study were exposed to LW. Hence, a new control group of students not exposed to LW was selected. One-way analysis of variance, Fisher's exact test, Kruskal-Wallis test and multilevel regression analysis were used as part of statistical analysis.

RESULTS

The LW group had greater scores for the assignment of lesion severity and activity, presence of marginal defect and treatment indication than the L group (P < 0.05). Multilevel regression analysis showed a positive impact of the workshop diagnosis in the correct assessment of lesion activity (P = 0.03). There was no statistical difference between the LW and L groups in students' perception of the activity. The LW group showed greater knowledge retention after six months than the L group (P = 0.027).

CONCLUSION

Lecture coupled with diagnostic workshop improved students' practical skills of diagnosis restorations and knowledge retention in the six months following intervention.

Repair increases the survival of failed primary teeth restorations in high-caries risk children: a university-based retrospective study

OBJECTIVES

We investigated factors associated with failure of adhesive restorations in primary teeth and whether repair may increase the survival of failed restorations placed in high-caries risk children.

MATERIALS AND METHODS

The sample comprised children who attended a university dental service to perform restorative treatment in primary teeth. Data were collected retrospectively from clinical records to assess the longevity of restorations. The outcomes were calculated in two levels: "Success" (Level 1)-when any re-intervention was considered as failure; "Survival" (Level 2)-when repaired restorations were considered clinically acceptable. The Kaplan-Meier survival test was used to analyze the longevity of restorations. Multivariate Cox regression with shared frailty was used to assess factors associated with failures (p < 0.05).

RESULTS

A total of 584 primary teeth restorations (178 patients) were included in the analysis. The longevity of restorations up to 36 months (Level 1) was 34.8% (AFR 29.6%). Multi-surface restorations showed significantly more failures than single-surface ones (HR 1.69; 95% CI 1.18, 2.41), and endodontically treated teeth presented more failures compared to vital teeth (HR 2.22; 95% CI 1.35, 3.65). There was an increase in restoration survival when repair was not considered as failure (p < 0.001). The survival of repaired restorations (Level 2) reached 43.7% (AFR 24.1%).

CONCLUSIONS

Adhesive restorations placed in primary teeth of high-caries risk children showed restricted longevity; however, the repair of failed restorations has increased its survival over time.

CLINICAL RELEVANCE

Repair is a more conservative and technically simple procedure that increases the survival of failed restorations in primary teeth.

Longevity of defective direct restorations treated by minimally invasive techniques or complete replacement in permanent teeth: A systematic review

OBJECTIVES

This systematic review aimed to verify if there is difference in the longevity of minimally invasive techniques compared to the complete replacement for the treatment of defective direct restorations in permanent teeth.

DATA

The data included randomized controlled clinical trials comparing the clinical performance of defective dental restorations treated by a complete replacement technique or minimally invasive techniques on permanent teeth. Evaluation of the risk of bias was performed using the Cochrane Collaboration common scheme for bias and the evidence was qualified using the GRADE tool.

SOURCE

A comprehensive search was performed in the electronic databases: PubMed, Scopus, ISI Web of Science, The Cochrane Library, LILACS, BBO, SIGLE, followed by manual search in the reference lists of the included studies, without any restrictions.

STUDY SELECTION

From 5554 retrieved studies, 10 met the eligibility criteria and were submitted to data extraction and quality assessment. The repair technique presented similar results to replacement and superior results when compared to sealing. In addition, refurbishment demonstrated to be a useful treatment for localized anatomical form defects. All the studies presented low risk of bias and high quality evidence for repair and refurbishment and moderate for the sealing technique.

CONCLUSIONS

The direct restorations treated by the repair, seal and refurbishment techniques did not present a significant difference in clinical longevity in comparison to the replacement technique in permanent teeth with overall moderate quality of evidence.

CLINICAL SIGNIFICANCE

The present findings demonstrated that the best treatment for defective restorations is conservative management. The evidence demonstrated here helps and encourages clinicians during the decision-making process. Moreover, it suggests not replacing imperfect restorations, but to managing them in a minimally invasive way, allowing the structure to be preserved.

Decision-making of general practitioners on interventions at restorations based on bitewing radiographs

OBJECTIVE

The aim of this study was to compare decision-making based on bitewing analysis of restored proximal surfaces by general dental practitioners (GDPs) with diagnossis and clinical decisions made by experts in cariology and restorative dentistry.

METHODS

This practice-based study used a database of 7 general dental practices. Posterior bitewing radiographs were selected from the electronic patient files of patients, and 770 cases of proximal restored surfaces were selected. Fifty percent of the cases which lead to the restorative decision, and the other half were cases decided for monitoring by the GDPs. Three experts performed radiographic assessment. The outcome variables were agreement of diagnosis and decision of treatment. Cohen's kappa statistic was used.

RESULTS

For the experts, moderate to substantial intraexaminer agreement was observed for the diagnostic criteria, and kappa values of 0.77, 0.79, and 0.88 were obtained for each expert regarding the treatment assignment. Agreement between GDPs and the majority of experts for secondary caries varied between 67 and 83%. One hundred seventy-three out of 385 cases that were treated by GDPs were decided for monitoring by the experts, while 8 cases that were decided for monitoring by the GDPs were decided for treatment. The agreement between experts and GDPs was moderate for secondary caries detection, and fair for treatment decision.

CONCLUSION

The GDPs tend to have a less conservative approach regarding the decision to intervene or not concerning the reassessment of restorations, showing moderate agreement with the experts for secondary caries detection and fair agreement regarding the treatment decision.

CLINICAL SIGNIFICANCE

This study highlights that GDPs tend to have a less conservative approach to the decision to intervene or not in posterior restorations, compared to experts in cariology and restorative dentistry. Efforts should be made to reduce these differences based on minimally invasive dentistry.

Should my composite restorations last forever? Why are they failing?

Composites resins have become the first choice for direct anterior and posterior restorations. The great popularity is related to their esthetic appearance and reduced need of sound tissue removal as compared with former treatments. Several studies have demonstrated that composite restorations may last long in clinical service. In this review we discuss the factors playing a role on the long-term longevity. Composite restorations have demonstrated a good clinical performance with annual failure rates varying from 1% to 3% in posterior teeth and 1% to 5% in anterior teeth. Factors related to the patients such as caries risk and occlusal stress risk, in addition to socioeconomic factors, may affect the survival significantly. Characteristics of the clinical operators, particularly their decision making when it comes to observing or approaching an existing restoration, are decisive for longevity. Cavity features such as the number of restored walls, composite volume, and presence of endodontic treatment are of major importance and may dictate the service time of the restorative approach. The choice of restorative composite seems to have a minor effect on longevity provided that appropriate technical procedures are used. The main reasons for failure in posterior teeth are secondary caries and fracture (restoration or tooth/restoration), while in anterior teeth esthetic concerns are the main reasons leading to restoration failures. Composite resin restorations can be considered a reliable treatment as long as both the professional and the patient are aware of the factors involved in restoration failures.

Periodontal Disease: Its Impact on Restorative Dentistry

A healthy periodontium provides stable gingival margins and stable tooth position prior to tooth preparations for indirect restorations. Good periodontal health allows easier tissue handling during tooth preparation, impression taking and restoration fitting. Periodontal health is integral to successful restorative care. This report documents common clinical scenarios in which periodontal problems cause aesthetic concern.