'I didn't want to pass that on to my child, being afraid to go to the dentist': making sense of oral health through narratives of connectedness over the life course.

While previous sociological research on oral health has identified the relevance of personal relationships, there is more scope to analyse the mouth through a lens of connectedness. Recent qualitative interviews with 43 older people (65+) in England and Scotland found that participants constructed relational narratives to make sense of their oral health practices. By drawing on ideas of family practices, family display and personal life, we illustrate how the mouth can be understood relationally. Participants presented their own embodied experiences as connected to the actions of their parents. Narratives also reflected how, as parents and grandparents themselves, participants tried to shape the experiences of others. In this way, oral health practices were conceptualised as being about family. This can be seen in self-narratives that demonstrated how participants located themselves as embedded in webs of ongoing relationships. We highlight the importance of narrated practices of thinking and feeling, whereby participants imagined doing oral health, and indeed family, in different ways. We thereby demonstrate how oral health practices are constituted through family connectedness and at the same time how these practices contribute to the constitution of family. Policy should therefore pay attention to family relations when promoting improvements in oral health practices.

Oral care as a life course project: A qualitative grounded theory study.

OBJECTIVE: To report on a theory to explain the oral health of older people over the life course. BACKGROUND: The study of ageing has burgeoned into a complex interdisciplinary field of research, yet there are few studies in oral health from the perspective of older people that bridge the gap between sociology and oral health related research. METHODS: A grounded theory study involving a convenience sample of 15 men and 28 women aged between 65 and 91 years across different levels of education. Data were subjected to grounded theory analysis using QSR NVivo 11.0 and where relevant phenomenological theory. RESULTS: Participants conceived of oral care as a life course project that resulted from an active plan to keep one's teeth into older age. This involved accessing the social world of dentistry, holding appropriate values, understanding the associated personality types, social practices, goals and outcomes. The life course project is a social project supported by social institutions. It involves ideas about appropriate ageing including how oral health is to be managed at different stages in the life course. The degree to which individuals are able to participate in this project is determined by both individual and social factors. CONCLUSIONS: The theory explains why the loss of a single tooth might be experienced as traumatic but also why older people adapt to their changing oral health. Oral health in older age represented a lifetime's investment in oral care. Future health policies should consider this lifetime investment when considering care for older people.

Development and feasibility testing of an oral hygiene intervention for stroke unit care.

OBJECTIVE: To develop an oral hygiene complex intervention and evaluate its feasibility in a single UK stroke centre. BACKGROUND: Oral hygiene interventions might improve clinical outcomes after stroke but evidence-based practice is lacking. MATERIALS AND METHODS: We used a sequential mixed methods approach and developed an oral hygiene complex intervention comprising: (i) web-based education and 'hands-on' practical training for stroke unit nursing staff, (ii) a pragmatic oral hygiene protocol consisting of twice-daily powered (or manual if preferred) brushing with chlorhexidine gel (or non-foaming toothpaste) ± denture care. We evaluated feasibility of (i) the staff education and training and (ii) the oral hygiene protocol in consenting inpatients with confirmed stroke, requiring assistance with at least one aspect of personal care. RESULTS: The staff education and training were feasible, acceptable and raised knowledge and awareness. Several barriers to completing the education and training were identified. The oral hygiene protocol was feasible and well-tolerated. 22% of eligible patients screened declined participation in the study. Twenty-nine patients (median age = 78 year; National Institutes of Health Stroke Scale score = 8.5; 73% dentate) were recruited at a median of 7 days from stroke onset. 97% of participants chose the default chlorhexidine-based protocol; the remainder chose the non-foaming toothpaste-based protocol. The mouth hygiene protocol was administered as prescribed on 95% of occasions, over a median duration of 28 days. There were no adverse events attributed to the oral hygiene protocol. CONCLUSION: Our oral hygiene complex intervention was feasible in a single UK stroke centre. Further studies to optimise patient selection, model health economics and explore efficacy are now required.

Oral hygiene of hospitalised older patients with lower limb fracture.

INTRODUCTION: good oral hygiene is important for eating, talking and improved quality of life, and is part of basic patient care, but there are few observational studies in hospitalised older patients. The aim of this study is to investigate dental plaque load in older patients over time in hospital. METHODS: we examined the mouths of 93 patients with lower limb fracture prospectively at day 1, 7 and 14 after admission in a Newcastle upon Tyne Hospital. We assessed dental and denture plaque load, dry mouth symptoms and tooth number, along with demographic and frailty variables. We used univariate generalised linear modelling and mixed effects models to investigate associations between increased plaque and patient characteristics. RESULTS: in dentate patients, plaque score increased with time in hospital (P = 0.007, odds ratio (OR): 1.02; 95% confidence of interval (CI): 1.01-1.04). Frailty (P = 0.015, OR: 1.19; 95% CI: 1.04-1.37), dementia (P < 0.001, OR: 4.30; 95% CI: 2.03-9.12), residence in an institution (P < 0.001, OR: 4.61; 95% CI: 2.18-9.74), decreased mobility (P = 0.013, OR: 0.97; 95% CI: 0.96-0.99), but not Charlson comorbidity index (P = 0.102, OR: 1.08; 95% CI: 0.99-1.19), were associated with increased plaque scores at every time point. CONCLUSIONS: oral hygiene deteriorated in dentate patients in hospital. Plaque scores were significantly higher in patients who were more likely to be dependent on others for their oral hygiene.

Organisation, practice and experiences of mouth hygiene in stroke unit care: a mixed-methods study.

AIMS AND OBJECTIVES: To (1) investigate the organisation, provision and practice of oral care in typical UK stroke units; (2) explore stroke survivors', carers' and healthcare professionals' experiences and perceptions about the barriers and facilitators to receiving and undertaking oral care in stroke units. BACKGROUND: Cerebrovascular disease and oral health are major global health concerns. Little is known about the provision, challenges and practice of oral care in the stroke unit setting, and there are currently no evidence-based practice guidelines. DESIGN: Cross-sectional survey of 11 stroke units across Greater Manchester and descriptive qualitative study using focus groups and semi-structured interviews. METHODS: A self-report questionnaire was used to survey 11 stroke units in Greater Manchester. Data were then collected through two focus groups (n = 10) with healthcare professionals and five semi-structured interviews with stroke survivors and carers. Focus group and interview data were recorded, transcribed verbatim and analysed using framework approach. RESULTS: Eleven stroke units in Greater Manchester responded to the survey. Stroke survivors and carers identified a lack of oral care practice and enablement by healthcare professionals. Healthcare professionals identified a lack of formal training to conduct oral care for stroke patients, inconsistency in the delivery of oral care and no set protocols or use of formal oral assessment tools. CONCLUSION: Oral care post-stroke could be improved by increasing healthcare professionals' awareness, understanding and knowledge of the potential health benefits of oral care post-stroke. Further research is required to develop and evaluate the provision of oral care in stroke care to inform evidence-based education and practice. RELEVANCE TO CLINICAL PRACTICE: Development of staff training and education, and evidence-based oral care protocols may potentially benefit patient care and outcomes and be implemented widely across stroke care.

Developing pathways for oral care in elders: challenges in care for the dentate the subject?

OBJECTIVE: This paper reviews potential age-associated risk factors for satisfactory oral function and oral disease to inform the development of care pathways for the older person. BACKGROUND: Alterations in dental status or both physical and biological change associated with age can impact on oral disease and oral function. MATERIALS AND METHODS: Older people tend to have fewer teeth and some are edentulous. Physical and biological changes in bodily function with age can also affect oral health care either directly or indirectly. RESULTS: Reductions in chewing ability impact on the foods people choose to eat because of perceived difficulty with chewing, with a potentially deleterious affect on dietary quality. This is worse in people with xerostomia where chewing and swallowing are impaired anyway. Change in the cell-mediated inflammatory response impacts on gingival and periodontal disease manifestation and progression. Sarcopenia makes the physical act of toothbrushing more challenging. Caries remains a clinical problem that affects both the crowns and the roots of teeth. Coronal lesions tend to be around existing restorations where there is no evidence base about care/prevention. CONCLUSION: The physical and clinical changes that occur with ageing require an altered pattern of care for older people which is adjusted to their disease risk and encourage diversity of foods consumption.

The Seattle Care Pathway for securing oral health in older patients.

There is a need for a structured, evidence based approach to care for older dental patients. The following article describes the development of the Seattle Care Pathway based upon a workshop held in 2013. An overview is provided on the key issues of older persons dental care including the demography shift, the concept of frailty, the need for effective prevention and treatment to be linked to levels of dependency and the need for a varied and well educated work force. The pathway is presented in tabular form and further illustrated by the examples in the form of clinical scenarios. The pathway is an evidence based, pragmatic approach to care designed to be globally applicable but flexible enough to be adapted for local needs and circumstances. Research will be required to evaluate the pathways application to this important group of patients.

Cantilever FPDs have lower success rates than end abutted FPDs after 10-years of follow-up.

SELECTION CRITERIA: Studies were located using a MEDLINE search strategy for English-language articles published from 1966 to 2004. A systematic review of 13 studies of cohort design (no randomized control trials were available) with the majority being retrospective. Seven hundred subjects with an age range of 26 to 84-years with a total of 816 FPDs with cantilever extensions were selected. The mean number of cantilever extensions varied from 1 to 6. Prostheses were of mixed design with 72% gold/acrylic structures. There are no data on the number of abutments compared with pontics or the overall length of the prostheses in this analysis KEY STUDY FACTOR: Longitudinal follow-up of cantilever FPDs to failure or complication. All studies were required to have a mean minimum follow-up time of 5 years. MAIN OUTCOME MEASURE: Time to survival of the restorations, with secondary outcome measures of proportion of restoration successful at 10 years (success was defined as survival with no biological or mechanical complications) and time to biological (caries, loss of vitality and periodontal disease) and technical (loss of retention, abutment fracture, superstructure fracture) complication. MAIN RESULTS: The estimated aggregate proportion of cantilever FPDs surviving at 10 years was 81.8% (95% CI: 78.2-84.9%), with an annualized failure rate of 2 per 100 FPDs (95% CI: 1.63%-2.46%). Failure was not influenced by the number of cantilevered pontics or the material used for bridge construction in these data. The estimated aggregate proportion of cantilever FPDs successful (free of all complications) at 10 years was 63% (95% CI: 54.7%-70.2%). The estimated aggregate proportion with caries at one or more abutment teeth at 10 years was 9.1% (95% CI: 6.3%-13%). The estimated aggregate proportion with loss of vitality of one or more abutment teeth at 10 years was 32.6% (95% CI: 13.9%-64.9%). Rates of loss of vitality were much higher in the studies using extensive (12-unit FPDs supported by 2 cuspids) mandibular prostheses than those with shorter extensions. The estimated aggregate proportion with progression of periodontal disease leading to loss of the FPD at 10 years was 1% (95% CI: 0.3%-3%).The estimated aggregate proportion with loss of retention of the FPD at 10 years was 16.1% (95% CI: 8.8%-28.4%). Rates of loss of retention were much higher in the studies using extensive (12-unit FPDs supported by 2 cuspids) mandibular prostheses than those with shorter extensions. The estimated aggregate proportion with fracture of abutment teeth at 10 years was 2.4% (95% CI: 0.6%-9.8%). The estimated aggregate proportion with framework, veneer, or core fractures at 10 years was 5.9% (95% CI: 3.3%-10.4%). CONCLUSIONS: Estimated survival and success rates of cantilever FPDs were lower than previously reported rates for typical end-abutement supported FPDs; a 10-year failure rate of 18.2% had previously been reported for end-abutment supported FPDs for comparison.

Chapter 12: Nutrient Deficiencies and Oral Health.

Malnutrition can significantly affect oral health, and poor oral health in turn can result in malnutrition. This co-dependent relationship, therefore, relies on good nutritional health promoting good oral health and vice versa. A diet lacking nutrients can lead to disease progression of the oral cavity through altered tissue homeostasis, reduced resistance to microbial biofilm, and a decrease in tissue healing. It may also affect the development of the oral cavity. In the absence of contributing factors, health professionals should consider poor nutritional status with periodontitis, poor healing response to surgical procedures, or recurrent oral disease. This is particularly evident amongst elderly patients and patients in long-stay care. The role of nutrition in oral health and its effects on the immune system and inflammatory pathways has attracted a recent increase in research. This chapter will explore the oral manifestations that can occur with nutritional deficiencies, the association of periodontitis with nutritional deficiencies in vitamins C and D, and the effect of vitamin D deficiency and tooth development.

Patient satisfaction with two designs of implant supported removable overdentures; ball attachment and magnets.

OBJECTIVE: The aim of this study was to compare ball and magnet attachments within implant-supported mandibular overdentures (ISMOD) using patient centred outcome measures. Our a priori hypothesis was that there is no difference in patient satisfaction between the two attachment types. MATERIAL AND METHODS: In this within-subject crossover randomised clinical trial, edentulous patients were recruited to the study and completed a denture satisfaction questionnaire before having two implants placed in the intraforaminal region of the mandible. They were randomly assigned to receive an ISMOD retained by either ball or magnetic attachment. After 3 months satisfaction questionnaires were repeated before attachments were changed to the alternative design. After a further 3 months patients completed final questionnaires. Patients were asked to choose their preferred prostheses and record the most influential factors in their final choice. The outcome variables of patient satisfaction were compared between baseline and the two attachment types using non-parametric two-related sample tests (Wilcoxon's signed rank). RESULTS AND DISCUSSION: Sixteen patients completed the study. Patient satisfaction improved significantly between baseline and the new prosthesis with each attachment type for all domains of satisfaction (P<0.05). Ball attachments provided greater satisfaction in the domains of general satisfaction, stability and ability to chew (P<0.05). Patients' general satisfaction with ball attachment retained overdentures was greater than that for magnetic attachments; however, both designs provide significantly greater satisfaction than conventional dentures. In this study, the majority preferred to retain the ball attachment although one-third of patients actively chose the magnetic attachment.

Changes in oral health over a 10-yr period in Switzerland.

The Swiss Health Surveys are conducted every 5 yr, and alternate surveys contain information on oral health. Worldwide the population is ageing and oral health is improving. The aim of this study was to identify if these trends are continuing in a relatively affluent society with low levels of edentulousness. Participants in the 1992 and 2002 surveys completed a written questionnaire including items on oral health (response rates 75% and 86% respectively). Data were weighted and bivariate analyses were performed to calculate the average number of missing teeth and the prevalence of different prosthetic dental restorations for each cohort. Over the 10-yr period the proportion of subjects retaining all natural teeth increased, and the mean number of teeth increased, on average, by 1.3. Among those who required prosthetic dental restorations, fixed restorations increased and complete denture use was reduced. Strikingly, 4.4% of this sample reported having oral implants in 2002. Greater numbers of missing teeth and a higher prevalence of use of removable prostheses were still seen in women, in those who had only completed compulsory education, in subjects from families with low income, in those who smoke, and in those who were overweight, in 2002.

Association of salivary Streptococcus mutans levels determined by rapid detection system using monoclonal antibodies with prevalence of root surface caries.

PURPOSE: To examine the hypothesis that salivary Streptococcus mutans levels determined by a rapid detection system using monoclonal antibodies are associated with prevalence of root surface caries in a selected population of older adults. METHODS: Oral examinations were performed in 241 elderly people aged over 60 years with at least 10 teeth, and root surface caries were recorded. Populations of S. mutans in saliva were classified into three groups (Low: < 1 x 10(5) CFU/mL; Moderate: < or = 1 x 10(5) CFU/mL, < 1 x 10(6) CFU/mL; High: < or = 1 x 10(6) CFU/mL) using the analyzing kit with species-specific monoclonal antibodies. Stimulated whole saliva was collected; the flow rate and pH value were determined. RESULTS: About 38% of subjects had at least one decayed lesion (inactive, active, or secondary lesions). Subjects were grouped according to levels of S. mutans into Low (51.5%), Moderate (39.4%), and High (9.1%). Significant associations were observed between inactive, secondary, or total decayed lesions and salivary S. mutans levels by Kruskal-Wallis test (P < 0.05). Multiple ordinary regression analyses demonstrated that numbers of inactive, secondary, and total decayed lesions were significantly associated with S. mutans levels (P < 0.05) independent of age, gender, frequency of brushing, salivary flow rate, or pH value of saliva.

Bonding of adhesive resin luting agents to metal and amalgam.

The shear bond strength of three adhesives, Panavia 21, Superbond, All Bond C&B Cement, and a dual cure resin (Variolink), to Ni-Cr-Be (Rexillium III), Midigold (Type III gold) and Amalgam (Sybraloy) were determined. Fifteen samples were prepared using 800 grit abrasive papers for Ni-Cr and Midi-Gold, and 100 grit papers for amalgam. Ni-Cr-Be and Midi-Gold samples were sandblasted for 30 s and steam cleaned for 10 s. The adhesives were bonded to the samples using gelatine capsules and were matured for 24 h in water at 37 degrees C. The samples were debonded in shear using an Instron at a cross-head speed of 1 mm/min. The data was analysed using ANOVA and a Tukey test. The bond strength of Superbond to both metal alloys was significantly higher (P<0.05) than any of the materials tested, with the exception Panavia 21 to gold. The bond strength of All Bond C&B cement had shown to be not significant difference from those of Panavia 21 and Variolink, when bonded to Rexillium and Midi-Gold, respectively. The bond strength of All Bond C&B Cement to amalgam was significantly greater (P<0.05) than those of the other materials tested. The shear bond strength to gold showed lower bonding for all adhesives when compared with Rexillium (P<.001). The ranking of bond strength to both alloys was as follows: Superbond>Panavia 21>All Bond C&B>Variolink. The nature of substrate to be used for bonding and the adhesive material itself are important factors in bonding which can be achieved between cast metals and prepared teeth with amalgam filling. Superbond should be successful as an adhesive for the attachment of all substrates tested, with the possible exception of amalgam, for which All Bond C&B Cement gives the best result.

Bonding of crown and bridge adhesive resins to dentine.

The shear bond strength of three adhesives, Panavia 21, Superbond, All Bond C&B Cement, and Variolink (a dual cure resin) to various dentine depths were determined. Fifteen human fully erupted permanent first and second molars were wet ground using 500 and then 800 grit abrasive papers to expose the superficial, middle and the deep dentine, for each adhesive tested. Five samples were prepared for each dentine depth. The adhesives were bonded to the samples using gelatine capsules and were matured for 24 h in water at 37 degrees C. The samples were debonded in shear using tensile testing machine at a cross-head speed of 1 mm/min. The data were analysed using ANOVA and the Tukey test. The fracture surfaces were examined by optical microscopy. The bond strength of Superbond to dentine was significantly higher (P<0.05) than any of the materials tested. The bond strength of all materials tested was shown to be affected by dentine depth, except for Superbond. Fractured dentine specimens showed that the samples of Superbond are almost cohesive (>90%), and the samples of other adhesives are mostly adhesive (>70%). These results confirm that Superbond is capable of forming a bond at various dentine depths.

New frontiers in Dental Technology: An Overview.

The pace of technological advance across science is staggeringly fast. Our ability to translate some of the potential developments in technology into concepts/products/devices that can assist dentists in caring for patients is key to ensuring that both the profession and the people we care for derive full benefit from these new technologies. This overview will focus in four areas: research and how we gather and interpret data to inform health care; the diagnosis and prevention of disease; planning care; and new concepts in terms of achieving desired health outcomes for patients. Some of the technological advances will be in their infancy and others close to or indeed clinical reality. The objective of this overview is to show where we are in terms of the cutting edge of technology and to whet the appetite for things to come.

Quality of life and mastication in denture wearers and cleft lip and palate adults.

The impact of oral rehabilitation on masticatory function and oral health-related quality of life (OHRQoL) may vary with the experience of the individual with tissue loss. Our hypothesis is that patient-centered outcomes vary among adults who have experienced large defects in the maxilla due to congenital or acquired conditions even after oral rehabilitation to restore aesthetics and function. This study compared OHRQoL, perceived masticatory ability, maximum bite force (MBF), and symptoms of pain and depression among subjects with acquired (edentulous maxilla) and congenital (cleft lip and palate) loss of oral tissues in the maxilla after dental treatment. A gender-matched sample (n = 60) of cleft lip and palate (CLP), maxillary denture wearers (DENT) and controls (CONT) was recruited. OHRQoL was assessed using OHIP-14. Chewing was evaluated through a masticatory ability questionnaire and by MBF. The RDC/TMD Axis II questionnaire was used to assess symptoms of pain and depression. Data were analyzed by Fisher's test, Kruskal Wallis test, and Spearman correlation coefficients. CLP showed higher OHIP-14 and depression scores than DENT and CONT (p < 0.05). Sub-analysis by OHIP-14 items (%FOVO) showed higher prevalence of psychological impact for CLP and of functional impacts for DENT. The number of foods difficult to chew, of food textures difficult to chew, and avoided foods were similar between CLP and DENT. OHIP-14, MBF, and depression scores showed significant correlation (p < 0.05). The results suggest that adults with treated CLP or maxillary DENT have chewing impairment and lower MBF than healthy subjects, with different psychological and functional impacts.

Oral care after stroke: Where are we now?

PURPOSE: There appears to be an association between poor oral hygiene and increased risk of aspiration pneumonia - a leading cause of mortality post-stroke. We aim to synthesise what is known about oral care after stroke, identify knowledge gaps and outline priorities for research that will provide evidence to inform best practice. METHODS: A narrative review from a multidisciplinary perspective, drawing on evidence from systematic reviews, literature, expert and lay opinion to scrutinise current practice in oral care after a stroke and seek consensus on research priorities.Findings: Oral care tends to be of poor quality and delegated to the least qualified members of the caring team. Nursing staff often work in a pressured environment where other aspects of clinical care take priority. Guidelines that exist are based on weak evidence and lack detail about how best to provide oral care. DISCUSSION: Oral health after a stroke is important from a social as well as physical health perspective, yet tends to be neglected. Multidisciplinary research is needed to improve understanding of the complexities associated with delivering good oral care for stroke patients. Also to provide the evidence for practice that will improve wellbeing and may reduce risk of aspiration pneumonia and other serious sequelae. CONCLUSION: Although there is evidence of an association, there is only weak evidence about whether improving oral care reduces risk of pneumonia or mortality after a stroke. Clinically relevant, feasible, cost-effective, evidence-based oral care interventions to improve patient outcomes in stroke care are urgently needed.

Dentin decontamination using chloramine T prior to experiments involving bacteria.

OBJECTIVES: This study aims to investigate the importance of ISO11405 recommended storage regime for extracted teeth in surface disinfectant chloramine T (chlT) prior to use in biofilm or in vitro caries studies involving microorganisms. ChlT may be absorbed into dentin and undergoes breakdown with organic material. METHODS: Extracted roots were stored in chlT (2 days), rinsed and transferred to distilled deionised water. HPLC at regular intervals determined chlT elution. At 4 weeks roots were boiled in water and eluent assessed with HPLC. ChlT breakdown (+/-organic material) over time was monitored with HPLC. ChlT minimum inhibitory/bactericidal concentration (MIC/MBC) against Lactobacillus acidophilus was evaluated using L. acidophilus broth and chlT serial dilutions. RESULTS: No significant increase in chlT elution was detected between 2h and 4 weeks (ANOVA, Tukeys, p>0.05), although levels tended to increase with time. ChlT detected in water was 0.005%, corresponding to 0.05% in dentin. After boiling (4 weeks) chlT breakdown products in water corresponded to 0.015% in dentin. MIC/MBC of chlT against L. acidophilus was 0.031%. SIGNIFICANCE: ChlT breakdown is accelerated by organic material. L. acidophilus is highly sensitive to chlT. ChlT readily leaches from dentin but rinsing does not reduce chlT concentration below MIC/MBC. Low levels of chlT may remain but will probably be in a less active form. Teeth disinfected in chlT for use in research involving bacteria must be stored in distilled water for at least 2h to reduce chlT concentration below MBC, although longer will give greater elution and breakdown.

An evaluation of the performance of cast gold bonded restorations in clinical practice, a retrospective study.

OBJECTIVES: To evaluate the performance of cast gold bonded restorations in clinical practice. MATERIALS AND METHODS: The records of all patients treated with cast gold bonded restorations between 1997 and 2004 of The Dental Hospital of Newcastle upon Tyne were reviewed. The following data were recorded: sex of patient, location of teeth (anterior or posterior), position of teeth (upper or lower) and type of cement (glass ionomer, zinc phosphate or resin cement). The survival time was calculated for each restoration; and the reason for failure (either debond or change of treatment plan) identified for each case. The restorations were stratified according to the age of the patient into 10-year age bands and survival analysis was used to identify variables associated with increased risk of failure. RESULTS: Restorations luted with resin cement showed the highest rate of survival after 7 years of follow-up. The alternative lutes had significantly worse survival (p<0.05). Restorations on anterior teeth had poorer survival than on posterior teeth but there were no differences between those placed in the mandible and the maxilla. CONCLUSIONS: Within the limitations of this study resin cements are most appropriate for this type of restoration with 80% survival at 7 years. Restorations placed on posterior teeth survived better.