Quality and Survival of Direct Light-Activated Composite Resin Restorations in Posterior Teeth: A 5- to 20-Year Retrospective Longitudinal Study.

PURPOSE: To analyze the clinical success of direct light-activated composite resin restorations in posterior teeth. The quality of the margins and occlusal surfaces were evaluated, as well as their survival, according to their extensions and locations. The clinical performance of posterior composite resin restorations with different compositions were compared. All restorations were performed by the first author in his private practice, in a 5- to 20-year period. MATERIALS AND METHODS: Several types of composite resins, provided by different manufacturers, were placed in posterior teeth, after isolation with rubber dams. To be included in the study, the restorations had to have been in function for at least 5 years and had to have been placed between October 1993 and October 2008 by the first author. The established failure criteria were: tooth and/or restoration fracture, secondary caries, endodontic treatment, or tooth loss. Included patients must have been treated in the first author's office for at least 7 years and still in the practice through 2013; all patients had complete dental arches. Patients with removable dental prostheses or disabilities, who had moved, or who had died were excluded. Of 210 patients who fulfilled the inclusion criteria, 138 randomly selected subjects were clinically examined between November 2013 and April 2014. Of these 138 patients, 61 had received 105 direct-light-activated composite resin restorations in posterior teeth, which met the inclusion criteria. Twenty-nine patients (47.5%) underwent annual maintenance therapy. The patient-based data collected from clinical exams and personal records were recorded on a specially designed form. Age, gender, period of clinical attendance, tooth preparation, location, size, quality and longevity of the restorations, restorative materials, adhesive systems, parafunctional habits, secondary caries, and maintenance therapy were the variables evaluated. Authors were blinded to the clinical assessments. Cohen's Kappa coefficient of the quality analysis of the margins and occlusal surfaces of the restorations ranged from 0.78 to 1. Data processing was performed using Epidat software, v3.1, developed by the Consellería de Sanidade de la Xunta de Galicia with the support of PAHO-WHO and SPSS software v13.0. If the number of complete values was too small, a Kaplan-Meier curve could not be used. Therefore the Fisher's exact test, Chi-square test, Kruskal-Wallis test, and Mann-Whitney non-parametric test were indicated to analyze significant differences. RESULTS: At the time of the examinations, 103 (98%) restorations were in function, and 98 (95.1%) were rated as clinically successful. Two restorations failed (2%). The observed mean survival time of restorations that remained functional was 11 years and 7 months. CONCLUSIONS: In the present report, direct light-activated composite resin restorations in posterior teeth showed a high clinical success rate and long-term mean survival time. These composite resins might be considered the material of choice to restore medium, extended, and in some clinical situations, large preparations in posterior teeth.

Estudio clínico retrospectivo, de 656 restauraciones de oro colado en dientes posteriores, entre 5 y 44 años: Análisis de los resultados / Retrospective clinical study of 656 cast gold inlays/onlays in posterior teeth, in a 5 to 44-year period: Analysis of results

Objetivos: 1) Evaluar el rendimiento clínico de las restauraciones posteriores de oro, durante 44 años; 2) Analizar su indicación y distribución, en relación con la evolución de la evidencia científica. Materiales y Métodos: En 100 pacientes, se estudiaron 656 restauraciones posteriores de oro colado. De 2552 pacientes registrados, 210 cumplieron los requisitos de inclusión. La muestra estadística representativa fue de 136 pacientes. Se seleccionaron al azar 140 y se estudiaron 138. Doce variables fueron analizadas. El procesamiento de datos se realizó con el software Epidat, versión 3.1 y del software SPSS versión 13.0. Resultados: Estaban en función 536 (81.7%) y 120 (18.3%) fracasaron. Según el Método de Kaplan-Meier, la sobrevida total estimada fue de 77.4% a los 39 años y 10 meses. Conclusiones: La constante actualización del conocimiento, responsabilidad ética del profesional, le permitirá introducir los cambios conceptuales y clínicos a la luz de las nuevas evidencias científicas.

Objective: 1) To assess the clinical performance of 656 cast gold inlay/onlays in a 44-year period; 2) To analyze their indications and distribution regarding the evolution of scientific evidence. Materials and Methods: A total of 656 cast gold inlays/onlays had been placed in 100 patients. Out of 2552 registered patients, 210 fulfilled the inclusion criteria. The statistical representative sample was 136 patients; 140 were randomly selected and 138 were the patients studied. Twelve variables were analyzed. Data processing was done using Epidat 3.1 and SPPS software 13.0. Results: At the clinical examination, 536 (81.7%) were still in function and 120 (18.3%) had failed. According to Kaplan-Meier's method, the estimated mean survival for the whole sample was 77.4% at 39 years and 10 months. Conclusions: Knowledge updating is an ethical responsibility of professionals, which will allow them to introduce conceptual and clinical changes that consider new scientific evidence.

Endocrown: estudio clínico retrospectivo de una serie de pacientes, en un período de 8 a 19 años / Endocrown: a retrospective patient series study, in a 8 to 19-year period

Objetivo: El objetivo de este trabajo es presentar el resultado clínico retrospectivo de 11 Endocrowns, realizados por el primer autor en su consultorio privado, en un período de 8 a 19 años. Materiales and Métodos: Se establecieron criterios de inclusión y exclusión para la muestra y las restauraciones. En ciento treinta pacientes seleccionados al azar, 11 Endocrowns habían sido realizados en 11 pacientes. Tres materiales restauradores y tres cementos de resina fueron utilizados. Se analizaron diferentes variables. El Indice Kappa de Cohen, referido al análisis de calidad de las restauraciones, tuvo una variación de 0.78 a 1. Para analizar las diferencias estadísticas significativas se utilizaron métodos estadísticos descriptivos. Resultados: Al momento del examen, 10 (90.9%) Endocrowns estaban en función Uno (9.1%) había fracasado. Conclusiones: Endocrown, es un procedimiento restaurador técnicamente sensible, conservador, estético, fácil, rápido, con muy aceptable funcionalidad y longevidad, para rehabilitar dientes posteriores endodónticamente tratados, principalmente molares.

Purpose. The aim of this paper is to present the retrospective clinical performance of 11 endocrowns, placed in a single private practice in an 8-to-19-year period. Materials and Methods. Inclusion and exclusion criteria for the sample and the restorations were established. One hundred and thirty patients were selected at random. Eleven endocrowns had been placed in 11 patients. Three restorative materials and three resin cements were used. Cohen’s Kappa coefficient, on the quality analysis of the restorations, ranged from 0.78 to 1. Due to the small sample, inferential statistical methods could not be used. Therefore, statistical descriptive methods were applied. Results. At the moment of the clinical examination, 10 (90.9%) endocrowns were in function and 1 failed (9.1%). Conclusions. Endocrown is a conservative and aesthetic technique-sensitive procedure used to restore posterior endodontically treated teeth, mainly molars, with a very good biomechanical and functional performance, and very acceptable longevity.

Postes colados: estudio clínico retrospectivo de 44 años en clínica privada especializada / Cast posts: a forty-four year retrospective clinical study in a specialized private practice

El objetivo de este estudio fue examinar el resultado clínico longitudinal de dientes endodónticamente tratados, rehabilitados con postes colados y una restauración coronaria, durante 44 años. Materiales y Métodos. En 130 pacientes seleccionados al azar, 95 presentaron 297 dientes rehabilitados con un poste colado y una restauración coronaria. El criterio de éxito fue que el diente rehabilitado permaneciera funcional sin patología clínica ni radiográfica. Resultados: Doscientos sesenta y ocho (90%) estaban en función y 29 (10%) habían fracasado. El Indice Kappa de Cohen, fue de 0.78 - 1. Conclusiones. El éxito clínico fue de 90%. La sobrevida media observada de los dientes estudiados fue de 19 años. La tasa de fracaso fue de 10%, siendo la fractura dentaria la falla más prevalente (5% de todos los dientes restaurados)...

The aim of this study was to examine the longitudinal clinical result of the use of cast posts and cores and crown restorations in endodontically treated teeth over a 44-year period. Materials and methods. Out of 130 randomly selected patients, 95 had had 297 teeth rehabilitated with cast posts and cores and crown restorations. The endodontic rehabilitation was considered successful when the tooth remained functional with no clinical or radiographic pathology. Results. The success rate was 90% (268) and the failure rate 10% (29). Cohen’s Kappa index ranged between 0.78 and 1. Conclusions. In this 44-year retrospective study, the clinical success rate was 90%. The mean survival time of the studied teeth was 19 years. The failure rate was 10%; tooth fractures were the most prevalent failures (5% of all restored teeth)...