Longevity of Indirect and Direct Restorations in Anterior Teeth.

It is the aim of this paper to present data on the survival of direct and indirect restorations in anterior teeth. Two sources of information are used: previously-published analysis of data from 1990 to 2006 from a 13 million restoration dataset from England and Wales; and evidence from published literature from 2011 to the time of writing (March 2022). The findings suggest that: (1) directly-placed resin composite materials may provide satisfactory survival of restorations in anterior teeth; (2) crowns provide better survival to re-intervention: however, crowning an incisor or canine tooth, as opposed to placement of a direct restoration, will lead to an earlier time to extraction of the restored tooth; (3) veneers perform more favourably than other restorations in terms of time to extraction of the restored tooth, but may have a less favourable time to re-intervention than crowns; (4) lithium disilicate crowns may be considered to perform satisfactorily with regard to time to re-intervention when placed in anterior teeth, but less satisfactorily in posterior teeth; and (5) operator factors influence survival of restorations.

Canine guidance on crowned teeth: time for a rethink?

This paper aims to discuss the concept of canine guidance in light of recent research with regard to time to extraction of the restored canine tooth, with crowns representing the worst performing restoration at 15 years (66% cumulative survival). Given that the upper canine tooth may be considered the 'cornerstone' of the arch, reasons for this poor performance are discussed by examination of the existing literature on canine guidance and other aspects relating to the preparation of an upper canine tooth for a crown. The authors question previous recommendations that canine teeth should be placed into canine guidance when restored with crowns, given that the previously-published data indicate that survival of upper canine teeth which have been crowned is worse than when they are restored with any other restoration. It is also suggested that, if clinicians wish to prolong the life expectancy of an upper canine tooth, they must try to avoid crowning it.

Patient history as a predictor of future treatment need? Considerations from a dataset containing over nine million courses of treatment.

Aim It is the aim of this paper to consider whether overall patient treatment history per se and what length of patient history, matters in predicting future treatment need.Methods This study used a data set (SN7024, available from UKDataService), consisting of treatment records for General Dental Services' (GDS) patients, this being obtained from all items of service payment records for patients treated in the GDS of England and Wales between 1990 and 2006. For the purpose of this study, the GDS dataset for patients attending in 2003 was restricted to adult patients (aged 18 or over on 31 December 1990; that is, year of birth earlier than 1973) who attended in both two-year periods 1991/2 and 2004/5. Each course of treatment was classified as 'active' (eg restoration, extraction, prosthesis) or 'not active' (eg prevention, diagnosis). Treatment costs for 2001-2005 (outcome), 2000 (one-year history), 1999-2000 (two-year history) and so on until 1991-2000 (ten-year history) were determined, and history and outcome correlated.Results A total of 455,844 patients met the inclusion criteria, namely adults with a full history. They received 9,341,583 courses of treatment, of which 49% were classified as 'active' and 51% as 'not active'. The analysis indicated that both total costs and active treatment costs are positively correlated with their historical values, with the correlation coefficients increasing from 0.24 and 0.25 with one year of history to 0.42 and 0.44 with ten years of history. Overall, therefore, future treatment cost is correlated with past treatment costs.Conclusions Treatment history may provide an important correlate of future dental treatment needs and the more history the better, at least up to five years. However, active treatment is the important component and should be distinguished from preventive and diagnostic treatments.

Dental practice in the UK in 2015/2016. Part 4: changes since 2002?

Objectives To determine, by means of anonymous self-report questionnaires, the changes in demographic profile, practising details and utilisation of clinical techniques/materials of general dental practitioners (GDPs) in the UK between 2002 and 2015. Method A wide-ranging, validated questionnaire, designed to elicit information on the practising arrangements and techniques and materials used, was distributed to UK-based GDPs in 2002, 2008 and 2015 with a request that they complete the questionnaire and return it by post in the reply-paid envelope to the corresponding author. Results Questionnaires were distributed by post to 1,000 UK-based GDPs in 2004 and 2008, with an additional 500 questionnaires being distributed at postgraduate meetings in 2015. Response rates of 70%, 66% and 78% were achieved, respectively. Of the respondents, 73% were male in 2002, while 67% and 60% were male in 2008 and 2015, respectively. In 2002, 65% were practice principals, falling to 51% in 2015. Regarding how patients paid for their dental care, 86% of respondents in 2002 treated patients within the NHS arrangements, compared with 57% and 50% in 2008 and 2015, respectively. The data collected in 2015 indicated that 55% of respondents had an intra-oral camera; while, with regard to recently introduced concepts and techniques, 80% used nickel-titanium files, 47% used zirconia-based bridgework, 25% used tricalcium silicate, and 17% used CAD/CAM restoration. Of great interest, perhaps, is the response to digital radiography/imaging, with the results indicating that, by 2015, 74% of respondents used this form of radiography. Conclusion Results from the three surveys indicated that NHS service provision has dropped to 50%. Regarding the staffing of dental practices, just over half the respondents were practice principals. The results also indicated that UK dentists continue to be innovative and forward-looking in the techniques that they employ.

Five Year Clinical Evaluation of Restorations Placed in a Low Shrinkage Stress Composite in UK General Dental Practices.

This paper evaluates the five year clinical evaluation of restorations formed in a low shrinkage stress resin composite material (3M ESPE Filtek Silorane, Seefeld, Germany) and placed in the general dental practices of five members of the PREP Panel, a group of UK practice-based researchers. Results indicated satisfactory performance of the material under evaluation, other than for marginal staining, which affected 60% of the restorations evaluated after five years, albeit with less than 10% of the circumference of the restorations being affected. CLINICAL RELEVANCE: The low shrinkage stress material, Filtek Silorane™, demonstrated good clinical performance in the majority of parameters which were assessed at five years.

British Society of Prosthodontics Debate on the Implications of the Minamata Convention on Mercury to Dental Amalgam--Should our Patients be Worried?.

In 2013, the Minamata Convention on Mercury called for a global phase-down of amalgam use, with a view to reduce environmental mercury pollution. This will significantly impact UK dentistry, given the still extensive use of amalgam in U.K. general dental practice. However, until now there has been little national discussion or debate. In Spring 2015, The British Society of Prosthodontics dedicated a significant part of its Annual Conference to debating the implications of this issue. Clinical case examples were discussed with audience interaction and voting facilitated using innovative Audience Response System Technology. A remarkable range of concerns and opinions were given. The debate elicited specific concerns amongst clinicians regarding the suitability of mercury-free alternatives to amalgam; particularly where cavities are large and extend beneath the gingival anatomy. There are also anecdotal reports of Dental Foundation (DF) dentists not being adequately taught the use of dental amalgam in undergraduate dental schools. CPD/CLINICAL RELEVANCE: Many clinicians, especially those treating patients for whom moisture control is challenging, feel that amalgam should remain available for clinicians to choose in certain clinical circumstances for the restoration of posterior teeth, even in the event of a complete phase-down.

A Practice-Based Clinical Evaluation of a Bulk Fill Restorative Material.

OBJECTIVE: To evaluate the handling, by a group of practice-based researchers, of a recently introduced bulk fill resin-based composite restorative material, Filtek Bulk Fill Restorative (3M ESPE). METHODS: The twelve selected evaluators were sent explanatory letters, a pack of the material under investigation to use for 8 weeks, and a questionnaire. RESULTS: The evaluators rated the ease of use of the bulk fill restorative the same as the previously used posterior composite material. The provision of one shade only for evaluation may have compromised the score for aesthetic quality. No post-operative sensitivity was reported. CONCLUSIONS: The bulk fill material was well received as indicated by the high number of evaluators who would both purchase the material and recommend it to colleagues. CLINICAL REVELANCE: A recently introduced bulk fill restorative material achieved a rating for handling which was similar to the evaluators' previously used resin composite, although there were some concerns regarding the translucency of the material.

A PREP Panel, Practice-Based, Evaluation of the Handling of the Kerr Demi-Ultra Light Curing Unit.

This paper describes the handling evaluation (by a group of practice-based researchers, the PREP Panel) of a recently introduced Light Curing Unit (LCU), the Kerr Demi-Ultra, which possesses a number of novel features such as its ultracapacitor power source, and the Light Emitting Diodes (LEDs) which provide the light output being placed close to the tip of the light guide. CPD/CLINICAL RELEVANCE: Testing of new devices and materials with respect to their handling is of importance, given that an easy to handle device should produce better clinical results than one which is difficult to use.

Technique Tips--The Cost of One Post-Operative Sensitivity following Placement of a Posterior Composite Restoration.

Use a low shrinkage stress composite but, if not, use incremental placement and a layer of flowable at the gingival box; Ensure good bonding to dentine and enamel and avoid (over) etching the dentine; Ensure good adaptation at the gingival floor of a Class II box; Make sure that the restoration has received sufficient light; Provide good isolation; Use reliable and tested materials throughout.

Dental Materials: What Goes Where? Class V Restorations.

A large number of Class V restorations are placed per annum to restore cervical lesions. This paper evaluates the pathogenesis of these lesions, with particular reference to the role of occlusal factors, and reviews the literature in order to provide advice on the material(s) which are most likely to produce optimal longevity of a Class V restoration. CPD/CLINICAL RELEVANCE: Resin-modified glass ionomer materials appear to provide optimal survival for a Class V restoration, but a (flowable) comDosite miaht Droduce a better aesthetic result.