Dental attendance, restoration and extractions in adults with intellectual disabilities compared with the general population: a record linkage study.

BACKGROUND: Oral health may be poorer in adults with intellectual disabilities (IDs) who rely on carer support and medications with increased dental risks. METHODS: Record linkage study of dental outcomes, and associations with anticholinergic (e.g. antipsychotics) and sugar-containing liquid medication, in adults with IDs compared with age-sex-neighbourhood deprivation-matched general population controls. RESULTS: A total of 2933/4305 (68.1%) with IDs and 7761/12 915 (60.1%) without IDs attended dental care: odds ratio (OR) = 1.42 [1.32, 1.53]; 1359 (31.6%) with IDs versus 5233 (40.5%) without IDs had restorations: OR = 0.68 [0.63, 0.73]; and 567 (13.2%) with IDs versus 2048 (15.9%) without IDs had dental extractions: OR = 0.80 [0.73, 0.89]. Group differences for attendance were greatest in younger ages, and restoration/extractions differences were greatest in older ages. Adults with IDs were more likely prescribed with anticholinergics (2493 (57.9%) vs. 6235 (48.3%): OR = 1.49 [1.39, 1.59]) and sugar-containing liquids (1641 (38.1%) vs. 2315 (17.9%): OR = 2.89 [2.67, 3.12]). CONCLUSION: Carers support dental appointments, but dentists may be less likely to restore teeth, possibly extracting multiple teeth at individual appointments instead.

Five year evaluation of the complications observed in porcelain fused to metal (PFM) crowns placed at a university hospital.

OBJECTIVE: To determine the frequency of complications in crowns cemented over a 5-year period in a tertiary care hospital and also to report the survival of these crowns. METHODS: The retrospective cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, from March 2017 to March 2018 and comprised porcelain fused-to-metal crowns placed on the anterior or posterior teeth that were fabricated at the institutional laboratory and were placed in institutional dental clinics in the preceding 5 years. Porcelain-fused to-metal The crowns were clinically and radio-graphically evaluated in a duration of two months for presence/absence of complications. Factors associated with the failure of the crowns, their survival and the impact of covariates, like gender, flossing and bruxism, on the survival time were determined. Data was analysed using SPSS 22. RESULTS: There were 150 crowns related to 107 patients who had a mean age of 45.0±11.4 years. The most common complication observed was open proximal contacts 9(6%) followed by de-cementation 8(5.3%), porcelain chipping 9(6%) and abutment fracture 2(1.3%). The 5-year survival rate of the crowns was 127(84.7%). The mean follow-up time was 57.2±1.0 months. Overall, year-wise survival of PFM crowns for one year till five years was 147 (98%), 144 (96%), 135 (90%), 130 (86%) and 119 (79%) respectively. CONCLUSIONS: The porcelain-fused-to-metal crowns had a high 5-year survival rate. Open proximal contacts represented the most common complication.

Skin color affect the replacement of amalgam for composite in posterior restorations: a birth-cohort study.

The aim of present study was to estimate the occurrence and associated factors for replacement of amalgam posterior restorations. A representative sample of all 5,914 births from the 1982 in Pelotas birth cohort study was prospectively investigated, and the posterior restorations were assessed at 24 (n = 720) and 31 years of age (n = 539). Individual-level variables, i.e., demographic characteristics, socio-economic factors, oral health conditions and use of dental services, were collected from different waves of the cohort. Tooth-level variables included dental group, estimated time in mouth of each amalgam restoration, and number of restored dental surfaces. Thus, 246 individuals presented 718 amalgam restorations at 24 years of age. After 7 seven years of follow-up, 18.9% of these restorations had been replaced with composite resins. Multilevel Poisson regression models showed that, compared to white individuals, blacks presented a lower risk of replacement of amalgam restorations for composite resins (IRR - 0.39 [0.16-0.95]). Individuals with high educational level at age 31 showed an increased likelihood of replacement of amalgam restorations. Therefore, skin color affects the replacement of amalgam for composite resin in posterior restorations.

Association of dietary habits with restorative dental treatment need and BMI among Finnish conscripts: a cross-sectional epidemiological study.

OBJECTIVE: Processed foods and fatty, sugary snacking products, such as fizzy drinks and desserts, have become more popular, causing a desire to replace meals with snacks worldwide. High-sugar and fat-rich food components have been reported to be associated with increased level of dental caries as well as underweight and overweight. The aim of the present cross-sectional population-based study was to analyse the eating behaviours of young, healthy Finnish males in association with oral health and BMI, considering self-reported and residential background factors. DESIGN: Cross-sectional study. SETTING: Finnish Defence Forces, Finland. PARTICIPANTS: The used clinical data were gathered from 13 564 Finnish conscripts born in the beginning of the 1990s through clinical check-ups. In addition, about 8700 of the conscripts answered a computer-assisted questionnaire ('Oral Health of the Conscripts 2011' data) about their background information and health habits. RESULTS: There was distinct variation in dietary patterns. Eating breakfast, regular physical exercise and daily tooth brushing all decreased the odds for restorative dental treatment need (decayed teeth), whereas smoking and drinking fizzy drinks for quenching thirst increased it. Eating breakfast and dinner were each associated with lower BMI, but smoking increased the odds for higher BMI (≥25 kg/m2). CONCLUSIONS: Regular, proper meals and especially eating breakfast decreased the odds for both dental caries and high BMI (≥25 kg/m2).

Skin color affect the replacement of amalgam for composite in posterior restorations: a birth-cohort study

Abstract The aim of present study was to estimate the occurrence and associated factors for replacement of amalgam posterior restorations. A representative sample of all 5,914 births from the 1982 in Pelotas birth cohort study was prospectively investigated, and the posterior restorations were assessed at 24 (n = 720) and 31 years of age (n = 539). Individual-level variables, i.e., demographic characteristics, socio-economic factors, oral health conditions and use of dental services, were collected from different waves of the cohort. Tooth-level variables included dental group, estimated time in mouth of each amalgam restoration, and number of restored dental surfaces. Thus, 246 individuals presented 718 amalgam restorations at 24 years of age. After 7 seven years of follow-up, 18.9% of these restorations had been replaced with composite resins. Multilevel Poisson regression models showed that, compared to white individuals, blacks presented a lower risk of replacement of amalgam restorations for composite resins (IRR - 0.39 [0.16-0.95]). Individuals with high educational level at age 31 showed an increased likelihood of replacement of amalgam restorations. Therefore, skin color affects the replacement of amalgam for composite resin in posterior restorations.

The ultimate guide to restoration longevity in England and Wales. Part 8: Canine teeth: time to next intervention and to extraction of the restored tooth.

Aim: It is the aim of this paper to present data on the survival of restorations in canine teeth by analysis of the time to re-intervention on the restorations and time to extraction of the restored tooth, and to discuss the factors which may influence this. Methods: A data set was established, consisting of General Dental Services (GDS) patients, this being obtained from all records for adults (aged 18 or over at date of acceptance) in the GDS of England and Wales between 1990 and 2006. The data consist of items obtained from the payment claims submitted by GDS dentists to the Dental Practice Board (DPB) in Eastbourne, Sussex, UK. This study examined the recorded intervals between placing a restoration in a canine tooth and re-intervention on the tooth, and the time to extraction of the restored tooth. Results: Data for more than three million different patients and more than 25 million courses of treatment were included in the analysis. Included were all records for adults (aged 18 or over at date of acceptance). Overall, 1,232,052 restorations involving canine teeth were included in the analysis. With regard to time to re-intervention, 33% of restorations had survived at 15 years, and with regard to time to extraction of the restored tooth, cumulative survival was 78% at 15 years. Veneers and crowns performed best in terms of time to re-intervention, but crowns performed worst when time to extraction was analysed. Conclusions: Overall, crowns and porcelain veneers placed on canine teeth perform best to re-intervention after 15 years, but crowns perform worst when the time to extraction of the restored tooth is examined and veneers perform best, with a 20 percentage point difference in cumulative survival at fifteen years between crowns and the best performing restoration in the under-40 year age group, this effect being accentuated in the over-40 year age group. Other factors influencing restoration longevity in canine teeth include: patient age, dentist age and the patient's annual need for dental treatment.

Effect of Refurbishing Amalgam and Resin Composite Restorations After 12 Years: Controlled Clinical Trial.

OBJECTIVES: The aim of this study was to clinically evaluate posterior amalgam and resin composite restorations refurbished over a period of 12 years by investigating the influence of refurbishing on the survival of restorations and comparing their behaviors with respect to controls. METHODS AND MATERIALS: Thirty-four patients were enrolled, ages 18 to 80 years, with 174 restorations, 48 restorations of resin composite (RC), and 126 restorations of amalgam (AM). Restorations with localized defects in anatomy, roughness, luster, or marginal staining that were clinically judged as suitable for refurbishing according to US Public Health Service (USPHS) Ryge criteria were assigned to group A-refurbishing (n=85; 67 AM, 18 RC)-or group B-control (n=89; 59 AM, 30 RC); the quality of the restorations was evaluated blindly according to the modified USPHS criteria. Two observers conducted evaluations at the initial state (k=0.74) and after one to five, 10, and 12 years (k=0.88). Wilcoxon, Friedman, and Mantel-Cox tests were performed to compare the groups, respectively. RESULTS: After 12 years, both groups experienced a similar decline, except for an evidently better performance in marginal adaptation in RC control (p=0.043) and in anatomy in AM refurbished (p=0.032). CONCLUSIONS: After 12 years, no difference was found in the clinical condition and longevity of the refurbished restorations compared to the control group.

Attitudes of Greek dentists towards repair of conservative restorations. An online survey.

OBJECTIVES: Repair versus replacement of a defective direct restoration is one important step for conserving tooth structure. This study was designed to collect information on the attitudes of Greek dentists towards repairing direct restorations. METHODS: An electronic questionnaire with 16 multiple-choice and rank-ordering questions was created online and its URL address was randomly emailed to 800 dentists in the area of Athens, Greece. The questionnaire remained open for 3 months, and after two reminder emails the data collected were analysed statistically to identify differences between clinician's sex or years of practicing dentistry, using the chi-square and Kruskal-Wallis tests at α = 0.05. RESULTS: Three-hundred and twenty dentists completed and submitted the questionnaire (response rate = 40%). A high proportion (86.8%) of the respondents reported that they routinely repair defective restorations, ranking the order of their frequency as 2.47 for amalgam and 2.41 for resin restorations. The reasons, with the highest ranks, for repairing amalgams were the restoration of bulk fractures (4.10) and restoration of marginal fractures (3.69). For repair of resin restorations, the reasons with the highest ranks were improving their colour (4.04) and removing marginal discoloration (3.99). Moreover, 94.1% of the respondents stated that they were enough, much and very much satisfied with the repair, 1 year after it was performed. CONCLUSIONS: A high percentage of Greek dentists are repairing defective direct restorations. There are discrepancies in the indications, techniques and materials used for repairs, such as bulk fractures and marginal restorations. Further studies on the efficacy of repairs, the criteria and procedure protocols are needed. Further, additional clinical education should be offered at the undergraduate or continuing education levels.

Repair may increase survival of direct posterior restorations - A practice based study.

OBJECTIVES: To investigate repairs of direct restorations by a group of Dutch general dental practitioners (GDPs) and its consequences on longevity of restorations. METHODS: Data set was based on dental records of patients attending 11 general dental practices (24 Dentists) in the Netherlands. Patients that received Class II Amalgam or Composite restorations were included in the study. The outcomes were considered in two levels: "Success" - When no intervention was necessary on the original restoration, it was considered clinically acceptable. "Survival" - Repaired restorations were considered clinically acceptable. Kaplan-Meier statistics and Multivariate Cox regression were used to assess restorations longevity and factors associated with failures (p<0.05). RESULTS: 59,722 restorations placed in 21,988 patients were analyzed. There was a wide variation in the amount of repairs among GDPs when a restoration had failed (Level 1). Repairs of multi-surface restorations were more frequent (p<0.001). A total of 9253 restorations (Level 1) or 6897 restorations (Level 2) had failed in a 12-year observation time. "Success" and "Survival" of the restorations reached 65.92% (AFR=4.08%) and 74.61% (AFR=2.88%) at 10 years, respectively. Patient (age, removable denture) and tooth/treatment-related factors (molars, >2 restored surfaces, endodontic treatment, Amalgam) were identified as risk factors for failure (p<0.001). CONCLUSION: Overall, the GDPs showed satisfactory rates of restoration longevity over 10 years. Repair can increase the survival of restorations although, substantial differences exist among practitioners in repair frequency and AFRs. Molars, multi-surface restorations, presence of an endodontic treatment and a removable denture were identified as risk factors for failure. CLINICAL SIGNIFICANCE: Repair, instead of total replacement of a defective restoration, is a Minimally Invasive procedure which can increase the survival of the original filling, reducing the risk for pulp complications and treatment costs.

Repair restorations: Questionnaire survey among dentists in the Canton of Zurich, Switzerland.

The aim of this study was to carry out a representative survey on the implementation of and experience with repairs of single-tooth restorations among dentists in the Canton of Zurich, Switzerland. An anonymous questionnaire was sent to all 1,411 dentists registered in the Canton of Zurich; 38.9% of the delivered questionnaires were returned and 35.3% could be evaluated. The statistical analysis comprised Kendall’s rank correlation coefficient (tau), Wilcoxon signed-rank tests, and Kruskal-Wallis tests. The level of significance was set at p≤0.05. Repair restorations are frequently made (composite: 98.5%, ceramic: 88.9%, crowns: 86.5%, metal: 54.6%, amalgam: 51.5%). Main indications for repairs were the partial loss of an existing restoration or of the adjacent dental hard substance, while restoration failures due to secondary caries were repaired to a lesser extent. The decision to repair is largely dependent on the size of the defect (90%), the size of the original restoration (63%), and the material of the failed restoration (84%). Repair restorations are most frequently made with composite following adequate conditioning of the repair surface. A majority of the dentists rate the lifespan of repair restorations as reduced in comparison with newly made restorations. In summary, repairs of defective single-tooth restorations are frequently performed by dentists in the Canton of Zurich, Switzerland, and constitute a well-established treatment procedure.

Attitudes, practice, and experience of German dentists regarding repair restorations.

OBJECTIVES: The aim of the present study was to perform a representative survey among German dentists about attitudes, practice, and experience regarding single-tooth repair restorations. MATERIALS AND METHODS: An anonymous questionnaire was designed and mailed to all registered dentists in Lower Saxony (n = 6600). Twenty-eight percent were returned (n = 1852), and n = 1805 could be analyzed. Statistical analyses were done by Wilcoxon signed-rank tests, Kruskal-Wallis tests, and ordered logistic regressions (p < 0.05). RESULTS: Only 2.2 % of the dentists declared to never perform repair restorations. Composite restorations were repaired significantly more often than all other materials. Frequency of performing repair restorations was partially associated to dentist-related factors. The decision for repairing a restoration was dependent on several tooth- and restoration-associated variables. The main indications for repair were the partial loss of restoration or adjacent tooth structure as well as chipping and endodontic access cavities of crowns. Repair restorations were mostly done with composite using various different preconditioning techniques. Overall patients' acceptance was reported to be high. Most of the dentists considered repair restorations as permanent restoration with a moderate to high longevity. Estimated success of repair restorations depended significantly on the dentists' experiences (frequency and techniques of repair restorations). CONCLUSIONS: Repair restorations were often performed and were well accepted by dentists and patients, but indications for repair restorations as well as applied materials and techniques varied distinctly. CLINICAL RELEVANCE: Repairs of single-tooth restorations are well accepted and frequently performed, but indications, techniques, and materials require further research.

Poor oral health including active caries in 187 UK professional male football players: clinical dental examination performed by dentists.

BACKGROUND: The few studies that have assessed oral health in professional/elite football suggest poor oral health with minimal data on impact on performance. The aim of this research was to determine oral health in a representative sample of professional footballers in the UK and investigate possible determinants of oral health and self-reported impact on well-being, training and performance. METHODS: Clinical oral health examination of senior squad players using standard methods and outcomes carried out at club training facilities. Questionnaire data were also collected. 8 teams were included, 5 Premier League, 2 Championship and 1 League One. RESULTS: 6 dentists examined 187 players who represented >90% of each senior squad. Oral health was poor: 37% players had active dental caries, 53% dental erosion and 5% moderate-severe irreversible periodontal disease. 45% were bothered by their oral health, 20% reported an impact on their quality of life and 7% on training or performance. Despite attendance for dental check-ups, oral health deteriorated with age. CONCLUSIONS: This is the first large, representative sample study in professional football. Oral health of professional footballers is poor, and this impacts on well-being and performance. Successful strategies to promote oral health within professional football are urgently needed, and research should investigate models based on best evidence for behaviour change and implementation science. Furthermore, this study provides strong evidence to support oral health screening within professional football.

Repair or replacement of restorations: A prospective cohort study by dentists in The National Dental Practice-Based Research Network.

BACKGROUND: A prospective cohort study that included dentists in The National Dental Practice-Based Research Network was conducted to quantify 12-month failures of restorations that were repaired or replaced at baseline. The study tested the hypothesis that no significant differences exist in failure percentages between repaired and replaced restorations after 12 months. It also tested the hypothesis that certain dentist, patient, and restoration characteristics are significantly associated with the incidence of restoration failure. METHODS: Dentists recorded data for 50 or more consecutive defective restorations. The restorations that were either repaired or replaced were recalled after 12 months and characterized for developing defects. RESULTS: Dentists (N = 195) recorded data on 5,889 restorations; 378 restorations required additional treatment (74 repaired, 171 replaced, 84 teeth received endodontic treatment, and 49 were extracted). Multivariable logistic regression analysis indicated that additional treatment was more likely to occur if the original restoration had been repaired (7%) compared with replaced (5%) (odds ratio [OR], 1.6; P < .001; 95% confidence interval [CI], 1.2-2.1), if a molar was restored (7%) compared with premolars or anterior teeth (5% and 6%, respectively) (OR, 1.4; P = .010; 95% CI, 1.1-1.7), and if the primary reason was a fracture (8%) compared with other reasons (6%) (OR, 1.3; P = .033; 95% CI, 1.1-1.6). CONCLUSIONS: An additional treatment was more likely to occur within the first year if the original restoration had been repaired (7%) compared with being replaced (5%). However, repaired restorations were less likely to need an aggressive treatment (replacement, endodontic treatment, or extraction) than replaced restorations. PRACTICAL IMPLICATIONS: One year after repair or replacement of a defective restoration, the failure rate was low. However, repaired restorations were less likely to need an aggressive treatment than replaced restorations.

Repair vs replacement of failed restorations in general dental practice: factors influencing treatment choices and outcomes.

OBJECTIVE: To investigate the impact of repair vs replacement of failed restorations on patient related outcome measures, and to explore the clinical factors that influence this decision. DESIGN: Multicentre, prospective practice-based study. SETTING: Dental practices within Salford, Trafford and East Lancashire in the North West of England. SUBJECTS AND METHODS: General dental practitioners were asked to participate and to recruit adult patients attending for routine dental treatment. INTERVENTIONS: Repair or replacement of failed restorations. MAIN OUTCOME MEASURES: Dental anxiety before treatment using the Corah Dental Anxiety Scale and pain intensity immediately and 24 hours post-operatively using the McGill short form pain questionnaire. Operative outcomes included depth of caries, time taken to complete the procedure, use of local anaesthetic and dental material used. RESULTS: Of the 103 patients diagnosed with a failed restoration, a statistically significantly greater number underwent replacement than repair (p = 0.004). Patients undergoing repairs were significantly less anxious (p = 0.008) and had shorter procedure times (p = 0.044). Repairs were associated with minimal caries depth and less use of local anaesthetic. CONCLUSION: Failed restorations should be repaired where clinically possible, as they are quick and associated with less patient anxiety. Future research should focus on providing high quality prospective data evaluating the longevity of repaired vs replaced restorations.

Dental skill mix: a cross-sectional analysis of delegation practices between dental and dental hygiene-therapy students involved in team training in the South of England.

BACKGROUND: Research suggests that health professionals who have trained together have a better understanding of one another's scope of practice and are thus equipped for teamwork during their professional careers. Dental hygiene-therapists (DHTs) are mid-level providers that can deliver routine care working alongside dentists. This study examines patterns of delegation (selected tasks and patients) by dental students to DHT students training together in an integrated team. METHODS: A retrospective sample of patient data (n = 2,063) was extracted from a patient management system showing the treatment activities of two student cohorts (dental and DHT) involved in team training in a primary care setting in the South of England over two academic years. The data extracted included key procedures delegated by dental students to DHT students coded by skill-mix of operator (e.g., fissure sealants, restorations, paediatric extractions) and patient demography. χ2 tests were conducted to investigate the relationship between delegation and patient age group, gender, smoking status, payment-exemption status, and social deprivation. RESULTS: A total of 2,063 patients managed during this period received treatments that could be undertaken by either student type; in total, they received 14,996 treatment procedures. The treatments most commonly delegated were fissure sealants (90%) and restorations (51%); whilst the least delegated were paediatric extractions (2%). Over half of these patients (55%) had at least one instance of delegation from a dental to a DHT student. Associations were found between delegation and patient age group and smoking status (P <0.001). Children under 18 years old had a higher level of delegation (86%) compared with adults of working age (50%) and patients aged 65 years and over (56%). A higher proportion of smokers had been delegated compared with non-smokers (45% cf. 26%; P <0.001). CONCLUSIONS: The findings suggest that delegation of care to DHT students training as a team with dental students, involved significantly greater experience in treating children and adult smokers, and providing preventive rather than invasive care in this integrated educational and primary care setting. The implications for their contribution to dentistry and the dental team are discussed, along with recommendations for primary care data recording.

Locked mouths: Tooth loss in a women's prison in northeastern Brazil.

BACKGROUND: Prisoners, in general, exhibit unsatisfactory oral conditions, especially with regard to the large number of missing teeth and with untreated caries. The aim of this study was to assess tooth loss, use of and need for prosthetic rehabilitation, and use of dental services among inmates. A cross-sectional study involving 65 inmates was developed at the Regional Women's Prison of Campina Grande, Brazil. Data regarding sociodemographic and sentencing profile, use of dental services, dental morbidity, and self-perceived oral health impacts were investigated. Chi-square, Pearson, and Kruskal-Wallis (P < 0.05) statistical tests were used. The mean tooth loss was 11.3 teeth. Significant association between tooth loss and oral health satisfaction (P = 0.049), self-perceived need for dental prosthesis (P < 0.001), uncomfortable teeth brushing (P = 0.005), difficult speaking (P = 0.002), and difficulty in performing routine tasks (P = 0.025) was observed. It was observed that 29.2% of inmates were using some type of prosthesis, all deemed unsuitable for use, and 78.5% of inmates needed prosthetic rehabilitation. The oral health condition of the population studied was found to be poor, and prisoners showed significant tooth loss and need for dentures, with the aggravation of having tooth extraction as the major reason for seeking dental care.

Frequency of restoration replacement in posterior teeth for U.S. Navy and Marine Corps personnel.

STATEMENT OF PROBLEM: There are no recent data that describe the replacement rates of resin composite and dental amalgam restorations placed by US Navy dentists. Information is needed to provide the best possible care for our military personnel which would minimize the probability of dental emergencies, especially for those who are deployed. PURPOSE: The purpose of this study was to determine if the frequency of posterior restoration replacement in military personnel differed based on the type of restorative material utilized. METHODS AND MATERIALS: Data contained in dental records in an observational study (retrospective cohort) were evaluated to identify resin composite and dental amalgam restorations placed by navy dentists in posterior teeth. The status of all erupted, unerupted, missing, and replaced teeth was documented. The type and condition of all existing restorations were recorded for each posterior tooth. Investigators reviewed 2921 dental records, and of those, 247 patients met the criteria for inclusion in the study. A total of 1050 restorations (485 resin composite and 565 amalgam) were evaluated. RESULTS: A Cox proportional hazards model was adjusted for number of tooth surfaces restored, caries risk, and filled posterior surfaces at initial exam. The overall rate of replacement for all restorations in the sample was 5.7% during the average 2.8-year follow-up. No significant elevation of risk for restoration replacement existed when comparing resin composite and amalgam. Both the number of restored surfaces and caries risk status were independent risk factors for replacement. When restoring multisurface cavity preparations, providers placed amalgams by an approximate 2:1 ratio over resin composites for this study population. CONCLUSION: The results for this study show that no difference existed in the rate of replacement for amalgam vs resin composite. When restorations increased from just a single occlusal surface to additional surfaces, the rate of replacement was elevated and statistically significant for both materials. A higher caries risk status was also significant in elevating replacement rates for both materials.

Longevity of repaired restorations: a practice based study.

UNLABELLED: The aim was to evaluate retrospectively the influence on restoration longevity of a repair and to evaluate longevity of repaired restorations. MATERIALS AND METHODS: In a practice, 1202 amalgam and 747 composite resin restorations were placed. 407 restorations failed (amalgam 293, composite 114), 246 restorations were repaired with composite resin using an etch-and-rinse technique. Of repaired restorations reason for failure and number of surfaces of original restoration, repair date, and date of patients' last visit were recorded. Whenever a new treatment was necessary, this was considered failure. Data were analysed by Kaplan-Meier statistics and log-rank tests (p<0.05). A multi-variate Cox-regression analysis was conducted on results for variables number of surfaces, repair reason, and repaired material. RESULTS: 133 amalgam restorations (57% due to fracture) and 113 composite restorations (62% due to caries) were repaired. 151 of 246 repaired restorations (61%) were still in service without further intervention after 4.8 years. The annual failure rates for repaired amalgam and composite restorations was 9.3% and 5.7% after 4 years (log-rank, p=0.001). Restorations that were repaired due to fracture had a lower survival than restorations that were repaired due to caries (log-rank, p=0.006). The Cox-regression showed influence of the gender but no significant influence of material or reason for repair, indicating that the findings are a consequence of joint negative influences of investigated variables. CONCLUSION: The present study shows that repairs can enhance the longevity of dental restorations considerably. Moreover, repairs on restorations failing due to caries have a better prognosis compared to repairs on restorations failing due to fracture.

Repair or replacement of defective restorations by dentists in The Dental Practice-Based Research Network.

BACKGROUND: The authors aimed to determine whether dentists in practices belonging to The Dental Practice-Based Research Network (DPBRN) were more likely to repair or to replace a restoration that they diagnosed as defective; to quantify dentists' specific reasons for repairing or replacing restorations; and to test the hypothesis that certain dentist-, patient- and restoration-related variables are associated with the decision between repairing and replacing restorations. METHODS: This cross-sectional study had a consecutive patient and restoration recruitment design. Practitioner-investigators (P-Is) recorded data for consecutively seen restorations in permanent teeth that needed repair or replacement. The DPBRN is a consortium of dental practitioners and dental organizations in the United States and Scandinavia. The collected data included the primary reason for repair or replacement, tooth surface or surfaces involved, restorative materials used and patients' demographic information. RESULTS: P-Is collected data regarding 9,484 restorations from 7,502 patients in 197 practices. Seventy-five percent (7,073) of restorations were replaced and 25 percent (2,411) repaired. Secondary caries was the main reason (43 percent, n = 4,124) for treatment. Factors associated with a greater likelihood of repairing versus replacing restorations (P < .05) included having graduated from dental school more recently, practicing in a large group practice, being the dentist who placed the original restoration, patient's being of an older age, the original restorative material's being something other than amalgam, restoration of a molar and the original restoration's involving fewer tooth surfaces. CONCLUSIONS: DPBRN dentists were more likely to replace than to repair restorations. Secondary caries was the most common reason for repairing or replacing restorations. Certain dentist-, patient- and restoration-related variables were associated with the repair-or-replace decision. CLINICAL IMPLICATIONS: The selection of minimally invasive treatment for an existing restoration is critical, as it may affect the longevity of the tooth.