A Multicenter Trial on the Long-term Performance of Direct Composite Buildups in the Anterior Dentition ­ Periodontal Health

PURPOSE: This sub-analysis of our multicenter trial was to assess the long-term periodontal health (PH) of teeth, esthetically reshaped by means of direct composite buildups. MATERIALS AND METHODS: 198 patients who received 667 direct composite buildups on 585 treated teeth (TT) between 01/2001 and 12/2013 were included. PH was assessed for each TT and for an untreated control tooth (CT) by recording the pocket probing depths (PPD), clinical attachment level (CAL), sulcus bleeding index (SBI), and Turesky's modification of the Quigley Hein plaque index (PI). Statistical analysis was performed using the two-sample Student's t-test and Mann-Whitney U-test. Regression models were performed to check for associations between PH and patients' age, gender, age of the buildups, enlargement range, jaw, and tooth type. The level of significance was set at α = 0.05. RESULTS: PI scores were significantly (p < 0.001) higher in TT (1.60 ± 0.81) than in CT (1.41 ± 0.81). Differences between TT and CT regarding PPD (TT: 2.14 ± 0.56/CT: 2.18 ± 0.56), CAL (TT: 2.34 ± 1.05/CT: 2.33 ± 0.92), and SBI (TT: 0.41 ± 0.60/CT: 0.41 ± 0.65) were not statistically significant (p > 0.05). The enlargement range of the TT and the tooth type were not associated with PH. Male patients had significantly higher PPDs, CAL, and SBI values than did female patients. CAL and SBI values increased over time for both the TT and CT. CAL, SBI, and PI values were significantly higher in the mandible and the PPD values in the maxilla. CONCLUSION: Direct composite buildups made for reshaping, change of color or position of teeth did not impair PH in the long term.

Oral health of centenarians and supercentenarians.

There are many studies on the homebound and institutionalized elderly; however, few studies focus on centenarians and supercentenarians, i.e., people aged 100 and 110 years, respectively. Due to the demographic changes, the population of centenarians is set to increase more than that of other age groups. Therefore, this article aims to review the available literature regarding how oral health might display in this age group and highlight aspects necessitating further research. Oral health, oral health-related quality of life, saliva, and the oral microbiome were emphasized in this study. Most papers relevant to the research questions were excluded because the mean age of participants was <100 years. Only two papers were found on centenarians' oral health status and saliva and no studies were found focusing on the oral health-related quality of life or oral microbiome. The reviewed studies demonstrate that centenarians presented with good oral mucosal conditions, dental conditions, and general health. The present literature is insufficient to come to a definite conclusion regarding how aging affects the oral health of centenarians and supercentenarians. The limited available research indicates that centenarians display better oral health than other individuals in their respective birth cohorts.

A Multicenter Trial on the Long-term Performance of Direct Composite Buildups in the Anterior Dentition - Survival and Quality Outcome.

Purpose: The purpose of this multicenter study was to evaluate the survival and quality outcome of direct composite buildups in the anterior dentition based on representative sample sizes. Materials and Methods: At three university clinics in Germany, the survival and quality outcome of n = 667 direct composite buildups performed between 2001 and 2012 was evaluated in n = 198 participants. Survival outcomes were categorized as failure (F), survival (SR), or successful (S). Restorations still in place and without failure prior to follow-up (n = 567) were rated using modified USPHS/FDI criteria to obtain the quality outcome. Detailed failure analysis was done by means of Cox regression models. Results: The restricted mean for overall survival was 15.5 years. N = 576 restorations were classified as successful (S), n = 81 survived with repair (SR) and n = 8 failed (F). Two restorations were removed due to iatrogenic interventions. Overall survival rates after 2, 10, and 15 years were 98.8% (CI: 97.6 and 99.4), 91.7% (CI: 89.0 and 93.8), and 77.6% (CI: 72.2 and 82.2), respectively. Functional survival rates were 100.0%, 98.9% (CI: 97.5 and 99.5), and 98.5% (CI: 96.7 and 99.3), respectively. Clinical quality was rated as excellent or good for most restorations. The dominant failure mode was chipping; however, regression analysis did not detect any influence of the evaluated parameters "enlargement range," "position in the jaw," or "tooth type" on failure. Conclusion: This multicenter study represents the first of its type including clinical survival and quality data on 576 direct anterior composite buildups over a restricted mean follow-up of 15.5 years in a relatively large group of participants. In particular, functional survival was outstanding due to the clinical reliability of this treatment option, while simultaneously providing flexibility, reparability, and minimal invasiveness.

The dental esthetic screening index: A new tool for assessment of dento-facial esthetics in restorative dentistry.

OBJECTIVES: There is a lack of comprehensive indexes, which can measure conditions or changes in dento-facial esthetics before and after treatment. Therefore, the 12-item Dental Esthetic Screening Index (DESI) was developed and validated. MATERIALS AND METHODS: Reliability was tested by five dental professionals, who evaluated 30 standardized patient photographs baseline and after 14 days. Clinical validation was done on 52 patients before and after restorative treatment. For subjective assessment, patients completed a validated questionnaire before and after treatment. Statistical analysis included inter and intrarater reliability, Wilcoxon test and linear regression analysis. RESULTS: The single item analysis identified two weak extraoral items (κ = 0.15; κ = -0.05), that were removed from the DESI. After this modification, both inter- (κ = 0.83-0.86) and intrarater reliability (ICC1-5 = 0.75-0.86) were in excellent to good agreement. In the clinical validation, the DESI was significantly lower after restorative treatment (P < .0001). The patients' perception questionnaires showed significant improvement after restorative therapy (P < .0001). A correlation of the DESI and the results of patients' perception questionnaires could be assumed (P < .0001; R2 = 0.32). CONCLUSIONS: The DESI was found to be a reliable and valid instrument for the quantitative assessment of dento-facial esthetics. It correlated well with the subjective assessment of the patients. CLINICAL SIGNIFICANCE: This comprehensive index would allow for objective quantification of clinical situations, for reliable baseline and outcome assessment in esthetic dentistry. As patients' esthetic feelings and sensations are subjective, this objective index is also proven to be congruent to patients' individual subjective assessment of dento-facial esthetics.

Fiber-reinforced composite fixed dental prostheses: A 4-year prospective clinical trial evaluating survival, quality, and effects on surrounding periodontal tissues.

STATEMENT OF PROBLEM: Although fiber-reinforced composite fixed dental prostheses (FRC FDPs) are a reliable treatment option for the restoration of single missing teeth, comparatively few prospective clinical trials (PCT) exist. PURPOSE: The purpose of this PCT was to evaluate the survival, quality outcome, and effect of FRC FDPs on periodontal health over 4 years. MATERIAL AND METHODS: Twenty-six consecutive patients (16 men, 10 women) receiving FRC FDPs with preimpregnated unidirectional fiber reinforcement were included in the trial. Eighteen FRC FDPs were placed in the maxilla and 8 in the mandible. Data from baseline, 12-, 36-, and 48-months of follow-up were recorded, and the prostheses were classified as "success," "survival," or "failure." Periodontal parameters (probing depth, clinical attachment level, plaque index, and bleeding index were assessed, and the quality was rated according to modified United States Public Health Service (USPHS)/Ryge or World Dental Federation (FDI) criteria. RESULTS: Functional survival at 4 years was 73.5% (95% confidence interval [CI], 52.9-87.3) with 17 FRC FDPs still functioning. Twelve of these were classified as "success" and 5 as "survival." Overall survival was 53.0% (95% CI, 30.4-74.4). Six FRC FPDs failed completely. Periodontal parameters did not change over the observation period. Regression analysis showed that probing depth and clinical attachment level did not influence the survival of FRC FDPs. According to USPHS/Ryge/FDI criteria only "wear" and "surface luster" increased significantly over 4 years. CONCLUSIONS: The survival rate of FRC FPDs confirms existing data. Negative effects on periodontal health were not seen over the period of observation. Aging effects such as wear were recorded and indicated that FRC FPDs are at risk of disintegration, as they are composed of a fiber framework and veneering composite resin.

A 6.5-year clinical follow-up of direct resin composite buildups in the posterior dentition: Introduction of a new minimally invasive restorative method.

OBJECTIVES: Restorative rehabilitation of missing single teeth in the posterior dentition is achieved primarily by dental implants or fixed dental prostheses. Here we introduce an uncommon, minimally invasive treatment option in order to close single tooth gaps. METHODS: The purpose of this study was to evaluate the clinical quality and survival of 45 direct composite buildups in the posterior dentition. A detailed clinical examination was performed, and restorations were rated qualitatively using the modified USPHS/FDI criteria. RESULTS: The mean extension of the direct composite buildups was 2.96 (1.12)mm per tooth. Interdental closures from both adjacent teeth had a significantly higher extension of the direct composite buildups than one-sided interdental closures (p=0.03). Patients with a history of prior tooth loss showed a significantly greater extension of direct composite buildups than patients without prior tooth loss (p=0.006). During the follow-up period, no restoration showed unfavorable events. The overall survival rate for the direct composite buildups was 100% after median follow-up of 78.96 months. The clinical quality rating indicated that most of the restorations (>94%) displayed excellent or good quality. No periodontal destruction, signs of gingival inflammation or increased plaque accumulation was observed. CONCLUSIONS: The posterior direct composite buildups evaluated in this study showed promising clinical survival data and excellent quality parameters after a median observation time of 6.5 years. CLINICAL SIGNIFICANCE: If a minimally or non-invasive treatment approach is indicated, posterior direct composite buildups provide a successful treatment alternative for the closure of single-tooth gaps to implant-supported or fixed dental prostheses.

Caries experience after periodontal treatment in aggressive and chronic periodontitis: results of a 10-year follow-up.

OBJECTIVE: To compare the increase of DMF-T and DMF-S in patients with aggressive periodontitis (AgP) and chronic periodontitis (ChP) after active periodontal therapy. MATERIALS AND METHODS: One hundred and thirty-six periodontally treated patients were re-examined after 10 years. Dental and periodontal status was assessed and patients' charts were screened for diagnosis, compliance to supportive periodontal treatment (SPT) and DMF-T/-S at baseline and re-examination. δDMF-T/-S was calculated and multi-level regression analyses were performed to identify factors contributing to increase of DMF-T/-S. RESULTS: Thirty patients with AgP, 37 with moderate ChP and 69 with severe ChP could be included. δDMF-T between first visit and re-examination was 2.07 (SD = 2.51, range = 0-14 teeth), mean δDMF-S = 14.66 (SD = 14.54, range = 0-83 surfaces). Patients with AgP showed a similar increase in DMF-T/-S to those with ChP. Regression analysis identified compliance as the only factor significantly accounting for preventing an increase of DMF-S (p = 0.017). No factor had a significant impact on DMF-T. CONCLUSIONS: DMF-T and DMF-S developed similarly in periodontally-treated patients with AgP and ChP during a follow-up of 10 years. SPT showed a positive influence on avoiding decline in DMF-S in periodontally compromised patients. No significant impact was detected for all other studied factors.