An update on the reasons for placement and replacement of direct restorations

Abstract

Aim

The aim of this study was to review patterns of restoration placement and replacement. A previous study had been carried out in the late 1990s and this study sought to update the literature in this important aspect of dental practice.

Method

Studies based on the protocol of Mjör (1981) were selected. Such studies involved participating dentists completing a proforma each time a patient presented for a new or replacement restoration.

Results

Twenty-five papers were included in this study, of which 12 were included in the original review. The pre-1998 review reported on the placement of 32,697 restorations, of which 14,391 (44%) were initial placements and 18,306 (56%) were replacements. The new studies included in the post-1998 review reported on an additional 54,023 restorations, of which 22,625 (41.9%) were initial placements and 31,398 (58.1%) were replacements. Therefore, across all studies considered, information is available on 86,720 restorations, of which 37,016 (42.7%) were new placements and 49,704 (57.3%) were replacements. Comparing review periods, there was a reduction in the placement of amalgam restorations from 56.7% (pre-1998 review) to 31.2% (post-1998 review), with a corresponding increase in the placement of resin composites from 36.7% to 48.5%. The most common use of amalgam was seen in Nigeria (71% of restorations), Jordan (59% of restorations) and the UK (47% of restorations). The most frequent use of resin composite was seen in Australia (55% of restorations), Iceland (53% of restorations) and Scandinavia (52% of restorations). Secondary caries was the most common reason for replacing restorations (up to 59% of replacement restorations).

Conclusion

In the years subsequent to the initial review, replacement of restorations still accounts for more than half of restorations placed by dentists, and the proportion of replacement restorations continues to increase. Trends towards the increased use of resin composites is noted in recent years.

Clinical significance

Further research is required in this area to investigate changes in the approaches to the restoration of teeth, especially with increased understanding of the concept of restoration repair as an alternate to replacement.

Introduction

Despite many advances in prevention, oral health education, improved oral hygiene practices and the availability of fluoride, the management of caries, via the placement of restorations, remains a significant component of the day-to-day work of the dental team. Despite efforts to reduce the effects of caries, population-based studies reveal that the prevalence of caries remains stubbornly high. An example of this is seen within the United Kingdom population, where 84% of dentate adults were found to have at least one restoration [ ]. Of these adults each had, on average, 7.2 filled teeth. Such figures are of concern when one considers the dental maintenance requirements of these patients, particularly as each restoration will require periodic intervention and management, let alone when one considers that the longevity of dental restorations in primary dental care settings is poor. Analysis of the survival of dental restorations from within a large database of dental treatments within UK dental practice reveals that further intervention is required [ ]:

  • within 11% of fillings after 1 year of placement

  • within 20% of fillings after 3 years of placement

  • within 50% of fillings after 10 years of placement

It is easy to appreciate that all restorations will ultimately suffer deterioration and degradation leading to the need for further intervention [ ]. Reasons for this can include marginal defects, secondary caries, fracture of the restoration or adjacent tooth substance and, in the case of tooth-coloured restorations, unacceptable appearance [ ]. However, the decision to intervene in an existing restoration may be highly subjective on the part of the operator: factors such as the age of the patient, the size and location of the restoration can influence the rate at which existing restorations receive further intervention, as can changing dentist [ ]. As such, there is potential for over-treatment. The risk of iatrogenic effects with over-treatment, notably the needless replacement of existing restorations, are significant, and often associated with the inevitably unnecessary loss of intact, healthy tooth tissue. Over the course of a lifetime, many such interventions cause great harm to a tooth, descending the so-called “restorative death spiral” [ ]. If a patient has a number of teeth irretrievably slipping down this spiral, the effects on the dentition may be many and varied, including a progressive deterioration in dental attractiveness and loss of occlusal function, possibly influencing quality of life. Also, lifetime cost of dental care may be substantially increased.

Almost 20 years ago, a review [ ] of studies with similar methodology reported that replacement restorations accounted for 56% of restorations placed by dentists. This review included studies performed between 1981 and 1998, and aggregated their findings. Since then there have been many changes in the approaches to the restoration of teeth. These include:

  • enhanced understanding of when it is necessary or, more precisely, not necessary to intervene in existing restorations.

  • a greater understanding of the concept of restoration repair where, in the presence of secondary caries or fracture, it is possible to perform a localised repair rather than unnecessarily removing the restoration in its entirety.

  • an increased use, matched by predictability, in the use of adhesive dentistry techniques, particularly the application of resin composites (composites) in posterior teeth.

As such, it was considered useful to expand the previous review to include studies completed since 1998, and to investigate, in particular, if patterns of placement/replacement restorations have changed. Therefore, the aim of the present study was to review relevant papers with a similar methodology published since 1981 and to consider the effects, if any, of recent changes in the approach to the restoration of teeth and management of already-restored teeth.

Methods

For the purposes of this review, studies based around the protocol of Mjör 1981 [ ] were selected. Such studies involved participating dentists completing a proforma each time a patient presented for a new or replacement restoration over a period of time. Dentists were asked to record all restorations placed, and indicate the main reason for the initial placement or replacement from a set of options.

Studies that did not include the selected methodology were excluded. Also, studies were excluded if they reported on reasons for placement only, restorations for anterior teeth only, or if it was not possible to separate data pertaining to different types of restoration.

Studies were identified using searches of electronic databases, as well as hand-searching of the literature, including the reference lists of related and similar studies. The search was last updated in September 2017.

The data sought was extracted from the reports of the selected studies and collated for analyses and comparison.

Methods

For the purposes of this review, studies based around the protocol of Mjör 1981 [ ] were selected. Such studies involved participating dentists completing a proforma each time a patient presented for a new or replacement restoration over a period of time. Dentists were asked to record all restorations placed, and indicate the main reason for the initial placement or replacement from a set of options.

Studies that did not include the selected methodology were excluded. Also, studies were excluded if they reported on reasons for placement only, restorations for anterior teeth only, or if it was not possible to separate data pertaining to different types of restoration.

Studies were identified using searches of electronic databases, as well as hand-searching of the literature, including the reference lists of related and similar studies. The search was last updated in September 2017.

The data sought was extracted from the reports of the selected studies and collated for analyses and comparison.

Results

Studies included

The original review included 12 papers [ ] ( Table 1 ). A review of the literature identified one additional paper from this period that was not included in the ‘original’ review [ ]. This paper was added to this current review.

Table 1
Original review: details of the restorations surveyed according to material and placement: replacement ratio.
Author(s) Year of publication Clinicians (Characteristics) Country Materials (where reported) Number of restorations n (%) Overall number of placement and replacement where reported Placement: replacement ratio
Placement Replacement
Mjor IA [ ] 1981 General Practitioners (Private practice) Sweden Amalgam 3527 (64.3%) 1023 (29%) 2504 (71%) 1:2.4
Composite 1960 (35.7%) 416 (21.2%) 1544 (78.8%) 1:3.7
Total 5487 (100%) 1439 (26.2%) 4048 (73.8%) 1:2.8
Qvist & others [ ] 1986 General Practitioners (postgraduate courses) Denmark Amalgam 1032 (70.9%) 491 (47.6%) 541 (52.4%) 1:1.1
Composite 424 (29.1%) 165 (38.9%) 259 (61.1%) 1:1.6
Total 1456 (100%) 656 (45.1%) 800 (54.9%) 1:1.2
Qvist & others [ ] 1990 General Practitioners (postgraduate courses) Denmark Amalgam 2317 (54%) 904 (39%) 1413 (61%) 1:1.6
Composite 1974 (46%) 752 (38.1%) 1222 (61.9%) 1:1.6
Total 4291 (100%) 1656 (38.6%) 2635 (61.4%) 1:1.6
Mjor & Toffenetti [ ] 1992 General Practitioners Italy Amalgam 1935 (65.4%) 1148 (59.3%) 787 (40.7%) 1:0.7
Composite 1025 (34.6%) 530 (51.7%) 495 (48.3%) 1:0.9
Total 2960 (100%) 1678 (56.7%) 1282 (43.3%) 1:0.8
Mjor & Um [ ] 1993 General Practitioners South Korea Amalgam 760 (64.7%) 471 (62%) 289 (38%) 1:0.6
Composite 415 (35.3%) 245 (59%) 170 (41%) 1:0.7
Total 1175 (100%) 716 (60.9%) 459 (39.1%) 1:0.6
Pink & others [ ] 1994 General Practitioners USA Amalgam 1825 (54%) 812 (44.5%) 1013 (55.5%) 1:1.2
Composite 1553 (46%) 741 (47.7%) 812 (52.3%) 1:1.1
Total 3378 (100%) 1553 (46%) 1825 (54%) 1:1.2
Wilson & others [ ] 1997 General Practitioners (university affiliated) United Kingdom Amalgam 1076 (45.2%) 377 (35%) 699 (65%) 1:1.9
Composite 876 (36.8%) 342 (39%) 534 (61%) 1:1.6
Glass ionomer 427 (18%) 149 (34.9%) 278 (65.1%) 1:1.9
Total 2379 (100%) 868 (36.5%) 1511 (63.5%) 1:1.7
Deligeorgi & others [ ] 1998 Students United Kingdom Amalgam 695 (51%) 290 (41.7%) 405 (58.3%) 1:1.4
Composite 465 (34.1%) 221 (47.5%) 244 (52.5%) 1:1.1
Glass ionomer 202 (14.8%) 168 (83.2%) 34 (16.8%) 1:0.2
Total 1362 (100%) 679 (49.9%) 683 (50.1%) 1:1
Deligeorgi & others [ ] 1998 Students Greece Amalgam 514 (43.6%) 321 (62.5%) 193 (37.5%) 1:0.6
Composite 601 (51%) 354 (58.9%) 247 (41.1%) 1:0.7
Glass ionomer 63 (5.3%) 48 (76.2%) 15 (23.8%) 1:0.3
Total 1178 (100%) 723 (61.4%) 455 (38.6%) 1:0.6
Burke & others [ ] 1999 Vocational dental practitioners and trainers United Kingdom Amalgam 4871 (53.9%) 1:1.3
Composite & Compomer 2690 (29.8%) 1:1.1
Glass ionomer & modified glass ionomer 1470 (16.3%) 1:0.7
Total 9031 (100%) 4423 (49%) 4608 (51%) 1:1
Total 32,697 (100%) 14,391 (44%) 18,306 (56%) 1:1.3
*empty cells indicate that data was not reported.

Twelve additional papers [ ] were identified and added to the post-1998 review ( Table 2 ). In some cases, two papers reported different aspects of the same study. Not all the papers reported data to the same level of detail. However, a decision was made to include these papers, as their exclusion would have skewed the answers to some of the key research questions (e.g. the overall ratio of placements: replacements).

Table 2
Post-1998 Details of the restorations surveyed according to material and placement: replacement ratio.
Author(s) Year of publication Clinicians (Characteristics) Country Materials (Where reported) Number of restorations n (%) Overall number of placement and replacement where reported Placement: replacement ratio
Placement Replacement
Mjor & Moorhead [ ] 1998 General Practitioners USA Amalgam 780 (38.3%) 392 (50.3%) 38 8 (49.7%) 1:0.99
Composite 832 (40.9%) 411 (49.4%) 421 (50.6%) 1:1.02
Glass ionomer 81 (4%) 38 (46.9%) 43 (53.1%) 1:1.1
Other 342 (16.8%) 115 (33.6%) 227 (66.4%) 1:1.97
Total 2035 (100%) 956 (47%) 1079 (53%) 1:1.1
Mjor & others [ ] 1999 & 2000 General Practitioners (Private & Salaried) Norway Amalgam 7165 (32%) 2006 (28%) 5634 (72%) 1:2.8
Composite 9180 (41%) 2293 (25%) 7004 (75%) 1:3
Glass ionomer 1791 (8%) 1003 (56%) 609 (44%) 1:0.6
modified glass ionomer 3583 (16%) 1648 (46%) 1522 (54%) 1:0.9
Other 672 (3%) 215 (32%) 457 (68%) 1:2
Total 22391 (100%) 7165 (32%) 15226 (68%) 1:2
Burke & others [ ] 2001 General Practitioners UK Amalgam 1710 (53.5%)
Composite 1008 (31.5%)
Glass ionomer 213 (6.7%)
Compomer 265 (8.3%)
Total 3196 (100%) 1097 (34.3%) 2099 (65.7%) 1:1.9
Mjor & others [ ] 2002 General Practitioners Iceland Amalgam(all prim + perm) 2435 (29.2%)
Composite 4449 (52.7%)
Glass ionomer 839 (9.5%)
modified glass ionomer 588 (7.1%)
Other 84 (1.4%)
Total 8395 (100%) 4398(52.4%) 3997 (47.6%) 1:0.9
Frost [ ] 2002 General Practitioners UK Amalgam 167 (21.4%) 55 (32.9%) 112 (67.1%) 1:2
Composite 89 (11.4%) 53 (59.6%) 36 (40.4%) 1:0.7
Glass ionomer 430 (55.2%) 196 (45.6%) 234 (54.4%) 1:1.2
Not specified 93 (12%) 60 (64.5%) 33 (35.5%) 1:0.6
Total 779 (100%) 364 (46.7%) 415 (53.3%) 1:1.4
Al-Negrish [ ] 2002 & 2001 General Practitioners Jordan Amalgam 3166 (58.6%) 1734 (54.8%) 1432 (45.2%) 1:0.8
Composite 2239 (41.4%) 1380 (61.6%) 859 (38.4%) 1:0.6
Total 5405 (100%) 3114 (58%) 2291 (42%) 1:0.7
Palotie & Vehkalahti [ ] 2003 General Practitioners (Public dental services) Finland Amalgam 143 (4.7%)
Composite 2076 (67.9%)
Glass ionomer & modified glass ionomer 640 (21%)
Temporary 137 (4.5%)
Unreported 60 (1.9%)
Total 3056 (100%) 2074 (67.9%) 982 (32.1%) 1:0.5
Forss &Widstrom [ ] 2004 General Practitioners (Private practice) Finland Amalgam 155 (4.5%)
Composite 2712 (78.5%)
Glass ionomer & modified glass ionomer 229 (6.6%)
Compomer 152 (4.4%)
Indirect restorations 134(3.9%)
Unreported 73 (2.1%)
Total 3455 (100%) 1206 (34.9%) 2249 (65.1%) 1:1.9
Tyas [ ] 2005 General Practitioners Australia Amalgam 767 (28.2%)
Composite 1481 (54.5%)
Glass ionomer 406 (14.9%)
modified glass ionomer 44 (1.6%)
Unreported 18 (0.7%)
Total 2716 (100%) 1256 (46.2%) 1460 (53.8%) 1:1.2
Udoye & Okechi [ ] 2008 General Practitioners Nigeria Amalgam 320 (71.1%)
Composite 100 (22.2%)
Glass ionomer 30 (6.7%)
Total 450 (100%) 324 (72%) 126 (28%) 1:0.4
Sunnegardh-Gronberg & others [ ] 2009 General Practitioners (Public dental health) Sweden Amalgam 7 (0.3%) 0 7 (100%)
Composite 1936 (90.3%) 624 (32.2%) 1312 (67.8%) 1:2.1
Glass ionomer & modified glass ionomer 152 (7.1%) 34 (22.4%) 118 (77.6%) 1:3.5
Other 50 (2.3%) 13 (26%) 37 (74%) 1:2.8
Total 2145(100%) 671(31.3%) 1474 (68.7%) 1:2.2
Total 54,023 22,625 (41.9%) 31,398 (58.1%) 1:1.4
Only gold members can continue reading. Log In or Register to continue

Jun 17, 2018 | Posted by in General Dentistry | Comments Off on An update on the reasons for placement and replacement of direct restorations
Premium Wordpress Themes by UFO Themes