Abstract
Objective
In this study the literature was systematically reviewed to investigate the clinical longevity of anterior composite restorations.
Data
Clinical studies investigating the survival of anterior light-cured composite restorations with at least three years of follow-up were screened and main reasons associated with restoration failure were registered.
Sources
PubMed, Scopus, and Cochrane databases were searched without restriction on date or language. Reference lists of eligible studies were hand-searched. The grey literature search was not made systematically.
Study selection
Two reviewers screened titles and/or abstracts of 2273 unique studies. In total, 41 studies were selected for full-text reading, from which 17 were included in the qualitative synthesis. The included studies evaluated the clinical performance of Class III and/or IV restorations (10 studies), which were placed due to caries, fracture, or replaced old restorations; veneers and full-coverage restorations placed for aesthetic reasons (five studies); and restorations in worn teeth (two studies). Annual failure rates (AFRs) were calculated for each study.
Conclusions
In total, 1821 restorations were evaluated and the total failure rate was 24.1%. AFRs varied from 0 to 4.1% and survival rates varied from 53.4% to 100%. Class III restorations generally had lower AFRs than the other restorations. Few studies addressed factors associated with failure, which included adhesive technique, composite resin, retreatment risk, and time required to build-up the restoration. Fracture of tooth/restoration was the most common reason for failure, whereas failures related to aesthetic qualities (color, anatomical form, surface stain) were more frequent when restorations were placed for aesthetic reasons.
1
Introduction
Dental caries remains a highly prevalent disease affecting a large part of the global population, especially those more deprived . A large demand for restorative procedures in clinical dentistry is still observed, with placement (and replacement) of restorations being one of the most common dental procedures accounting for a significant part of the dentists’ working time . Since their introduction, composite resins have gained popularity as restorative materials, particularly due to their aesthetic properties and reduction of sound tissue removal . A continuous development in composites’ technology has also occurred in the past decades. Currently, composite resin is the first choice material to restore anterior and posterior teeth .
Clinical data on the performance of posterior composite restorations are abundant in the literature, usually indicating that these restoratives might present low annual failure rates (AFRs) and long-lasting survival in posterior teeth . The main reported reasons for failure in posterior teeth are secondary caries and fracture . In contrast, despite the large use of composites in the anterior area, there is a lack of evidence from clinical trials regarding the performance of anterior restorations in the long term. Clinical trials on anterior restorations usually are limited to periods up to three years, with follow-up for periods over 10 years being seldom reported .
The increasing demand for aesthetics, especially in anterior teeth, suggests that restorative needs and reasons for restoration failure other than caries and fracture might occur in a large extent in anterior restorations. However, this remains to be determined, especially in long-term clinical trials. Another factor of interest is to determine if formulation characteristics of composites such as filler size could influence the clinical performance of anterior restorations. A number of distinct composites are available for use in anterior teeth; in vitro tests usually indicate differences among materials whereas appreciable differences between composites are hardly observed in vivo . In addition, it has been shown that patients’ factors and operator characteristics might affect the long-term performance of posterior composite restorations ; the same could be true for anterior restorations, but there is no available evidence to support that yet.
The aim of this study was to gather information by a systematic review of the literature on the long-term clinical performance of composite resin restorations placed in anterior teeth. Clinical studies investigating the survival of anterior composite restorations with follow-up periods of at least three years were searched to address main reasons for restorations failure and investigate whether variables related to patient, operator, and materials would impact the clinical longevity of direct restorations.
2
Materials and methods
2.1
Eligibility criteria
This systematic review is reported in accordance with the PRISMA Statement guidelines . Eligible studies were longitudinal prospective or retrospective clinical trials that evaluated the clinical survival of direct restorations in anterior permanent teeth placed with visible light-cured composite resin. The restorations evaluated included Class III and IV cavities, direct veneers, and full-coverage build-ups. Included studies should have a follow-up time of at least three years.
2.2
Search strategy
Selection of studies was based on a search strategy for each international electronic database (National Library of Medicine – MEDLINE/PubMed, SciVerse Scopus, and Cochrane Central Register of Controlled Trials), being the last search carried out in December 3, 2014. The structured search strategy is detailed in Table 1 . The search and selection of studies was performed without any restriction on date or language. The references of all eligible studies identified by the search were checked to find other relevant studies, while the grey literature search was not made systematically.
| Search | Topic and terms |
|---|---|
| #4 | Search #1 AND #2 AND #3 |
| #3 | Composite resin: “composite resins”[MeSH Terms] OR “resins, composite” OR (“composite”[All Fields] AND “resins”[All Fields]) OR “composite resins”[All Fields] OR (“composite”[All Fields] AND “resin”[All Fields]) OR “composite resin”[All Fields] |
| #2 | Anterior teeth/Restoration: ((“front”[All Fields] OR “anterior”[All Fields]) AND (“tooth”[MeSH Terms] OR “tooth”[All Fields] OR “teeth”[All Fields])) OR “Dental Veneers” [MeSH Terms] OR “Dental Veneers” [All Fields] OR “Veneer, Dental” [All Fields] OR “Veneers, Dental” [All Fields] OR “Dental Laminates” [All Fields] OR “Dental Laminate” [All Fields] OR “Laminate, Dental” [All Fields] OR “Laminates, Dental” [All Fields] OR “Dental Veneer”[All Fields] OR “Class III” [All Fields] OR “Class IV” [All Fields]) |
| #1 | Clinical trial/Longitudinal study/Retrospective study: ((“clinical” [Title/Abstract] AND “trial” [Title/Abstract]) OR “clinical trials” [MeSH Terms] OR “clinical trial” [Publication Type] OR random*[Title/Abstract] OR “random allocation”[MeSH Terms] OR “therapeutic use” [MeSH Subheading] OR “Longitudinal Studies”[MeSH Terms] OR “Longitudinal Studies” [All Fields] OR “Longitudinal Study” [All Fields] OR “Studies, Longitudinal” [All Fields] OR “Study, Longitudinal” [All Fields] OR “Longitudinal Survey” [All Fields] OR “Longitudinal Surveys” [All Fields] OR “Survey, Longitudinal” [All Fields] OR “Surveys, Longitudinal” [All Fields] OR “Retrospective Studies”[MeSH Terms] OR “Studies, Retrospective” [All Fields] OR “Study, Retrospective” [All Fields] OR “Retrospective Study” [All Fields] OR “Clinical Evaluation” [All Fields] OR “Follow-up” [All Fields]) |
a Searches in Scopus and Cochrane were adapted according to the database.
2.3
Study selection
Titles and abstracts of all identified studies were screened independently by two reviewers (K.C. and F.H.C.) for eligibility. All studies that met the eligibility criteria were selected for full-text reading. Full-text articles that fulfilled the eligibility criteria were included in the study and processed for data extraction, while reasons for exclusion were recorded. In all steps, lists were compared between the reviewers; in case of disagreement, final decisions on inclusion or exclusion were made following discussion with an experienced researcher (F.F.D.).
2.4
Data extraction
Data from selected full-text papers were independently extracted by the two reviewers. Data collection was done on general study information, intervention characteristics, and longevity outcomes (AFR, survival rate or success rate, and factors associated with restoration failure). For studies that presented results in survival or success rate, the AFR were calculated according to the formula: (1 − y ) z = (1 − x ), in which ‘ y ’ expresses the mean AFR and ‘ x ’ the total failure rate at ‘ z ’ years . Data were divided in three groups according to type of restoration assessed. For two reports from the same group , data were collected and included in the table together because the studies had the same sample and follow-up time, only differing in the clinical outcome assessed for the same restorations.
2.5
Data analysis
High heterogeneity was observed among the selected studies regarding study design, methods, and outcomes. Therefore, a meta-analysis was not considered appropriate and a qualitative synthesis was performed for the data collected.
2
Materials and methods
2.1
Eligibility criteria
This systematic review is reported in accordance with the PRISMA Statement guidelines . Eligible studies were longitudinal prospective or retrospective clinical trials that evaluated the clinical survival of direct restorations in anterior permanent teeth placed with visible light-cured composite resin. The restorations evaluated included Class III and IV cavities, direct veneers, and full-coverage build-ups. Included studies should have a follow-up time of at least three years.
2.2
Search strategy
Selection of studies was based on a search strategy for each international electronic database (National Library of Medicine – MEDLINE/PubMed, SciVerse Scopus, and Cochrane Central Register of Controlled Trials), being the last search carried out in December 3, 2014. The structured search strategy is detailed in Table 1 . The search and selection of studies was performed without any restriction on date or language. The references of all eligible studies identified by the search were checked to find other relevant studies, while the grey literature search was not made systematically.
| Search | Topic and terms |
|---|---|
| #4 | Search #1 AND #2 AND #3 |
| #3 | Composite resin: “composite resins”[MeSH Terms] OR “resins, composite” OR (“composite”[All Fields] AND “resins”[All Fields]) OR “composite resins”[All Fields] OR (“composite”[All Fields] AND “resin”[All Fields]) OR “composite resin”[All Fields] |
| #2 | Anterior teeth/Restoration: ((“front”[All Fields] OR “anterior”[All Fields]) AND (“tooth”[MeSH Terms] OR “tooth”[All Fields] OR “teeth”[All Fields])) OR “Dental Veneers” [MeSH Terms] OR “Dental Veneers” [All Fields] OR “Veneer, Dental” [All Fields] OR “Veneers, Dental” [All Fields] OR “Dental Laminates” [All Fields] OR “Dental Laminate” [All Fields] OR “Laminate, Dental” [All Fields] OR “Laminates, Dental” [All Fields] OR “Dental Veneer”[All Fields] OR “Class III” [All Fields] OR “Class IV” [All Fields]) |
| #1 | Clinical trial/Longitudinal study/Retrospective study: ((“clinical” [Title/Abstract] AND “trial” [Title/Abstract]) OR “clinical trials” [MeSH Terms] OR “clinical trial” [Publication Type] OR random*[Title/Abstract] OR “random allocation”[MeSH Terms] OR “therapeutic use” [MeSH Subheading] OR “Longitudinal Studies”[MeSH Terms] OR “Longitudinal Studies” [All Fields] OR “Longitudinal Study” [All Fields] OR “Studies, Longitudinal” [All Fields] OR “Study, Longitudinal” [All Fields] OR “Longitudinal Survey” [All Fields] OR “Longitudinal Surveys” [All Fields] OR “Survey, Longitudinal” [All Fields] OR “Surveys, Longitudinal” [All Fields] OR “Retrospective Studies”[MeSH Terms] OR “Studies, Retrospective” [All Fields] OR “Study, Retrospective” [All Fields] OR “Retrospective Study” [All Fields] OR “Clinical Evaluation” [All Fields] OR “Follow-up” [All Fields]) |
a Searches in Scopus and Cochrane were adapted according to the database.
2.3
Study selection
Titles and abstracts of all identified studies were screened independently by two reviewers (K.C. and F.H.C.) for eligibility. All studies that met the eligibility criteria were selected for full-text reading. Full-text articles that fulfilled the eligibility criteria were included in the study and processed for data extraction, while reasons for exclusion were recorded. In all steps, lists were compared between the reviewers; in case of disagreement, final decisions on inclusion or exclusion were made following discussion with an experienced researcher (F.F.D.).
2.4
Data extraction
Data from selected full-text papers were independently extracted by the two reviewers. Data collection was done on general study information, intervention characteristics, and longevity outcomes (AFR, survival rate or success rate, and factors associated with restoration failure). For studies that presented results in survival or success rate, the AFR were calculated according to the formula: (1 − y ) z = (1 − x ), in which ‘ y ’ expresses the mean AFR and ‘ x ’ the total failure rate at ‘ z ’ years . Data were divided in three groups according to type of restoration assessed. For two reports from the same group , data were collected and included in the table together because the studies had the same sample and follow-up time, only differing in the clinical outcome assessed for the same restorations.
2.5
Data analysis
High heterogeneity was observed among the selected studies regarding study design, methods, and outcomes. Therefore, a meta-analysis was not considered appropriate and a qualitative synthesis was performed for the data collected.
3
Results
The flow diagram of the systematic review is shown in Fig. 1 . From the initial 2273 studies identified after removal of duplicates, 41 full-text articles were assessed for eligibility and 17 studies were included in the qualitative analysis. The included studies evaluated the clinical performance of Class III and/or Class IV restorations (10 studies), which were placed due to caries, fracture, or replaced old restorations; veneers and full-coverage restorations placed for aesthetic reasons (five studies); and restorations placed in worn teeth (two studies). In total, 1821 restorations were evaluated and the failure rate was 24.1% (439 restorations), without taking into consideration the follow-up times.
Table 2 shows all studies included in the systematic review and the variables collected. Included studies were published between 1996 and 2013, and the follow-up times varied from three to 17 years, with six articles reporting follow-up periods over 10 years. Most studies were carried out prospectively, in European dental schools, with multiple operators placing the restorations. Dental students were operators in only one study . The number of restorations in each study varied from 25 to 341, with most studies including less than 100 restorations. Only 7 studies were restricted to the evaluation of anterior direct restorations. A modified version of the United States Public Health Service (USPHS) criteria was the criteria most often used to evaluate restorations; three studies used their own criteria, and the two most recently published studies used the FDI World Dental Federation criteria .
| Author, Year | Country | Service type/Operators/Study design 1 | Follow-up time (years) | Patients/Number of restorations | Restoration type 2 | Composite 3 | Success rate/AFR 4 | Failure criteria 5 | Factors associated with failure |
|---|---|---|---|---|---|---|---|---|---|
| Restorations in worn teeth | |||||||||
| Al-Khayatt et al., 2013 | England/UK | Dental hospital/Multi/PL | 7 | 15/85 | Build-ups | Herculite XRV | 85%/2.3% | Modified USPHS | Time to build-up the restoration |
| Smales and Berekally, 2007 | Australia | Dental hospital/Multi/RL | 10 | * /164 | 125 (Class IV) 39 (Build-up) |
* | 74.4%/3% | Own criteria a | * |
| Restorations for aesthetic reasons | |||||||||
| Gresnigt et al., 2012 | Netherlands | University/Multi/PL | 4 | 23/96 | VENEERS/Reanatomization | Enamel Plus HFO, Miris2 | 87.5%/3.2% | Modified USPHS | No factors were associated |
| Peumans et al., 1997 | Belgium | Private clinic/Single/PL | 5 | 23/87 | Veneers/Diastemas | Herculite XRV | 82.8%/3.7% | Own criteria b | * |
| Frese et al., 2013 | Germany | Dental hospital/Multi/RL | 5 | 58/176 | Veneers/Diastemas | Enamel Plus HFO, Artemis, Herculite XRV, EsthetX | 84.6%/3.2%†† | Modified USPHS/FDI | * |
| Alonso et al., 2012 | Spain | Private clinic/Single/RL | 11 | 13/21 | Veneers/Reanatomization | TPH Spectrum, Herculite XRV, Filtek A110 | 75.2%/2.6% | Modified USPHS | * |
| Restorations due to caries, fractures, and replaced restorations | |||||||||
| Ermis et al., 2010 | Turkey | University/Single/PL | 3 | 30/80 | Class III | Clearfil AP-X | No failures | Modified USPHS | * |
| de Moura et al., 2011 | Brazil | University/Multi/RL | 3 | * /170 | 134 (Class III) 36 (Class IV) |
TPH Spectrum | 91.8%/2.8% (Class III) 77.8%/8.0% (Class IV) | Modified USPHS | * |
| Deliperi, 2008 | Italy | * / * /PL | 5 | 20/25 | Class III/Class IV | Vitalescence | No failures | Modified USPHS | * |
| van Dijken, 1999 | Sweden | * /Multi/PL | 5 | 52/149 | Class III/Class IV | Pekafill PLT | 96%/0.8% | Modified USPHS | * |
| Spinas, 2004 | Italy | University/ * /PL | 7 | * /70 | Class IV † | * | 100% failures | Modified USPHS | * |
| Millar et al., 1997 | England/UK | Research institute/Multi/PL | 8 | * /28 | 25 (Class III) 3 (Class IV) |
Opalux | 85.7%/1.9% | Modified USPHS | * |
| Kubo et al., 2011 | Japan | University/Single/RL | 10 | 58/147 | Class III | Clearfil AP-X | 81.5%/2% | Modified USPHS | Replacement risk, adhesive technique |
| van Dijken and Pallesen, 2010 | Sweden | * / * /PL | 14 | * /43 | Class IV | Pekafill PLT | 74.4%/2.1% | Modified USPHS | * |
| Smales and Hawthorne, 1996 | Australia | Private clinic/Multi/RL | 15 | * /341 | 284 (Class III) 57 (Class IV) |
* | 53.4%/4.1% | Own criteria c | * |
| Baldissera et al., 2013 | Brazil | Private clinic/Single/RL | 17 | 55/219 | 168 (Class III) 51 (Class IV) |
Charisma, Herculite XRV | 89.9%/0.6% | FDI | Composite tested |
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