Elsevier

Journal of Dentistry

Volume 37, Issue 9, September 2009, Pages 673-678
Journal of Dentistry

Selection of dental materials and longevity of replaced restorations in Public Dental Health clinics in northern Sweden

https://doi.org/10.1016/j.jdent.2009.04.010Get rights and content

Abstract

Objectives

To investigate the selection of direct restorative materials and longevity of replaced restorations in relation to operator and patients characteristics.

Methods

A cross-sectional study of treatment in practice, recording all new placements and replacements of direct restorations was performed during 2 weeks comprising all dentists within the Public Dental Health clinics in the county council of Västerbotten.

Results

A total of 2834 data collection sheets, one for each placed restoration, were received with a dropout of 10%. Restorations analyzed in the study were placed in permanent teeth in patients older than 15 years. First restorations placed due to primary caries were 671 and replacements 1536. Class II was the most frequently treated cavity followed by class I. The median longevity of replaced restorations was for amalgam, resin based composite and glass ionomer 16, 6 and 11 years, respectively. High caries risk patients showed shorter longevity for resin based composite restorations than low or moderate risk patients. Secondary caries as reason for failure for class II resin based composite restorations occurred significantly later than loss or fracture. Significantly longer longevity was observed for replaced restorations executed by more experienced dentists.

Conclusions

The use of amalgam was negligible and the material was predominantly replaced by resin based composites in first and replaced restorations. Class II was the most frequent placed and replaced restorations. Caries risk and experience of operator influenced longevity of replacements.

Introduction

New dental materials, operative techniques and treatment strategies have been introduced during the last years decreasing the use of amalgam in Sweden. Tooth coloured materials have replaced amalgam successively as a restorative in all indication areas.1 Consequently cavity preparations have become less destructive by using adhesive techniques and the intervention of dental caries is shifting towards more preventive based strategies based on individualized needs and recall patterns. Clinical evaluations of new materials and techniques are mostly performed in longitudinal trials, carried out under well defined conditions and performed by few operators with small numbers of patients, reflecting the potential of the restorative materials.2, 3, 4 Cross-sectional studies performed in Public Dental Health clinics mirror real-life dentistry and may give more information about the performance of restoratives in general practice when used by many operators.5 Both study designs are needed to illustrate the long-term function of restorations. The need of conferment in General Dental Services is therefore necessary. In the Swedish Public Dental Health, patient's recall visits are based upon recall intervals regarding the individual risk of caries, periodontal disease and the technical degree of difficulty. Children and adolescents up to 19 years of age are free of charge. The aim of this study was to evaluate quality aspects of placement of restorations and to measure longevity of replaced restorations. The null hypothesis was that no significant differences exist between cavity classes regarding longevity of replaced resin composite restorations.

Section snippets

Participants and study design

The study design was a cross-sectional structured data collection study, aimed to investigate treatment in practice, applied to consecutive patients at the Public Dental Health clinics in the county council of Västerbotten in north Sweden. All 31 clinics were invited to participate. The production within the Public Dental Health clinics was in the year 2006, 71,810 direct placed restorations. The inhabitants of the county that year were 257,581 persons and 124,836 of those were registered as

Results

A total of 2834 data collection sheets were collected. They consisted, according to the payment claims of 90% of the 3140 consecutive treatments performed in 2295 patients by the participating 99 dentists (42 men, 53 women and 4 unstated) during the 2 weeks registration period. Restorations analyzed in the study were placed in permanent teeth in patients older than 15 years (n = 2449). A subgroup with the inclusion criteria “reason for treatment: replacement” was formed (n = 1599) to be analyzed in

Discussion

A marked change in selection of dental restorative materials started in Sweden during the nineties following recommendations to use other restorative materials than amalgam as the first choice material.5, 7 Mjör described in 1997 an increasing use of RC in stress bearing cavities reported by a group Swedish general practitioners.5 In the present study, the predominant material used was RC in all placed (93%) and replaced cavity types (89%). Less than 1% of the restorations placed were amalgam.

Conclusions

It can be concluded that the use of amalgam was negligible and substituted with RC in both first and replaced restorations. Class II cavities were the most frequent placed and replaced restorations. Replaced RC restorations showed a median longevity of 6 years with the shortest for class II and the longest for class III restorations. Replacements made in patients with high caries risk show decreased longevity compared with low risk patients. Dentist with less professional experience made

Acknowledgements

The authors sincerely thank the clinicians’ at Public Dental Health clinics for all time and effort spent in completing the recordings. The support from the County council of Västerbotten and the National Board of Welfare is gratefully acknowledged.

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