A Systematic Review of Recall Regimen and Maintenance Regimen of Patients with Dental Restorations. Part 1: Tooth‐Borne Restorations

Abstract

Purpose To evaluate the current scientific evidence on patient recall and maintenance of dental restorations on natural teeth, standardize patient care regimens, and improve maintenance of oral health. An additional purpose was to examine areas of deficiency in the current scientific literature and provide recommendations for future studies. Materials and Methods An electronic search for articles in the English language literature from the past 15 years was performed independently by multiple investigators using a systematic search process. After application of predetermined inclusion and exclusion criteria, the final list of articles was reviewed in depth to meet the objectives of this review. Results The initial electronic search resulted in 2161 titles. The systematic application of inclusion and exclusion criteria resulted in 12 articles that met the objectives of the study. An additional 4 articles were added through a supplemental search process for a total of 16 studies. Out of these, 9 were randomized controlled clinical trials and 7 were observational studies. The majority of the studies (14 out of 16) were conducted in the past 5 years, and most of the studies were conducted in Europe (10). Results from the qualitative data, on a combined 3569 patients, indicated that outcome improvements in recall and maintenance regimen were related to (1) patient/treatment characteristics (adherence to recall appointments, type of restoration and type of restorative material); (2) agent (chlorhexidine, fluoride, triclosan); and (3) professional interventions (repeated oral hygiene instruction, regular oral hygiene intervention). Conclusions There is minimal evidence related to recall regimens in patients with removable and fixed tooth‐borne restorations; however, there is considerable evidence indicating that patients with tooth‐borne removable and fixed restorations require lifelong dental professional maintenance to provide repeated oral hygiene instruction and regular oral hygiene intervention customized to each patient's treatment. Current evidence also indicates that use of specific oral topical agents like chlorhexidine, fluoride, and triclosan can aid in reducing risk for gingival inflammation, dental caries, and candidiasis. Therefore, these agents may aid in improvement of professional and at‐home maintenance of various tooth‐borne dental restorations. Furthermore, due to the heterogeneity of patient populations, restorations, and treatment needs, the evidence compels forethought of creating clinical practice guidelines for recall and maintenance of patients with tooth‐borne dental restorations.

Clinical practice guidelines for recall and maintenance of patients with tooth-borne and implant-borne dental restorations

“…Given the resources required to treat patients with complex dental needs, an appropriate patient recall regimen, professional maintenance regimen, and at-home maintenance regimen are paramount for long-term success. 13,14 Furthermore, it is likely that the professional and at-home maintenance protocols in healthy adult patients with tooth-and implant-borne restorations may be significantly different when compared to patients with no restorations, or patients with acute or chronic oral and systemic diseases. For toothborne restorations, guidelines on the options and relative merits of professional and at-home maintenance protocols to predictably achieve stable results are lacking.…”

“…For toothborne restorations, guidelines on the options and relative merits of professional and at-home maintenance protocols to predictably achieve stable results are lacking. 13 Current guidelines for the maintenance of implant restorations are poorly defined and often based on empiricism or traditional protocols for patients with natural dentition rather than what is most suitable for maintenance of implant restorations and supporting tissues.…”

“…The detailed methodology for the search processes are described in the respective systematic review articles. 13,14 For tooth-borne restorations, 16 studies were identified in the systematic review that reported data on a combined 3569 patients. Of these, nine were randomized controlled clinical trials (RCT), and seven were observational studies.…”

“…Two separate systematic reviews of the literature were conducted to evaluate the recall and maintenance regimens for tooth-and implant-borne restorations. 13,14 The systematic review on tooth-borne restorations included articles published from January 1, 1999 to December 31, 2014. The systematic review on implant-borne restorations included articles published from January 1, 2004 to December 31, 2014.…”

A Call for a Continuing Dialogue on Recall and Maintenance of Patients with Tooth‐Borne and Implant‐Borne Restorations

“…The response to the publication of our recent systematic reviews and clinical practice guidelines (CPGs) has been encouraging. Soon after the release of the Journal of Prosthodontics supplement, Yahoo Finance, Econotimes.com, and other national media outlets picked it up.…”