Direct composite restorations for the worn mandibular anterior dentition: a 7‐year follow‐up of a prospective randomised controlled split‐mouth clinical trial

Abstract

The purpose of this study was to report on the 7-year follow-up of 15 patients who took part in a prospective randomised controlled split-mouth trial to evaluate the performance and patient satisfaction of 107 direct composite restorations bonded to their worn anterior mandibular dentition. This is the continuation of a study by Poyser et al., which investigated the performance of the same direct composite restorations on this cohort of patients at 2.5 years. The results of the present study suggest that direct composite restorations bonded to the worn anterior mandibular dentition to have an approximate survival of 85% at the 7-year follow-up. Approximately 53% of patients experienced survival of all of their restorations. Pre-operative circumferential preparation did not influence restoration survival, patient satisfaction or other clinical variables (restoration staining, marginal discolouration, shade match, surface roughness and marginal adaptation). The time taken to initially build-up the restorations was shown to be statistically significant with a longer procedural time meaning less chance of the restoration being present at 7 years. This treatment modality exhibited no biological complications for the teeth, supporting periodontium or TMJ apparatus. The placement of these restorations provided an improvement in the aesthetics of the teeth, a reduction in the concern over the longevity of the worn lower anterior teeth, and improvements with regard to sensitivity experienced with hot or cold foods or drinks. Marginal breakdown was the most frequently recorded clinical complication. Thus, for the majority of patients, the restorations offered a high degree of patient satisfaction and required an acceptable level of maintenance in the 7-year follow-up period.

Survival rates of anterior composites in managing tooth wear: systematic review

“…The materials used were as follows: microfilled Durafill composite , microhybrid Herculite XRV composite and ceromer Artglass ® . When it came to bonding techniques, two studies used Optibond ® in conjunction with the Herculite XRV composite , one study used 2bond2 resin cement with Artglass ® , and two studies did not mention their bonding techniques . Details of tooth preparation prior to placement of restorations were not clear in three studies .…”

“…When it came to assessing the restorations, three studies used calibrated assessors , while two did not detail their assessor calibration process. Two studies had one calibrated assessor and the third had five calibrated assessors at their 2·5‐year follow‐up and six assessors at their 7‐year follow‐up.…”

“…There was a slight decline in survival rate at 2·5 years when using direct composite restorations, with Hemmings and Poyser reporting similar rates of 93% and 94%, respectively. At 7 years, the reported survival rate of direct composite restorations was 85% . At 10 years, Gulamali reported that only 29% of direct and indirect composite restorations survived, exhibiting no major modes of failures.…”

Anterior composite restorations: A systematic review on long-term survival and reasons for failure

“…In one study that evaluated build-ups placed in worn teeth [33], it was shown that restorations that took longer to place had higher chance to fail after seven years. The authors suggested that the association could be a result of those restorations being placed under more challenging clinical conditions, such as when moisture control was difficult to achieve, which would likely compromise their performance.…”

Anterior composite restorations in clinical practice: findings from a survey with general dental practitioners

“…These materials were developed to produce a smoother surface, similar to enamel, increasing the aesthetic appearance 3 . They are not indicated in stress bearing areas, being indicated for anterior teeth or Class V in posterior teeth 1 . Nanohybrid composites are a new class of material and some studies have demonstrated that they could present advantages in relation to microhybrid composites 21,26 .…”