How Dentists Diagnose and Treat Defective Restorations: Evidence from The Dental Practice-based Research Network

Abstract

Objectives to (1) identify and quantify the types of treatment that dentists in general dental practice use to manage defective dental restorations; and (2) identify characteristics that are associated with these dentists’ decisions to replace existing restorations. The Dental Practice-Based Research Network (DPBRN) comprises dentists in outpatient practices from five regions: AL/MS: Alabama/Mississippi, FL/GA: Florida/Georgia, MN: dentists employed by HealthPartners and private practitioners in Minnesota, PDA: Permanente Dental Associates in cooperation with Kaiser Permanente’s Center for Health Research, and SK: Denmark, Norway, and Sweden. Methods A questionnaire was sent to all DPBRN practitioner-investigators who reported doing at least some restorative dentistry (n=901). Questions included clinical case scenarios that used text and clinical photographs of defective restorations. Dentists were asked what type of treatment, if any, they would do in each scenario. Treatment options ranged from no treatment to full replacement of the restoration, with or without different preventive treatment options. We used logistic regression to analyze associations between the decision to intervene surgically (repair or replace) and specific dentist, practice, and patient characteristics. Results 512 (57%) DPBRN practitioner-investigators completed the survey. A total of 65% of dentists would replace a composite restoration when the defective margin is located on dentin; 49% would repair it when the defective margin is located on enamel. Most (52%) would not intervene surgically when the restoration in the scenario was amalgam. Dentists participating in solo or small private practice (SPP) chose surgical intervention more often than dentists who participate in large group practices (LGP) or in public health practices (PHP) (p<.0001). Dentists who do not routinely assess caries risk during treatment planning were more likely to intervene surgically and less likely to choose prevention treatment (p<.05). Dentists from the SK region chose the “no treatment” option more often than dentists in the other regions. Conclusions Dentists were more likely to intervene surgically when the restoration was an existing composite, compared to an amalgam restoration. Treatment options chosen by dentists varied significantly by specific clinical case scenario, whether the dentist routinely does caries risk assessment, type of practice, and DPBRN region.

Concordance between responses to questionnaire scenarios and actual treatment to repair or replace dental restorations in the National Dental PBRN

“…64 The consistency within individual practitioners’ treatment approaches across primary occlusal caries, primary proximal caries, and secondary caries suggests that diagnostic and treatment differences across practitioners for specific restorations may reflect fundamental differences in dentists’ approaches to similar clinical findings. 16173 The lack of agreement over time will result in a specific patient receiving additional restorative treatment.…”

“…However, network dentists have substantial diversity in a broad range of characteristics and have much in common with dentists at large. 3435 These characteristics include: 1) substantial percentages of network general dentists are represented in the various response categories of the characteristics listed in Table 1; 2) findings from several network studies document that network dentists report patterns of diagnosis and treatment that are similar to patterns determined from non-network dentists, 6363726 and 3) the similarity of network dentists to non-network dentists using the best available national source, the 2010 ADA Survey of Dental Practice. 38 The ADA survey samples both ADA members and non-ADA members, and it is based on a national probability sample, providing the most comprehensive information on the characteristics of United States dentists.…”

“…234 Except in the cases of extreme disease or lack of disease, studies of treatment decisions for existing restorations find moderate to low agreement among clinicians for the same restoration. 356 Diagnostic decisions about caries associated with existing restorations showed a significant lack of agreement. 789 …”

Minimal Invasive Treatment for Defective Restorations: Five-Year Results Using Sealants

“…Significant differences exist among dentists when deciding whether or not a restoration should be replaced. [28][29][30][31][32][33] Although minimally invasive dentistry has been introduced in the dental curriculum, it has taken place only in recent years. Therefore, several dentists have not been trained on proper diagnosis and application of the minimally invasive procedures.…”

Selective removal of dental composite with a diode-pumped Er:YAG laser

“…Dentists spend more time replacing existing restorations that fail due to microleakage and secondary caries than they do placing new restorations. [1, 2] Tooth colored restorations are difficult to differentiate from the surrounding tooth structure and adhere strongly to the underlying enamel and dentin making them challenging to remove without damaging tooth structure. Hence, the clinician frequently removes excessive amounts of healthy tooth structure to ensure complete removal of the composite.…”