Management of Class I and Class II Amalgam Restorations with Localized Defects: Five-Year Results

Abstract

Replacement of dental restorations has been the traditional treatment for defective restorations. This five-year prospective clinical trial evaluated amalgam restorations with localized defects that were treated by means of repair or refurbishing. Fifty-two patients (50% female and 50% male, mean age 28.3 ± 18.1 years, range 18–80) with 160 class I and class II defective restorations were included. The study focused on the application of two minimally invasive treatments for localized restoration defects and compared these with no treatment and total replacement as negative and positive controls, respectively. Restorations were assessed by two calibrated examiners according to modified U.S. Public Health Service criteria, including marginal adaptation, anatomic form, secondary caries, and roughness. At five years, recall was examined in 45 patients with 108 restorations (67.5%). The results suggest that repair treatment is as effective as total replacement of restorations with localized defects, reducing biological costs to the patient and providing new tools to the clinician. Refinishing restoration is a useful treatment for localized anatomic form defects.

Longitudinal Results of a 10-year Clinical Trial of Repair of Amalgam Restorations

“…Another difference is that Smales' study 47 was carried out retrospectively in private practice and the present investigation was prospectively conducted in a university environment. This study agreed with other studies when it suggested repairing restorations instead of replace- This cohort includes data of restorations previously reported 25,27,29,30,46 and patients subsequently recruited. In a study by Fernandez et al 49 data of resin composites restorations was reported with similar methodology.…”

“…The restorations showed some deterioration over time; however, they retained their acquired properties satisfactorily during the observation period in similar conditions other than replacement. 17,29,42,46 It is necessary to consider that repairing a restoration could serve to reduce the dimension of the repaired cavity, because it improves repair strength, and additionally it has been observed that rounded undercuts slightly reduce the repair strength values. 39 A previous retrospective study by Smales and Hawthorne 47 compared the long-term survival rate of repaired vs replaced amalgam restorations, with no significant survival differences between both groups at year 5; however, higher failure rates of the repaired amalgam were seen after 10 years (only 37.2% of the restorations survived).…”

Seal, replacement or monitoring amalgam restorations with occlusal marginal defects? Results of a 10-year clinical trial

“…Previous studies have also described this issue. 24,25 However, all restorations of sealed and replaced groups were assessed as clinically acceptable (Alpha or Bravo) in the marginal adaptation parameter after 10 years. These observations suggest that instead of replacing amalgam restorations with marginal gaps that are no larger than 1 mm, the placement of a sealant might be a simpler alternative to improve the quality of defective restorations.…”

“…20,21,23 Alternative treatments to replacing defective restorations, such as sealing marginal gaps, are easy, quick and simple solutions that improve the overall clinical properties of restorations that have defective areas with minimal intervention. [23][24] A previous study showed that the application of resin sealants at the margin of defective restorations achieved similar marginal adaptation results as replacement of the restoration after five years, demonstrating that sealants are a simple and acceptable alternative to replacing restorations with marginal defects. 20,23 Therefore, the longevity of the tooth is increased with minimal intervention, cost and trauma to the adjacent tooth structures.…”

Aumento de longevidad de restauraciones de resinas compuestas y de su unión adhesiva. Revisión de tema

“…2,4,27,33,34 The average failure rate of CRs is considered to be 2.2% per year, 28 being secondary caries and fractures the most common reasons for it; 1, 28, 35 replacement has been the traditional treatment but it implies loss of healthy tooth tissue-even in areas far from the failure-and risks of tooth weakening. 9,36 Repairing restorations that have localized defects is an alternative treatment to increase longevity; 9,39 however, these techniques have not been confirmed by Cochrane reviews due to lack of randomized clinical trials. 40 Aproximadamente la mitad de las restauraciones colocadas por el odontólogo de práctica general son reemplazadas por defectos o fracasos después de los 10 años de servicio.…”