Prevalence and Characteristics of Radiographic Radiolucencies Associated with Class II Composite Restorations

Abstract

Bitewing radiographic examination of the Class II composite restorations is commonly performed for diagnosis and preoperative planning of posterior teeth. The purpose of this study was to describe the prevalence; location; and characteristics of radiolucency findings associated with proximal class II composite restorations. Bitewing radiographs of proximal composite restorations of healthy adult patients (18 to 88 years old) who underwent restorative care at predoctoral clinics at the University of Maryland School of Dentistry from August 2016 to July 2019 were identified. Atypical radiographic features were categorized by location and associated material (adhesive or composite). In addition, demographic and clinical details (tooth position; restored surface) were recorded. Out of the 669 radiographically examined bitewings of restorations; 16.5% of radiographs showed no atypical findings; and 83.5% had unusual radiographic signs. The atypical radiographic findings were distributed as 16.5% internal voids; 3% overhang; 7.8% interlayer lines; 12.6% secondary caries; 20.7% interfacial gaps; and 23.1% multiple atypical findings. Class II composite restorations have a high prevalence of atypical radiolucency; particularly in the body of the composite; premolars; and disto-occlusal restorations. The information reported here emphasizes the clinical challenge of ascertaining an appropriate diagnosis of the radiolucencies underneath composite restorations.

Predictors of procedural errors in class II resin composite restorations using bitewing radiographs

“…Our findings aligned with previous reports indicating that class II resin composite restorations were highly associated with atypical findings ( AlOtaibi et al, 2020 , Bazerbashi et al, 2023 , de Moura et al, 2011 ). A study conducted in the United States reported that 83.50% of proximal restorations were associated with procedural errors, with interfacial gaps and internal voids being the most frequent observations ( Bazerbashi et al, 2023 ).…”

“…Our findings aligned with previous reports indicating that class II resin composite restorations were highly associated with atypical findings ( AlOtaibi et al, 2020 , Bazerbashi et al, 2023 , de Moura et al, 2011 ). A study conducted in the United States reported that 83.50% of proximal restorations were associated with procedural errors, with interfacial gaps and internal voids being the most frequent observations ( Bazerbashi et al, 2023 ). Another study conducted in Saudi Arabia reported that 61.75% of the class II resin composite restorations were associated with atypical findings, with overhang and voids being recognized as the most common procedural errors ( AlOtaibi et al, 2020 ).…”

“…Remaining caries was observed 54 times, representing 8.04% of the reported single errors. Similar findings were observed in other studies where remaining caries was observed in 5.75% ( AlOtaibi et al, 2020 ) and 12.60% ( Bazerbashi et al, 2023 ) of the reported errors. This error was not found to be influenced by any factors, except when comparing citizen to non-citizen patients.…”

“…We found that internal voids were significantly associated with premolars compared to molars and back-to-back restorations placed by the same operator. Another study also found that more void formation was associated with premolars than molars ( Bazerbashi et al, 2023 ), suggesting that students tend to entrap air when they attempt to push large increments into the small proximal box in premolars. Dental students may tend to pack resin composite softly when restoring back-to-back class II preparation to avoid over-contouring their first restoration.…”