Risk Factors for Dental Restoration Survival: A Practice-Based Study

Abstract

To improve patient dental care, it is necessary to identify possible risk factors for the failing of restorations. This practice-based cohort study investigated the performance and influence of possible risk factors at the level of the practice, patient, tooth, and restoration on survival of direct class II restorations. Electronic patient files from 11 Dutch general practices were collected, and 31,472 restorations placed between January 2015 and October 2017 were analyzed. Kaplan-Meier statistics were performed; annual failure rates (AFRs) were calculated; and variables were assessed by multivariable Cox regression analysis. The observation time of restorations varied from 0 to 2.7 y, resulting in a mean AFR of 7.8% at 2 y. However, wide variation in AFRs existed among the operators, varying between 3.6% and 11.4%. A wide range of patient-related variables is related to a high risk for reintervention: patient age (elderly: hazard ratio [HR], 1.372), general health (medically compromised: HR, 1.478), periodontal status (periodontal problems: HR, 1.207), caries risk and risk for parafunctional habits (high: HR, 1.687), restorations in molar teeth (HR, 1.383), restorations placed in endodontically treated teeth (HR, 1.890), and multisurface restorations (≥4 surfaces: HR, 1.345). Restorations placed due to fracture were more prone to fail than restorations placed due to caries. When patient-related risk factors were excluded, remaining risk factors considerably changed in their effect and significance: the effect of operator, age of the patient, and endodontic treatment increased; the effect of the diagnosis decreased; and the socioeconomic status became significant (high: HR, 0.873). This study demonstrated that a wide variation of risk factors on the practice, patient, and tooth levels influences the survival of class II restorations. To provide personalized dental care, it is important to identify and record potential risk factors. Therefore, we recommend further clinical studies to include these patient risk factors in data collection and analysis.

How to intervene in the caries process: proximal caries in adolescents and adults—a systematic review and meta-analysis

“…(3) Most RCTs included not only class II restorations placed due to primary caries, but also replacement restorations of failed fillings, which are probably larger and more likely to fail (again) than newly placed restorations. A recent study [59] also showed that restorations placed due to caries were less prone to fail than restorations placed due to fracture. In view of this, survival of class II restorations for cavitated proximal caries lesions might be even slightly better than demonstrated in the present review.…”

“…Besides, some of the RCTs reported on restorative materials that are no longer available, which also limits the validity of this meta-review. (2) Survival of restorations depends on various patient-related risk factors [59][60][61] which were not addressed in this meta-review. Only about a quarter of the RCTs assessed the caries risk of the patients as, e.g.…”

Antibacterial Drug-Release Polydimethylsiloxane Coating for 3D-Printing Dental Polymer: Surface Alterations and Antimicrobial Effects

“…Note that the human oral environment is more complicated than the in vitro experimental context because the oral cavity temperature, food intake, and the pH and composition of saliva vary between subjects and even within a subject [ 43 ]. In addition, the mechanical properties and material stability of the coating layer were not investigated in this study.…”

Practice based research in dentistry: an alternative to deal with clinical questions

“…There are some initiatives proposing pragmatic trials in the context of PBRN. One good example is the ongoing trial in the Dutch PBRN, 34 which aims to investigate the effectiveness of antimicrobial containing dental adhesives for the prevention of secondary caries. For this study, a cohort of dental practices with motivation to participate and that are acknowledged for keeping very good dental records were invited to take part in the study.…”