Validity of clinical judgements for the presence of secondary caries associated with defective amalgam restorations

Abstract

Eighty patients were selected, who were each deemed to require the replacement of a defective amalgam restoration. The patients had a mean age of 36.7 years and were dentally fit on average 40 months previously. The main reasons given for the replacement of the defective restorations were perceived radiographic secondary caries (31%), fracture of the restoration (20%), marginal defect (17%), and perceived secondary caries observed clinically (14%). Following the removal of the restorations, a highly significant relationship was found between the consistency and colour of the underlying dentine (P < 0.00001). Soft dentine was found underlying 36 (88%) of the 41 defective amalgam restorations which were diagnosed as having caries associated with them. However, hard dentine was found underlying only 19 (49%) of the 39 teeth where no caries had been diagnosed. The presence of soft dentine where not anticipated was mainly in association with fractured restorations (11 out of 16). Younger patients were more likely to have soft dentine underlying their defective amalgam restorations than older patients (P = 0.005). No relationship was found between the presence of corrosion products on the cavity walls associated with defects and the consistency of the underlying dentine.

Distribution of Three Cariogenic Bacteria in Secondary Carious Lesions around Amalgam Restorations

“…Cross-sectional studies in the USA have reported similar results [Klausner and Charbeneau, 1985;Kelsey et al, 1981]. In Canada, the percentage of amalgam replacements because of secondary caries has been reported to be between 20 and 56% [Lavelle, 1976;Boyd and Richardson, 1985;MacInnis et al, 1991], whereas in Europe the percentages have been between 34 and 72 [Dahl and Eriksen, 1978;Mjör, 1981;Qvist et al, 1986Qvist et al, , 1990Allander et al, 1990;Jokstad and Mjör, 1991;Mjör and Toffenetti, 1992;Foster, 1994;Gruythuysen et al, 1996;Mjör and Qvist, 1997].…”

A New in vitro Model to Study the Relationship of Gap Size and Secondary Caries

“…Moreover, Hodges et al [1995] found an average difference of 187 m between gaps associated with secondary caries compared to a noncarious site. However, several investigations found that marginal defects were not necessarily associated with secondary caries incidence [Hamilton et al, 1983;Foster, 1994;Kidd et al, 1995Kidd et al, , 1996. However, considering the differences in study designs, one should not be surprised by these conflicting results.…”

Validity of Radiographs for Diagnosis of Secondary Caries in Teeth with Class II Amalgam Restorations in vitro

“…Espelid and Tveit [1991] found for ra diographic caries diagnosis in the gingival area of class 11 restorations a sensitivity of 47% and a specificity of 88%, rising to 64 and 97%, respectively, when the radiographic examination was supplemented with 'clinical' findings. Foster [1994] concluded that the combined radiographic and clinical diagnosis of secondary caries as the reason for re placement of fillings was generally well founded (sensitiv ity 64%, specificity 79%). Fitzgerald et al [1994] found for radiographic diagnosis, after validation against the presence of bacteria, a sensitivity for secondary caries detection of 50% and a specificity for the absence of caries of 73%.…”