Restorative treatment provided over five years for adults regularly attending general dental practice

Age-related variation in volume and content of restorative private dental care for adults in Finland in 2012-2017: A nationwide register-based observation

OBJECTIVES

This study assessed age-related variation in the volume and content of restorative dental care performed by private dentists for adults in Finland in 2012-2017.

METHODS

This retrospective register-based observational study utilized the Social Insurance database of private dental services in 2012 and 2017, including all patients. The data were aggregated into 5-year age groups for 20-89-year-olds; those aged 90+ formed one group. A patient was one who had received at least one treatment, and a restoration patient one who received at least one restoration (direct/indirect), excluding prosthetic crowns. Attendance rate was the proportion of the population treated. Volume of restorative treatment was the proportion of restoration patients among all patients using private dental services. Content of restorative treatment was described as the number of teeth receiving restoration and the size of restoration (number of surfaces restored). Correlation coefficient demonstrated associations between age groups and numbers of restorations.

RESULTS

Rate of restoration patients was 64.8 % in 2012 and 61.1 % in 2017, the rate for individuals aged under 80 years in each calendar year being smaller than in previous years. Mean number of restorations received per patient was 1.59 in 2012 and 1.42 in 2017, increasing with age (r = 0.85 in 2012; r = 0.95 in 2017). Small restorations dominated; one to two surfaces were covered in 72.3 % and 75.5 % of restorations in 2012 and 2017, respectively.

CONCLUSIONS

Volume and content of restorative dental care for adults vary by age and have decreased slightly over time.

CLINICAL SIGNIFICANCE

Restorative treatments are a prominent part of dental care for adults. This paper sheds light on the entity of restorative dental care for adults visiting private dentists. Variation in restoration volume and content is shown according to patient's age group, and changes are assessed across six years.

Type and time of first re-intervention of posterior restorations - 13-year scenario at the public dental service

Objectives: We investigated the first re-interventions of two- and three-surface direct restorations on posterior teeth, specifically noting the type and time of the first re-intervention.Materials and methods: In 2002, altogether 5542 posterior two- and three-surface composite and amalgam restorations were done for 3051 patients aged 25-30 years at Helsinki City Public Dental Service (PDS). Based on electronic patient records, we analysed all restorations (n = 2445) having re-intervention during a 13-year follow-up. We recorded the type of tooth, restoration size, and type of first re-intervention. The time to re-intervention was the interval between the date of the placement of restoration at the year 2002 and its first re-intervention.Results: Restorative treatment was the most common (77.9%) first re-intervention, followed by endodontics (11.5%), extractions (5.2%), and other (5.4%). Males, more frequently than females, had extraction or endodontics as first re-intervention. The average time to re-intervention was 5.7 years (SD 3.8; median 5.2). Both median and mean times were shortest for cases involving endodontics or extractions.Conclusions: For the majority of two- and three-surface posterior restorations, the first re-intervention is restorative (replacement or repair of restoration). The shortest time to re-intervention is for restorations that have endodontics or extraction as the first re-intervention.

INTERVAL (investigation of NICE technologies for enabling risk-variable-adjusted-length) dental recalls trial: a multicentre randomised controlled trial investigating the best dental recall interval for optimum, cost-effective maintenance of oral health in dentate adults attending dental primary care

Background

Traditionally, patients at low risk and high risk of developing dental disease have been encouraged to attend dental recall appointments at regular intervals of six months between appointments. The lack of evidence for the effect that different recall intervals between dental check-ups have on patient outcomes, provider workload and healthcare costs is causing considerable uncertainty for the profession and patients, despite the publication of the NICE Guideline on dental recall. The need for primary research has been highlighted in the Health Technology Assessment Group’s systematic review of routine dental check-ups, which found little evidence to support or refute the practice of encouraging 6-monthly dental check-ups in adults. The more recent Cochrane review on recall interval concluded there was insufficient evidence to draw any conclusions regarding the potential beneficial or harmful effects of altering the recall interval between dental check-ups. There is therefore an urgent need to assess the relative effectiveness and cost-benefit of different dental recall intervals in a robust, sufficiently powered randomised control trial (RCT) in primary dental care.

Methods

This is a four year multi-centre, parallel-group, randomised controlled trial with blinded outcome assessment based in dental primary care in the UK. Practitioners will recruit 2372 dentate adult patients. Patient participants will be randomised to one of three groups: fixed-period six month recall, risk-based recall, or fixed-period twenty-four month recall. Outcome data will be assessed through clinical examination, patient questionnaires and NHS databases. The primary outcomes measure gingival inflammation/bleeding on probing and oral health-related quality of life.

Discussion

INTERVAL will provide evidence for the most clinically-effective and cost-beneficial recall interval for maintaining optimum oral health in dentate adults attending general dental practice.

Trial registration

ISRCTN95933794 (Date assigned 20/08/2008).

How mobile are protons in the structure of dental glass ionomer cements?

The development of dental materials with improved properties and increased longevity can save costs and minimize discomfort for patients. Due to their good biocompatibility, glass ionomer cements are an interesting restorative option. However, these cements have limited mechanical strength to survive in the challenging oral environment. Therefore, a better understanding of the structure and hydration process of these cements can bring the necessary understanding to further developments. Neutrons and X-rays have been used to investigate the highly complex pore structure, as well as to assess the hydrogen mobility within these cements. Our findings suggest that the lower mechanical strength in glass ionomer cements results not only from the presence of pores, but also from the increased hydrogen mobility within the material. The relationship between microstructure, hydrogen mobility and strength brings insights into the material's durability, also demonstrating the need and opening the possibility for further research in these dental cements.

Effect of restoration volume on stresses in a mandibular molar: a finite element study

STATEMENT OF PROBLEM

There can be significant disagreement among dentists when planning treatment for a tooth with a failing medium-to-large--sized restoration. The clinician must determine whether the restoration should be replaced or treated with a crown, which covers and protects the remaining weakened tooth structure during function.

PURPOSE

The purpose of this study was to evaluate the stresses generated in different sized amalgam restorations via a computational modeling approach and reveal whether a predictable pattern emerges.

MATERIAL AND METHODS

A computer tomography scan was performed of an extracted mandibular first molar, and the resulting images were imported into a medical imaging software package for tissue segmentation. The software was used to separate the enamel, dentin, and pulp cavity through density thresholding and surface rendering. These tissue structures then were imported into 3-dimensional computer-aided design software in which material properties appropriate to the tissues in the model were assigned. A static finite element analysis was conducted to investigate the stresses that result from normal occlusal forces. Five models were analyzed, 1 with no restoration and 4 with increasingly larger restoration volume proportions: a normal-sized tooth, a small-sized restoration, 2 medium-sized restorations, and 1 large restoration as determined from bitewing radiographs and occlusal surface digital photographs.

RESULTS

The resulting von Mises stresses for dentin-enamel of the loaded portion of the tooth grew progressively greater as the size of the restoration increased. The average stress in the normal, unrestored tooth was 4.13 MPa, whereas the smallest restoration size increased this stress to 5.52 MPa. The largest restoration had a dentin-enamel stress of 6.47 MPa. A linear correlation existed between restoration size and dentin-enamel stress, with an R(2) of 0.97.

CONCLUSIONS

A larger restoration volume proportion resulted in higher dentin-enamel stresses under static loading. A comparison of the von Mises stresses to the yield strengths of the materials revealed a relationship between a tooth's restoration volume proportion and the potential for failure, although factors other than restoration volume proportion may also impact the stresses generated in moderate-sized restorations.

The Influence of a Short Training Program on the Clinical Examination of Dental Restorations

Training in restoration assessment and the evaluation of such in the clinical environment is shown to produce positive benefits that include improved reliability and agreement with the set standard.

Finnish dentists' perceptions of the longevity of direct dental restorations

OBJECTIVES

To evaluate Finnish dentists' perceptions of the longevity of direct dental restorations; to assess the possible impacts of dentists' characteristics on these perceptions; and to compare the present longevity estimates with those of recent European reports.

METHODS

A questionnaire to 592 general practitioners, systematically sampled from the Finnish Dental Association's membership list, was posted in April 2004 and data collection was finished by the end of June. The question "In general, what is your estimate for the mean age of restoration in permanent teeth?" pointed restorations: Class II and MOD composites and amalgam in a posterior tooth and Class III composites in an incisor. Dentists' gender, main work, and year of graduation served as background information. Of the 339 (57%) respondents, only public and private dentists were included; 11 were excluded. Three studies fulfilled the inclusion criteria for recent reports on restoration longevity. Statistical evaluation was by one-way ANOVA, with p=0.05 as the level of significance.

RESULTS

The mean of the estimates for all types of composite was 9.0 years (SD 3.6; 95% CI 8.6-9.3) and 18.7 years for amalgam (SD 7.3; 95% CI 18.0-19.5). Male dentists gave longer estimates than female dentists for posterior composites, but shorter estimates for amalgam. Compared to public dentists, private dentists gave longer estimates for posterior composites. All estimates were longer than those reported in the recent literature.

CONCLUSION

Dentists' perceptions of posterior composite longevity are significantly longer among males than among females and among private than public sector dentists, and exceed the median longevity reported in recent studies.

Using quality report cards for reshaping dentist practice patterns: a pre-play communication approach

Rationale, aims and objectives Understanding how information disclosure influences dentists' patterns of practice change is important in developing quality-improvement policies and cost containment. Thus, using quality report cards is a promising strategy for investigating whether dentists will reshape their patterns of practice because of the influence of peer comparison. Methods Based on the coordination game, a data warehouse decision support system (DWDSS) was used as a pre-play communication instrument, along with the disclosure of quality report cards, which allow dentists to search their own service rates of dental restoration and restoration replacement as well as compare those results with others. Results and conclusions The group using the DWDSS had a greater decrease in two indicators (i.e. service rates of dental restoration and restoration replacement) than the dentists who did not use it, which implies that the DWDSS is a useful facility for helping dentists filter and evaluate information for establishing the maximum utility in their practice management. The disclosure of information makes significant contributions to solving managerial problems associated with dentists' deviation of practice patterns.

What is the prevalence of various types of prosthetic dental restorations in Europe?

OBJECTIVES

The aim of this review was to analyse the prevalence of prosthetic dental restorations in the adult population in Europe and to investigate factors influencing the frequencies of fixed restorations and removable dental prostheses (RDP).

MATERIAL AND METHODS

A search for literature up to 31 October 2006 on dental restorations was performed in Medline via PubMed and in an additional hand search using several keywords related to epidemiology and dental restorations. Out of approximately 6000 titles listed, 136 articles were identified, which were related to 13 different European countries. 43 articles fulfilled the inclusion criteria and were included in this review.

RESULTS

Approximately half of the adult population in most European countries have had some type of prosthetic dental restoration. The frequency of RDPs among adults varied between 13 and 29%, with 3-13% edentulous subjects wearing complete dentures in both jaws. The frequency of fixed restorations including crowns and fixed dental prostheses (FDPs, bridges) was the highest in Sweden with 45% and Switzerland (34%). In the recent decades, there has been a slight decrease in RDP use reflecting a decline in edentulism, while more subjects had maintained a residual dentition and were wearing removable partial dentures or fixed restorations. The latter are less prevalent in countries with lower prosperity. If only a few teeth are absent, these are generally replaced with FDPs or have no replacement. If more teeth are missing, the likelihood of a removable restoration increases with the number of teeth to be replaced. A higher frequency of removable restorations is present in older age groups, in subjects living in rural areas, in those from a lower socio-economic status and in subjects with less education and lower incomes.

CONCLUSIONS

All types of fixed and removable restorations are highly prevalent, especially among older age groups, in most European countries. There is a trend towards higher frequencies of fixed restorations, more removable partial dentures and a reduction in complete dentures.

Analysis of an administrative database of half a million restorations over 11 years

AIM

This paper describes the analytical approach used to extract empirical distributions of the interval from the date of placement of a direct restoration to the date when the next intervention took place on the same tooth, that is, an estimate of restoration survival.

METHODS

Data, based on the complete attendance and treatment history, over the eleven years from 1991 to 2001, of a statistically representative sample of 82,537 General Dental Services' patients in England and Wales, all of whom received at least one directly placed restoration during the observation period, have been analysed. The patients on the database received a total of 719,009 courses of treatment, and there were 503,965 occasions when a tooth was directly restored. The method of analysis involved, first, the estimation of the probability that the patient will eventually return, given an interval without attending, by analysing the observed patterns of re-attendance. This estimated probability of re-attendance was then used to modify the standard Kaplan-Meier procedure to produce realistic estimates of the hazard of re-intervention.

RESULTS

The results demonstrate that the newly developed methodology has produced robust estimates of the distribution of survival intervals to next intervention on the same tooth. Regarding attendance patterns, re-attendance probability varies with length of interval since last attendance. There is also a strong association with patient age. The older the patient, the more likely it is that a gap in attendance is indicative that the patient will never return. The detailed cumulative survival curve over eleven years has been plotted and forty-seven per cent of restorations, overall, survived without re-intervention for at least ten years. The entire analysis was then successfully replicated on a second, independently selected, sample of attendance and treatment records, confirming the ten-year survival estimate.

CONCLUSIONS

This newly developed methodology has produced robust estimates of the distribution of survival intervals to next intervention on the same tooth. Patient re-attendance probability varies with length of interval since last attendance and with patient age. The ten-year overall survival rate to next intervention on the same tooth for direct restorations placed within the GDS in England and Wales is circa 47%.

Restorative treatment and use of local anesthesia in free and subsidized public dental services in Helsinki, Finland

Our aim was to evaluate restorative treatment and the use of local anesthetics in free and subsidized public dental care in Helsinki, Finland. Public dental clinics are open to all patients under the age of 36, and to some specific groups above that age. Patients up to age 19 receive all treatment free of charge and others at highly subsidized rates. Data were collected in May 2001 during a maximum 2-week period covering all public dental clinics in Helsinki. A one-page questionnaire was sent to all dentists (n = 140) in clinical fields. The data requested included the patient's gender and year of birth, and details on restorations: which tooth and which surfaces were filled, the reason for placement or replacement, the material used, and use of local anesthetic. The response rate was 96%. Of all restorations (n = 3057) placed, 14% were in primary teeth and in permanent teeth: 17% in premolars, 17% in incisors, and 52% in molars; the restorative material most often used was composite resin (69%). Glass-ionomer/compomers dominated in the primary teeth. Local anesthetic was used least (35%) in patients under 13 years of age. Replacements of restorations accounted for 10% of all in the free service (under 20 years of age) and 46% in subsidized dental care (20 and older). The major reasons for replacement were secondary caries (41%) and fractured or lost restoration (40%).

Qualitative evaluation of elderly home residents' fixed and removable prostheses in relation to the ADL index

Functional diversity and biopsychosocial state is a significant issue, which greatly influences elderly oral health and state of fixed and removable prostheses.

OBJECTIVES

The goal of the investigation was to evaluate the quality of fixed and removable prostheses in a group of elderly home residents in relation to the ADL index.

METHODS

The group consisted of 175 institutionalised elderly, mean age 76.8 years. Special care need was assessed on ADL scale. To evaluate the quality and need for replacement of fixed and removable prostheses Karlsson's and modified Nevalainen et al. indices were used.

RESULTS

Spearman's correlation analysis showed significant correlation of ADL index scores and both Karlsson's index values (rho=-0.468, p<0.01) as well as for modified Nevalainen's indices (rho=-0.572, p<0.01). Lower ADL score was correlated with poorer oral hygiene and condition of fixed or removable dentures. It was determined that 87% of the examined patients were in objective need of fixed, removable or combined prosthodontic treatment.

CONCLUSIONS

The study showed that lower ADL index scores of functionally dependent elderly patients correlate with poorer condition of fixed and removable prostheses and greater need of fixed, removable or combined prosthodontic treatment.

Reasons for replacement and the age of failed restorations in posterior teeth of young Finnish adults

Using dentist characteristics, our aim was to evaluate the reasons for replacements of fillings, the age of failed restorations in the posterior teeth of young adults, and replacement rates. Altogether 205 patient records from the Public Oral Health Service of the City of Vantaa, Finland were evaluated. Patient age was restricted to between 25 and 30 years and type of tooth to posterior teeth only (third molars excluded). Information collected from the records included the patient's date of birth, latest DMFS and DMF, and the code for background data on the dentist. Details of each filled premolar and molar included the restorative material, location, and surface coverage of filling(s). The age of replacement of filling in premolar(s) or molar(s) was screened retrospectively from patient records. The total number of filled premolars and molars was 1873, with 1969 fillings. Forty percent of the patients had undergone replacement of filling in premolar(s) or molar(s). In all, 140 replacements had been made, accounting for 6.9% of amalgam fillings and 8.5% of tooth-colored fillings. Secondary caries, along with fractures, overhangs, and marginal discrepancy, was the most common reason for replacement. The mean age of failed amalgam fillings was 8.9 years (SD 5.2) and of failed tooth-colored fillings 2.4 years (SD 1.6). In the public sector, female dentists form the majority and their replacement rate for amalgam fillings was twice that of male dentists (7.6% vs 3.2%; P = 0.01).

An audit on the placement and replacement of restorations in a general dental practice

OBJECTIVES

To determine the reasons for placing and replacing restorations in a general dental practice amongst a group of patients.

METHODS

This study used the method devised by Mjör and later modified by Burke and others. Instruction and data collection sheets were sent out to general dental practitioners (GDPs) for participation in a multicentre study. The GDPs were asked to record consecutively all restorations placed over a period of one month. The author is presenting his data collected over a period of six months using the same methodology. The author's results will be compared with a VDP study and the multicentre study.

RESULTS

779 restorations were placed during the six months of the study. Three hundred and sixty-four (47%) were initial placements and 415 (53%) replacements. Primary fractured teeth totalled (16%) of the restorations. Other reasons for restoration placement were marginal fracture/degradation (31%), non-carious defects (13%) and both primary and secondary caries (9%). The proportion of glass-ionomer restorations increased with the age of the patient compared with amalgam and composites (chi-square: p < 0.001), averaging 64% in age groups between 35 and 75 years, increasing to 88% in those patients over 75 years.

CONCLUSIONS

The principal reasons for placement and replacement of restorations in this study were repairs to tooth fractures. The proportion of amalgams and composites decreased with age while the proportion of glass ionomers increased.