Attitudes of some European dental undergraduate students to the placement of direct restorative materials in posterior teeth

Longevity of composite restorations in posterior teeth placed by dental students: a 12-year retrospective study

OBJECTIVES

To evaluate the longevity of resin composite restorations placed in posterior teeth by dental students, using data from electronic records from 2008 to 2019.

MATERIALS AND METHODS

Demographic (gender and age) and clinical variables (dental group, position in dental arch, and the number of restored surfaces) were evaluated. The 5-year follow-up was assessed according to the day the restoration was placed. Kaplan-Meier curves were generated to calculate the annual failure rate. Data were analyzed by Chi-Square, Kruskal-Wallis, and Mann-Whitney tests (α = 0.05).

RESULTS

In total, 3.883 records relative to return periodicity were analyzed. The final sample consisted of 900 restorations from 479 patients. The majority were females, aged between 31 and 60. In total, 256 failures were reported (success rate = 78%), showing an annual failure rate of 2.05%. The main reasons for failures were restoration replacement (55.5%), endodontics (21.9%), prosthetics (14.5%) and extraction (8.2%). There was a higher risk of failure in restorations involving three or more surfaces (p = 0.000) and in patients over 60 years (p < 0.001). In females (p = 0.030), molars (p = 0.044), and maxillary teeth (p = 0.038) failed in a shorter time.

CONCLUSIONS

Resin composite restorations placed in permanent posterior teeth by dental students had high survival rates. The main reason for failure was the replacement of restorations. The age group and the number of restored surfaces significantly affected the success of the restorations.

CLINICAL RELEVANCE

The electronic health records over 12 years showed that 78% of the resin restorations in posterior teeth placed by dental students were successful for a minimum of five years.

Barriers in Rubber Dam Isolation Behaviour of Dental Students During Adhesive Restorative Treatments: A Cross-Sectional Study

PURPOSE

 There are unfavorable opinions connected with rubber dam isolation amongst dental students during adhesive restorative treatments. The aim of this study was to investigate the various barriers to practicing rubber dam isolation during dental procedures and provide necessary insight towards implementation of rubber dam among undergraduate dental students in Jazan.

MATERIALS AND METHODS

 A pre-validated questionnaire in English entitled Rubber Dam Isolation Survey (E-RDIS) based on the Capability Opportunity Motivation-Behaviour (COM-B) model of behavioral change wheel was responded by 226 university dental students.

RESULTS

 The satisfaction of training was highest among sixth year students (Mean=3.57, p<0.001). Fourth year dental students scored higher in the capability (Mean=3.18) and were more highly motivated to use rubber dams (Mean=4.21). Third year students were more likely to use rubber dams in anterior teeth (Mean=3.52) whereas fourth year students use rubber dam in posterior teeth (Mean=3.74). Lack of motivation was found to be the significant barrier influencing rubber dam usage (odds ratio (OR)=12.1; 3.74, p<0.05).

CONCLUSION

 The satisfaction with training differed among the students of different years. The rubber dam technique might be used more frequently if it were made clear to students that mastering it would be necessary for them to receive good grades.

Choice of Restorative Materials for Direct Posterior Restorations among Undergraduate Saudi College Students

Background:

The most common restorative materials used in dentistry are amalgam and composite. Amalgam is a controversial material owing to its mercury toxicity. With recent advances in the properties of composite materials, there has been a shift towards its use.

Objectives:

The aim of this study was to understand the perceptions of undergraduate dental students in a northern Saudi Arabian dental school about the choice of restorative materials for restoring posterior teeth.

Methodology:

The study included undergraduate students studying in 4th and 5th year dental program in College of Dentistry, Jouf University. A four-item questionnaire with 18 close-ended questions was developed by the investigators, which were hand delivered to all the students. Data analysis is presented through tables and descriptive methods.

Results:

A total of 98 (out of 131) undergraduate students participated in this study. Overall, the students reported a significantly strong influence of the type of restorative materials in relation to the cavity size and margin of the restorations along with the esthetics factor(p<0.05). There was slight influence on the student’s choice because of the instructor's influence, whereas the students felt they were knowledgeable and had appropriate training to use either amalgam or composite. The study also found that patient’s preference had a strong influence on choosing composite material. The students were mostly not influenced while choosing the material as far as the safety of it was concerned. However, the patient’s influence was slight when it came to the choice of the material. A significant difference was noted among the students when it came to pregnancy-related safety concerns where the choice of material was not influenced by either amalgam or composite (p=.002).

Conclusion:

The undergraduate dental students at College of Dentistry, Jouf University are comfortable in using both amalgam and composite as a posterior restorative material. They are knowledgeable about both the materials and are adequately trained to use either one.

Practice-based analysis of direct posterior dental restorations performed in a public health service: Retrospective long-term survival in Brazil

The aim of this retrospective study was to evaluate the survival and associated factors for the longevity of direct posterior restorations and to verify whether the geographic location of public health units could influence the long-term survival of such restorations. Data were extracted from electronic patient files of the Brazilian public oral health services. The sample comprised 2,405 class I and II restorations performed 4 to 24 years ago (mean, 8.9 years) in 351 patients (6.8 teeth/patient) across 12 public health units located in different city regions (42 professionals—55 restorations). The restoration was considered successful if it had not been repaired or replaced at the time of evaluation; failure was defined as replacement of the restoration, the need for endodontic treatment, tooth/restoration fracture or tooth extraction. Data were analyzed using the Kaplan-Meier test for restoration survival and Cox regression to evaluate the factors associated with failure. The majority of the restorations involved the use of amalgam (85%), involved a single face (70%), and were without pulp/dentin capping (85%). The overall survival rate was 95%, and the mean observation time was 8.9 years. The restoration survival was 79% (95% CI: 60.6–89.5) over 24 years, and the mean survival time was 22.2 years (95% CI: 21.9–22.6 years). The annual failure rate up to 24 years was 0.9%. After the adjustment, only the number of restored faces and the geographic location where the restoration was performed remained associated with failure of the restoration. The direct posterior restorations performed at the evaluated public health service units presented high survival rates. The restorations of people with lower access to POHS had lower survival rates. Class I restorations presented higher survival rates than class II restorations with two or more faces, regardless of the restorative material used.

Direct Posterior Restorations: A 13-Year Survey of Teaching Trends and Use of Materials

Objective:

The study aimed to evaluate teaching trends and use of materials in direct posterior restorations during a 13-year period in an Israeli dental school.

Methods:

Data registered in computerized files, relating to posterior restorations performed in the student clinic during the past 13 years (2004-2016), were collected. The restorative materials used (ie, amalgam vs composite), the type of tooth, and the number of surfaces restored were analyzed.

Results:

Data analysis included 26,925 restorations performed during 13 years. The number of one-surface composite restorations increased from 54.7% (n=330) to 81.9% (n=873). Two-surface restorations increased from 33.3% (n=254) to 64.3% (n=721). The percentage of amalgam restorations in three-surface restorations decreased from 72.08% to 51.34% (n=173). Analysis of tooth type showed that in 2016, the number of composite restorations performed in premolars reached 80.87% (n=723) and in molars 63.50% (n=1035). The percentage of composite restorations in the mandible and the maxilla was virtually equal.

Conclusions:

A clear trend in favor of composite resin restorations is evident in the 13-year survey and suggests a move toward an amalgam-free era.

Managing the phase-down of amalgam: part II. Implications for practising arrangements and lessons from Norway

The announcement of the Minamata Convention has triggered the lead into a phase-down in the use of dental amalgam. This paper considers aspects of this development in the context of the experience of banning the use of dental amalgam in Norway. It is suggested that strong top-down leadership and joined-up working by all relevant stakeholders, including patients, may be one of the most important keys to an effective, seamless transition to the provision of preventatively orientated, patient-centred, minimally interventive operative dentistry, based on state-of-the-art selection and application of tooth-coloured restorative materials. The benefits of such a transition are considered to be an important goal for dentistry in the UK.

Knowledge and attitudes of general dental practitioners towards posterior composite restorations in northern saudi arabia

INTRODUCTION

The restoration of posterior teeth with composite restoration is a common clinical practice nowadays. Opinions regarding posterior composite restorations vary among dentists. The aim of the present study was to determine the knowledge and opinions of general dental practitioners towards composite resins for posterior teeth restorations.

MATERIALS AND METHODS

A questionnaire was devised to elicit information regarding placement of composite restoration in posterior teeth in northern Saudi Arabia. It was distributed to 230 dentists by hand and e-mail. A response rate 136 (59%) was obtained. The questionnaire sought details about case selection criteria for composite restoration, problems associated with composites and reasons for selecting composite restoration in posterior teeth. The data was processed and analysed by SPSS statistical software 19. Frequencies and percentages were calculated for various responses of the participants.

RESULTS

Regarding the selection of composite restoration in posterior teeth, 97% of the dentists did not prefer composite placement for class I restoration with heavy occlusal contacts. 83% of the participants did not select composite for class II restoration. 78% of the respondents opted for restoring composites in small defects. Patients' aesthetic demands (90%), amalgam replacement (22%) and restoration of endodontically treated teeth (42%) were the contributing factors. Regarding the problems associated with posterior composite restorations. Recurrent caries (87%), post-operative sensitivity (84%), restoration fracture (83%) and polymerization shrinkage (73%) were the major problems reported by respondents associated with composite restorations. The other minor concerns were wear (60%), contact build up in case of class II cavity restorations (51%) and isolation for composite restorations (36%). Conservative cavity preparation (78%), aesthetics (73%) and patient preference (65%) were the main reasons for choosing composite restoration for the posterior teeth.

CONCLUSION

Posterior composites are not popular among dentists practicing in northern Saudi Arabia and there is a need of continued professional education and clinical training for the dentists for posterior composite restorations.

Survival characteristics of composite restorations in primary teeth

OBJECTIVES

This retrospective study analyzed restoration survival of composite fillings in children with at high caries risk in relation to age, sex, operator, tooth type, filling extension, and material used.

MATERIALS AND METHODS

Among 667 children treated in 2004-2012 in a university setting without sedation or general anesthesia, 2388 composite fillings were included. Relevant data from regular recall intervals were retrieved from patients' records. Either total-etch or a self-etch adhesive combined with flowable and/or (nano)hybrid composite was used. The Kaplan-Meier estimator and Cox proportional hazard analysis with backward elimination model were applied for survival analysis.

RESULTS

For the observation period of 8 years (mean 1.7 years), the cumulative failure rate was 17.2 % with annual failure rates of 10.0 %. In 8.8 % of the cases, fillings failed due to secondary caries. In 8.3 % technical failure due to total filling loss, loosening, marginal gaps, or tooth fracture occurred. Tooth type, filling extension, age, operator, dental dam, and type of adhesive were significant for survival (p < 0.05).

CONCLUSIONS

Filling survival was comparably lower to composite restorations observed in prospective clinical studies on permanent teeth and other tooth-colored restoratives used in primary teeth. Due to the very high caries risk and young age of the population, frequent loss due to secondary caries was observed. With respect to the high caries risk, composite restorations can be used to treat carious primary teeth, though a strict caries prevention regimen should be followed to minimize restoration failure.

CLINICAL RELEVANCE

Filling loss of composites in the primary dentition is associated with secondary caries on the long term.

Dentists' restorative decision-making and implications for an 'amalgamless' profession. Part 1: a review

The Minamata Convention has agreed to a worldwide reduction and ultimate elimination in the production and use of mercury containing products. This will have implications for the practice of dentistry. Australian organizations' pronouncements on the issue are limited and research examining the Australian context dated. The restoration of teeth with direct materials has changed significantly since the 1980s. Up to this time amalgam was the material of choice for direct posterior restorations. Its properties and guidelines for placement were, and remain, well established. Resin composite has replaced amalgam as the material of choice in many clinical situations. Despite inherent clinical disadvantages compared to amalgam, there continues to be a shift toward greater use of resin composite. There is consensus worldwide that the restoration of posterior teeth using resin composite now exceeds that of amalgam. The reasons for this are reviewed in this article along with current evidence and commentary relating to direct restorative and evidence-based decision-making, minimally invasive approaches, and approaches to education. The implications for these in an 'amalgamless' profession are identified.

The decision to repair or replace a defective restoration is affected by who placed the original restoration: findings from the National Dental PBRN

OBJECTIVES

To evaluate how restoration characteristics are associated with the decision to repair or replace an existing restoration. The following hypotheses were studied: dentists who placed the original restoration are more likely to repair instead of replace restorations (H1) that are in molar teeth; (H2) that are in the upper arch; (H3) that have amalgam restorative material; (H4) if a fracture is not the primary reason for the defect; and (H5) when the restoration comprises more than one surface.

METHODS

This cross-sectional study used a consecutive patient/restoration recruitment design. 194 dentists members of a dental practice-based research network recorded data on restorations in permanent teeth that needed repair or replacement.

RESULTS

For 6623 of the 8770 defective restorations in 6643 patients, the treatment was provided by the dentist who had not placed the original restoration (75%). The 2-way interaction revealed that dentists who had placed the original restoration often chose to repair when the defective restoration was in a molar, relative to premolar or anterior teeth (OR=2.2, p<.001); and chose to replace when the restoration had amalgam (OR=0.5, p<.001), and when it was a fracture compared to another reason (OR=0.8, p=001).

CONCLUSION

Most dentists are not conservative when they revisit a restoration that they originally placed regardless of type of failure, number of surfaces or material used. However, dentists who had placed the original restoration were significantly more likely to repair it when the defective restoration was in a molar tooth.

CLINICAL SIGNIFICANCE

Most dentists who placed the original restoration were prone to replace it, however if the defective restoration was located in a molar tooth they would consider repairing it.

Translating research into everyday clinical practice: lessons learned from a USA dental practice-based research network

OBJECTIVES

This paper discusses practice-based research (PBR) as a means to speed up the translation of research findings to clinical practice. It also reviews repair versus replacement of defective restorations as one example of the delay in the application of research findings to clinical practice.

METHODS

Despite the existence of clinical studies, a significant delay exists between the generation of new knowledge and its application into the medical/dental community and their patients. One example is the repair of defective dental restorations. About 75% of practitioners in general dental practices do not consider the repair of dental restorations as a viable alternative to the replacement of defective restorations. Engaging and partnering with health practitioners in the field on studies addressing everyday clinical research questions may offer a solution to speed up the translation of the research findings.

RESULTS

Practice-based research (PBR) offers a unique opportunity for practitioners to be involved in the research process, formulating clinical research questions. Additionally, PBR generates evidence-based knowledge with a broader spectrum that can be more readily generalized to the public. With PBR, clinicians are involved in the entire research process from its inception to its dissemination.

SIGNIFICANCE

Early practitioner interaction in the research process may result in ideas being more readily incorporated into practice. Clinical studies are of paramount importance for testing and translation of the research findings to the community.

Restorative material and other tooth-specific variables associated with the decision to repair or replace defective restorations: findings from The Dental PBRN

OBJECTIVES

Using data from dentists participating in The Dental Practice-Based Research Network (DPBRN), the study had 2 main objectives: (1) to identify and quantify the types of restorative materials in the existing failed restorations; and (2) to identify and quantify the materials used to repair or replace those failed restorations.

METHODS

This cross-sectional study used a consecutive patient/restoration recruitment design. Practitioner-investigators recorded data on consecutive restorations in permanent teeth that needed repair or replacement. Data included the primary reason for repair or replacement, tooth surface(s) involved, restorative materials used, and patient demographics.

RESULTS

Data for 9875 restorations were collected from 7502 patients in 197 practices for which 75% of restorations were replaced and 25% repaired. Most of the restorations that were either repaired or replaced were amalgam (56%) for which most (56%) of the material used was direct tooth-coloured. The restorative material was 5 times more likely to be changed when the original restoration was amalgam (OR=5.2, p<.001). The likelihood of changing an amalgam restoration differed as a function of the tooth type (OR=3.0, p<.001), arch (OR=6.6, p<.001); and number of surfaces in the original restoration (OR=12.2, p<.001).

CONCLUSION

The probability of changing from amalgam to another restorative material differed with several characteristics of the original restoration. The change was most likely to take place when (1) the treatment was a replacement; (2) the tooth was not a molar; (3) the tooth was in the maxillary arch; and (4) the original restoration involved a single surface.