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Posterior resin composite failures
Restorative Dentistry Posterior resin composite failures Background.—Posterior resin composites are excellent materials for posterior direct restorations and offer mean annual failure rates between 1% and 3%. However, most observation times are less than 5 years. These materials demonstrate properties that are more than adequate, so the survival of these restorations may be the result of nonmaterial factors, such as patient- or tooth-related risk factors. Often these factors are not the primary focus of attention in survival studies and are not reported in detail. An analysis of the raw data of relevant studies was undertaken to assess the influence of patient-, materials-, and tooth-related variables on the survival of posterior resin composite restorations. Methods.—A search of the Cochrane Library, PubMed, the Web of Science, and Scopus covering January 1990 to
February 2013 yielded 12 longitudinal studies of direct posterior resin composite restorations follow-up for at least 5 years. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Authors were contacted for access to their original datasets. The data analyzed included patient age, gender, and caries risk status; upper or lower jaw involvement; number of restored surfaces; resin composite and adhesive materials used; and whether glass-ionomer cement was used as a base or liner. Annual failure rate (AFR) was also calculated. Results.—The 12 studies covered 2816 restorations. Because 1324 of the restorations came from a single dental practice, analyses were made including all studies and excluding these restorations to account for any possible
Fig 2.—Kaplan-Meier graph showing survival of molar and premolar restorations. Separate graph lines express survival of low- and high- þ medium-risk patients, including a line for combined risks. (Courtesy of Opdam NJM, van de Sande FH, Bronkhorst E, et al: Longevity of posterior composite restorations: A systematic review and meta-analysis. J Dent Res 93:943-949, 2014.)
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influence this large number of restorations may have had on the final outcomes. A total of 569 restorations failed. In the first year after the restoration was placed, the reason for failure was nearly always endodontic complications. In later years, caries and fractures accounted for most failures, with few endodontic problems causing loss of the restoration. Composites in materials with a greater than 60% vol filler load (compact-filled) and those with a less than 60% vol filler load (midway-filled) were compared. Adhesives could not be divided into relevant groups for analysis. In both molars and premolars there was a higher failure rate in teeth with a high caries risk, presence of lining cement, and increased number of surfaces restored. In addition, molars restored with compact-filled resin composites had a higher risk of failure than those restored with normal hybrid materials. The AFR for teeth at high or medium caries risk at 10 years was 4.6%, whereas that for teeth at low risk was 1.6% (Fig 2). Discussion.—Caries risk and number of surfaces restored were significant factors in the failure of these posterior resin composite restorations. Specific materials
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Dental Abstracts
factors that contributed included the presence of a liner or base of glass-ionomer cement and the use of compactfilled materials. Endodontic failures were largely confined to the first year after placement, with failures thereafter stemming from caries or fractures.
Clinical Significance.—Posterior resin composite restorations tend to have good survival, with a mean annual failure rate of 1.8% after 5 years and just 2.4% after 10 years. Factors that can shorten survival include caries risk, number of surfaces restored, and the use of a glassionomer liner or compact-filled materials.
Opdam NJM, van de Sande FH, Bronkhorst E, et al: Longevity of posterior composite restorations: A systematic review and metaanalysis. J Dent Res 93:943-949, 2014 Reprints available from NJM Opdam, Radboud Univ Nijmegen Medical Ctr, College of Dental Sciences, Preventive and Restorative Dentistry, Ph van Leydenlaan 25, PO Box 9101 6500HB Nijmegen, The Netherlands; e-mail: [email protected]
February 2013 yielded 12 longitudinal studies of direct posterior resin composite restorations follow-up for at least 5 years. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Authors were contacted for access to their original datasets. The data analyzed included patient age, gender, and caries risk status; upper or lower jaw involvement; number of restored surfaces; resin composite and adhesive materials used; and whether glass-ionomer cement was used as a base or liner. Annual failure rate (AFR) was also calculated. Results.—The 12 studies covered 2816 restorations. Because 1324 of the restorations came from a single dental practice, analyses were made including all studies and excluding these restorations to account for any possible
Fig 2.—Kaplan-Meier graph showing survival of molar and premolar restorations. Separate graph lines express survival of low- and high- þ medium-risk patients, including a line for combined risks. (Courtesy of Opdam NJM, van de Sande FH, Bronkhorst E, et al: Longevity of posterior composite restorations: A systematic review and meta-analysis. J Dent Res 93:943-949, 2014.)
Volume 60
Issue 2
2015
e73
influence this large number of restorations may have had on the final outcomes. A total of 569 restorations failed. In the first year after the restoration was placed, the reason for failure was nearly always endodontic complications. In later years, caries and fractures accounted for most failures, with few endodontic problems causing loss of the restoration. Composites in materials with a greater than 60% vol filler load (compact-filled) and those with a less than 60% vol filler load (midway-filled) were compared. Adhesives could not be divided into relevant groups for analysis. In both molars and premolars there was a higher failure rate in teeth with a high caries risk, presence of lining cement, and increased number of surfaces restored. In addition, molars restored with compact-filled resin composites had a higher risk of failure than those restored with normal hybrid materials. The AFR for teeth at high or medium caries risk at 10 years was 4.6%, whereas that for teeth at low risk was 1.6% (Fig 2). Discussion.—Caries risk and number of surfaces restored were significant factors in the failure of these posterior resin composite restorations. Specific materials
e74
Dental Abstracts
factors that contributed included the presence of a liner or base of glass-ionomer cement and the use of compactfilled materials. Endodontic failures were largely confined to the first year after placement, with failures thereafter stemming from caries or fractures.
Clinical Significance.—Posterior resin composite restorations tend to have good survival, with a mean annual failure rate of 1.8% after 5 years and just 2.4% after 10 years. Factors that can shorten survival include caries risk, number of surfaces restored, and the use of a glassionomer liner or compact-filled materials.
Opdam NJM, van de Sande FH, Bronkhorst E, et al: Longevity of posterior composite restorations: A systematic review and metaanalysis. J Dent Res 93:943-949, 2014 Reprints available from NJM Opdam, Radboud Univ Nijmegen Medical Ctr, College of Dental Sciences, Preventive and Restorative Dentistry, Ph van Leydenlaan 25, PO Box 9101 6500HB Nijmegen, The Netherlands; e-mail: [email protected]