- Email: [email protected]
Posterior composites
Patients make the final decision but should be guided by the dentist to consider longevity, strength, and where the restoration will be located as well as aesthetics.
Christensen GJ: Restoration longevity versus esthetics: A dilemma for dentists and patients. J Am Dent Assoc 142:1194-1196, 2011 Reprints available from GJ Christensen, CR Foundation, 3707 N Canyon Rd, Suite 3D, Provo, UT 84604
Posterior composites Background.—Resin composites are now the most popular and widely used choice for direct posterior restorations. These materials offer aesthetic properties and good clinical service. However, the long-term durability of these restorations remains in question, with most studies focusing on short-term results only. Methods.—A literature review was conducted to identify clinical trials that investigated the performance of posterior composite restorations over at least 5 years. The 34 studies selected were published between 1996 and 2011. Results.—When hybrid composites are used, the annual failure rates (AFRs) are between 1% and 3%, depending on factors other than properties of the material. Failure occurs as a result of secondary caries and fracture. Seldom is material failure to blame unless the patient bruxes or clenches the teeth. Clinical factors that contribute to failure include the type, size, and location of the restoration. The operator’s
technique and quality of work also contribute. Patient factors that can influence longevity of a restoration include socioeconomic factors such as income and type of dental service, demographic factors such as age, and behavioral influences, including caries prevalence. In an evaluation covering restorations in place for up to 22 years, 61 of 110 failed restorations were repaired rather than replaced. When repaired and replaced restorations were considered failures, the AFR was 1.9% over the 22 years (Fig 1). When repaired restorations were considered successes, the AFR fell to 0.7%. Choosing more conservative treatments when dealing with restoration defects will help prevent premature failures and improve longevity (Fig 2). Discussion.—Only after extended periods of observation or in the presence of glass-ionomer cement base were significant differences in AFRs identified. Posterior composite restorations, including those using hybrid materials that are no longer available on the market, fail
Fig 1.—Kaplan-Meier survival curves for two composites evaluated over up to 22-year observation period. When both repaired and replaced restorations were considered to be failures (left-hand side graph), the AFR was 1.9%. On the other hand, when repaired restorations were considered to be successes (right-hand side graph), the AFR decreased to 0.7%. (Courtesy of Demarco FF, Corr ea MB, Cenci MS, Moraes RR, Opdam NJ: Longevity of posterior composite restorations: Not only a matter of materials. Dent Mater 28:87-101, 2012.)
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Issue 4
2013
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Fig 2.—Representative pictures of a restoration evaluated on the 22-year follow-up study [3] that was still clinically acceptable (A) or that have been repaired during the follow-up period (B). In (B), repair was considered an alternative to replacement and the restoration was still clinically serviceable 7 years after being repaired. (Courtesy of Demarco FF, Corr ea MB, Cenci MS, Moraes RR, Opdam NJ: Longevity of posterior composite restorations: Not only a matter of materials. Dent Mater 28:87-101, 2012.)
mainly because of secondary caries or fracture of the tooth or the restoration. These may have nothing to do with the material used for the restoration. Secondary caries occur as part of a continuum from primary caries, which respond to effective clinical and patient efforts in prevention. Fracture is partially the result of having a softer base under the restoration, such as a lining. The strongest material with the best fracture toughness should be used to avoid this problem. Good results are being achieved with the currently available posterior composite materials.
Clinical Significance.—Repair is a viable alternative to replacement and can significantly extend the life of a restoration. Composite restorations perform well in posterior teeth, having AFRs of 1% to 3%. The success of these
restorations depends mainly on factors related to the patient and dentist, as well as to the material used. The use of preventive and conservative approaches to replacement helps achieve the best outcomes. Future materials may address the prevention of secondary caries and the reduction in fracture incidence.
Demarco FF, Corr ea MB, Cenci MS, Moraes RR, Opdam NJ: Longevity of posterior composite restorations: Not only a matter of materials. Dent Mater J 28:87-101, 2012 Reprints available from FF Demarco, Graduate Program in Dentistry, Federal Univ of Pelotas, Rua Gonc¸alves Chaves 457, Pelotas, RS 96015-560, Brazil; fax: þ55 53 3222 6690x135; e-mail: flavio. [email protected] or [email protected]
Risk Management Avoiding lawsuits Background.—Patients who have poor outcomes after oral surgical procedures are more likely than patients who are dissatisfied after other types of dental procedures to file a lawsuit against the dentist. These suits also tend to generate significantly higher awards than suits after a general dental procedure. Steps can be taken to minimize the chance of litigation against the dental practice, which will avoid the entire emotional, painful, and time-consuming experience.
Why Sue?—Factors that encourage lawsuits against dental professionals include several trends in society, as follows:
196
Dental Abstracts
Dentists and other health care providers are no longer considered community leaders as they were in the past. Health care providers are considered business people rather than dedicated healers. Lower insurance payments related to managed care contracts mean health care providers cannot afford the luxury of spending significant time with patients to develop meaningful rapport. Patients see litigation as a solution to their financial needs in this weak economy with high unemployment, significant underemployment, and high levels of personal debt.
Christensen GJ: Restoration longevity versus esthetics: A dilemma for dentists and patients. J Am Dent Assoc 142:1194-1196, 2011 Reprints available from GJ Christensen, CR Foundation, 3707 N Canyon Rd, Suite 3D, Provo, UT 84604
Posterior composites Background.—Resin composites are now the most popular and widely used choice for direct posterior restorations. These materials offer aesthetic properties and good clinical service. However, the long-term durability of these restorations remains in question, with most studies focusing on short-term results only. Methods.—A literature review was conducted to identify clinical trials that investigated the performance of posterior composite restorations over at least 5 years. The 34 studies selected were published between 1996 and 2011. Results.—When hybrid composites are used, the annual failure rates (AFRs) are between 1% and 3%, depending on factors other than properties of the material. Failure occurs as a result of secondary caries and fracture. Seldom is material failure to blame unless the patient bruxes or clenches the teeth. Clinical factors that contribute to failure include the type, size, and location of the restoration. The operator’s
technique and quality of work also contribute. Patient factors that can influence longevity of a restoration include socioeconomic factors such as income and type of dental service, demographic factors such as age, and behavioral influences, including caries prevalence. In an evaluation covering restorations in place for up to 22 years, 61 of 110 failed restorations were repaired rather than replaced. When repaired and replaced restorations were considered failures, the AFR was 1.9% over the 22 years (Fig 1). When repaired restorations were considered successes, the AFR fell to 0.7%. Choosing more conservative treatments when dealing with restoration defects will help prevent premature failures and improve longevity (Fig 2). Discussion.—Only after extended periods of observation or in the presence of glass-ionomer cement base were significant differences in AFRs identified. Posterior composite restorations, including those using hybrid materials that are no longer available on the market, fail
Fig 1.—Kaplan-Meier survival curves for two composites evaluated over up to 22-year observation period. When both repaired and replaced restorations were considered to be failures (left-hand side graph), the AFR was 1.9%. On the other hand, when repaired restorations were considered to be successes (right-hand side graph), the AFR decreased to 0.7%. (Courtesy of Demarco FF, Corr ea MB, Cenci MS, Moraes RR, Opdam NJ: Longevity of posterior composite restorations: Not only a matter of materials. Dent Mater 28:87-101, 2012.)
Volume 58
Issue 4
2013
195
Fig 2.—Representative pictures of a restoration evaluated on the 22-year follow-up study [3] that was still clinically acceptable (A) or that have been repaired during the follow-up period (B). In (B), repair was considered an alternative to replacement and the restoration was still clinically serviceable 7 years after being repaired. (Courtesy of Demarco FF, Corr ea MB, Cenci MS, Moraes RR, Opdam NJ: Longevity of posterior composite restorations: Not only a matter of materials. Dent Mater 28:87-101, 2012.)
mainly because of secondary caries or fracture of the tooth or the restoration. These may have nothing to do with the material used for the restoration. Secondary caries occur as part of a continuum from primary caries, which respond to effective clinical and patient efforts in prevention. Fracture is partially the result of having a softer base under the restoration, such as a lining. The strongest material with the best fracture toughness should be used to avoid this problem. Good results are being achieved with the currently available posterior composite materials.
Clinical Significance.—Repair is a viable alternative to replacement and can significantly extend the life of a restoration. Composite restorations perform well in posterior teeth, having AFRs of 1% to 3%. The success of these
restorations depends mainly on factors related to the patient and dentist, as well as to the material used. The use of preventive and conservative approaches to replacement helps achieve the best outcomes. Future materials may address the prevention of secondary caries and the reduction in fracture incidence.
Demarco FF, Corr ea MB, Cenci MS, Moraes RR, Opdam NJ: Longevity of posterior composite restorations: Not only a matter of materials. Dent Mater J 28:87-101, 2012 Reprints available from FF Demarco, Graduate Program in Dentistry, Federal Univ of Pelotas, Rua Gonc¸alves Chaves 457, Pelotas, RS 96015-560, Brazil; fax: þ55 53 3222 6690x135; e-mail: flavio. [email protected] or [email protected]
Risk Management Avoiding lawsuits Background.—Patients who have poor outcomes after oral surgical procedures are more likely than patients who are dissatisfied after other types of dental procedures to file a lawsuit against the dentist. These suits also tend to generate significantly higher awards than suits after a general dental procedure. Steps can be taken to minimize the chance of litigation against the dental practice, which will avoid the entire emotional, painful, and time-consuming experience.
Why Sue?—Factors that encourage lawsuits against dental professionals include several trends in society, as follows:
196
Dental Abstracts
Dentists and other health care providers are no longer considered community leaders as they were in the past. Health care providers are considered business people rather than dedicated healers. Lower insurance payments related to managed care contracts mean health care providers cannot afford the luxury of spending significant time with patients to develop meaningful rapport. Patients see litigation as a solution to their financial needs in this weak economy with high unemployment, significant underemployment, and high levels of personal debt.