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Introduction: Hall's technique preformed metal crown (HTPMC) has been used widely by pediatric dentists in developed countries as a new approach for managing decayed primary molars without local anesthesia, caries removal, and tooth preparation. Currently, inadequate information is available regarding the implementation of this technique (HTPMC) in Malaysia. This study is aimed at evaluating the implementation of HTPMC by Malaysia's pediatric dentists and identify the co-occurrence frequencies of the HTPMC implementation with the respondents' demographic profile., Materials and Methods: A cross-sectional questionnaire-based research was conducted among 65 pediatric dentists in Malaysia. Online questionnaires were distributed to the pediatric dentists employed at public hospitals (MOH) and universities in Malaysia., Result: It was found that over half of the respondents (65.6%) employed HTPMC. The analysis of the co-occurrence network frequency revealed that a high frequency of female pediatric dentists who were within the age group of 31-40 years old had fulfilled their postgraduation overseas and was employed in the university mainly applied HTPMC., Conclusion: The application of HTPMC among respondent pediatric dentists in Malaysia was high. However, most respondents considered HTPMC a treatment option only to manage carious primary molar rather than a treatment of choice., Competing Interests: There was no conflict of interest nor significant financial support present in this work to affect its results., (Copyright © 2021 Fabiha Jesmin et al.)

Objective: To determine the frequency of complications in crowns cemented over a 5-year period in a tertiary care hospital and also to report the survival of these crowns., Methods: The retrospective cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, from March 2017 to March 2018 and comprised porcelain fused-to-metal crowns placed on the anterior or posterior teeth that were fabricated at the institutional laboratory and were placed in institutional dental clinics in the preceding 5 years. Porcelain-fused to-metal The crowns were clinically and radio-graphically evaluated in a duration of two months for presence/absence of complications. Factors associated with the failure of the crowns, their survival and the impact of covariates, like gender, flossing and bruxism, on the survival time were determined. Data was analysed using SPSS 22., Results: There were 150 crowns related to 107 patients who had a mean age of 45.0±11.4 years. The most common complication observed was open proximal contacts 9(6%) followed by de-cementation 8(5.3%), porcelain chipping 9(6%) and abutment fracture 2(1.3%). The 5-year survival rate of the crowns was 127(84.7%). The mean follow-up time was 57.2±1.0 months. Overall, year-wise survival of PFM crowns for one year till five years was 147 (98%), 144 (96%), 135 (90%), 130 (86%) and 119 (79%) respectively., Conclusions: The porcelain-fused-to-metal crowns had a high 5-year survival rate. Open proximal contacts represented the most common complication.

Aim: To assess whether the timing of pulp disease after tooth restoration was associated with type of restorative dental material used, extent of the restoration or tooth type., Methodology: A comprehensive search and analysis of data using the Titanium Oral Health Management software program at The Oral Health Centre of Western Australia were performed to correlate procedural codes for teeth that had restorations placed and subsequently developed pulp disease requiring endodontic treatment or extraction from 1st January 2009 to 31st December 2013. Manual analysis of paper and/or electronic patient record cards was also performed. Data collected included restoration type, restored tooth surfaces, tooth type and the dates of restoration and subsequent endodontic intervention or extraction., Results: Of 330 teeth that met the inclusion criteria, 84 (26%) had composite resin restorations, 80 (24%) had amalgams, 119 (36%) had glass-ionomer cement (GICs), and 47 (14%) had crowns. The average time between restoration and further intervention was 330 days with a range from 3 to 1775 days (approximately 5 years). Teeth restored with crowns or five-surface restorations were significantly more likely to require earlier intervention than other restorations. Premolar and anterior teeth were also more likely to require earlier intervention., Conclusions: Teeth that developed pulp disease requiring further intervention that were restored with crowns and five-surface GIC developed the disease sooner than teeth that were restored with amalgam or composite. In teeth with five-surface restorations that developed pulp disease requiring further intervention, premolar and anterior teeth developed the pulp disease sooner than molars., (© 2018 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

Aim: It is the aim of this paper to present data on the survival of restorations in canine teeth by analysis of the time to re-intervention on the restorations and time to extraction of the restored tooth, and to discuss the factors which may influence this., Methods: A data set was established, consisting of General Dental Services (GDS) patients, this being obtained from all records for adults (aged 18 or over at date of acceptance) in the GDS of England and Wales between 1990 and 2006. The data consist of items obtained from the payment claims submitted by GDS dentists to the Dental Practice Board (DPB) in Eastbourne, Sussex, UK. This study examined the recorded intervals between placing a restoration in a canine tooth and re-intervention on the tooth, and the time to extraction of the restored tooth., Results: Data for more than three million different patients and more than 25 million courses of treatment were included in the analysis. Included were all records for adults (aged 18 or over at date of acceptance). Overall, 1,232,052 restorations involving canine teeth were included in the analysis. With regard to time to re-intervention, 33% of restorations had survived at 15 years, and with regard to time to extraction of the restored tooth, cumulative survival was 78% at 15 years. Veneers and crowns performed best in terms of time to re-intervention, but crowns performed worst when time to extraction was analysed., Conclusions: Overall, crowns and porcelain veneers placed on canine teeth perform best to re-intervention after 15 years, but crowns perform worst when the time to extraction of the restored tooth is examined and veneers perform best, with a 20 percentage point difference in cumulative survival at fifteen years between crowns and the best performing restoration in the under-40 year age group, this effect being accentuated in the over-40 year age group. Other factors influencing restoration longevity in canine teeth include: patient age, dentist age and the patient's annual need for dental treatment.

Objectives: This retrospective longitudinal study aimed to assess the longevity of single unit crowns placed by several dentists and to investigate risk factors associated with crown failures., Methods: From patient files, longevity of 3404 full crown restorations placed in 1557 patients by 8 Dutch dentists between 1996 and 2011 were analyzed. Annual failure rates (AFRs) were calculated and variables associated with failure (success and survival of crowns) were assessed by multivariate Cox-regressions analysis with shared frailty for patients., Results: Most of crowns were PFM (63.8%) placed in molars (58.1%) and non endodontically treated teeth (65.4%). The observation time of restorations varied from 3 weeks to 11 years with a mean of 7 years, resulting in a mean AFR at 11 years of 2.1% and 0.7% for success and survival of crowns, respectively. Among dentists a relevant variation for type of interventions was observed with AFR varying between 1.2% and 3.5%. The most significant risk factor for failure of crowns was the presence of an endodontic treatment, resulting in Hazard ratios of 1.31 for success [95%CI 1.07-1.61] and 1.89 [95%CI 1.35-2.65] for survival of crowns. Tooth type, tooth position (jaw) and gender showed also a significant influence on success of crowns. For survival, increase in patients' age results in a higher risk for failure., Conclusions: Overall, crowns placed by a selected group of dentist showed a good to acceptable success and survival rates, mainly dependent from the practice. The presence of an endodontically treated tooth was a significant risk factor leading to more failures., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Introduction: The aim was to compare the periapical status of root-filled teeth restored with resin composite, laboratory-fabricated crowns, or amalgam in a Swedish adult population., Methods: The subjects consisted of 440 individuals from a randomly selected sample of 1000 adult residents of a Swedish county. The type, material, and quality of the restorations were recorded for all root-filled teeth by using clinical examination and intraoral clinical photographs. Periapical status, root-filling quality, and marginal bone loss were evaluated on panoramic radiographs. The association between periapical status and type, material, and quality of the restorations was analyzed by using the χ(2) test and logistic regression., Results: No difference in the frequency of apical periodontitis (AP) between teeth restored with resin composite, laboratory-fabricated crowns, or amalgam (29.7%, 26.2%, and 43.1%, respectively) of adequate quality was found. No association between AP and resin composite restorations was disclosed; however, there was an association between AP and inadequate root-filling quality and marginal bone loss >1/3 of the root length., Conclusions: The results did not indicate any association between AP and resin composite restorations. Neither the type nor the material of the restoration was of significance for periapical status as long as the quality was adequate., (Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Purpose: This study compares the FEA-calculated stresses generated within the supporting periodontal structure of a mandibular second molar restored with a full ceramic crown and with a porcelain-fused-to-metal (PFM) crown, each resisting occlusal forces acting at different inclinations., Materials and Methods: Three-dimensional finite element models representing the crown of an unrestored mandibular second molar and two relevant restoration designs were constructed. Two designs represented the molar restored with a full ceramic crown and with a PFM crown, each cemented with the same resin cement. Occlusion was assumed at three contact areas, which equally shared a 100 N force. The analysis was carried out for forces located in the bucco-axial-lingual plane at five inclinations, 0, 22.5°, 45°, 67.5°, and 90°, measured from the axial direction of the tooth. The magnitudes and sites of the maximum equivalent stress (MES) generated within the supporting periodontium of each analyzed model were collected., Results: Generally, there were no significant differences in the site and magnitude of MES in the regions of the supporting structure for the analyzed models. The MES was located at the tooth periodontal ligament (PDL) bifurcation area and distal root apex, crestal bone at the junction between cortical and cancellous bone, and the distal wall of the mesial root socket of cancellous bone. The highest stresses corresponded to a horizontal load, followed by the axial load in the PDL and cortical zones. The results show opposite observations for the cancellous bone. The lowest stresses were generated under a load inclination between 22.5° and 45°., Conclusion: Considering the stresses generated within the supporting structures, the present work validates, by calculation, the proposed clinical use of either a full ceramic crown or a PFM crown as a restoration for mandibular second molars., (© 2014 by the American College of Prosthodontists.)

Introduction: The purpose of this study was 2-fold: (1) to investigate the critical time-lapse of endodontic intervention subsequent to various restorations and tooth surfaces and (2) to assess and compare the risk factors associated with the restorations, tooth surfaces, and endodontic treatment., Methods: A comprehensive computerized analysis of all dental school patients at the Case Western Reserve University School of Dental Medicine who received restorations from 2008-2013 was obtained. Inclusion and exclusion criteria were applied. The sample size was limited to teeth with endodontic treatment completed by the endodontic postgraduate dental clinic. Data collected included restoration type, restored tooth surfaces, tooth type, and the dates of restoration and subsequent endodontic treatment. A 2-sample paired t test (95% confidence interval, P < .05) and pair-wise comparison with Bonferroni corrections were implemented., Results: The mean time between restoration placement and resultant endodontic intervention was 270 days, with a mean difference of 247-294 days (P < .0001). Further analysis revealed composite resin was 1.91 times more likely than amalgam and 5.69 times more likely than crowns to cause resultant endodontic intervention. Teeth with 2 or more restorative surfaces required endodontic intervention (P < .001)., Conclusions: Of the patients who required endodontic treatment after restoration placement, the critical time-lapse was 9 months. Composite restorations and teeth with 2 or more restorative surfaces were significantly associated with endodontic treatment. From the results of the current study, we recommended that all dental practitioners should perform a thorough endodontic evaluation and diagnosis before, during, and after all restorative procedures., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Statement of Problem: Milling is a central and important aspect of computer-aided design and computer-aided manufacturing (CAD/CAM) technology. High milling accuracy reduces the time needed to adapt the workpiece and provides restorations with better longevity and esthetic appeal. The influence of different milling processes on the accuracy of milled restorations has not yet been reviewed., Purpose: The purpose of this study was to investigate the influence of different milling processes on the accuracy of ceramic restorations., Material and Methods: Four groups of partial crowns were milled (each n = 17): Three groups in a 4-axial milling unit: (1) 1-step mode and Step Bur 12S (12S), (2) 1-step mode and Step Bur 12 (1Step), (3) 2-step mode and Step Bur 12 (2Step), and (4) one group in a 5-axial milling unit (5axis). The milled occlusal and inner surfaces were scanned and superimposed over the digital data sets of calculated restorations with specialized difference analysis software. The trueness of each restoration and each group was measured. One-way ANOVA with a post hoc Tukey test was used to compare the data (α = .05)., Results: The highest trueness for the inner surface was achieved in group 5axis (trueness, 41 ± 15 μm, P<.05). The 4-axial milling unit exhibited trueness at settings ranging from 61 μm (2Step) to 96 μm (12S). For the occlusal surface, the highest trueness was achieved with group 5axis (trueness, 42 ± 10 μm). The 4-axial milling unit exhibited trueness at settings ranging from 55 μm (1Step) to 76 μm (12S)., Conclusions: Restorations milled with a 5-axial milling unit have a higher trueness than those milled with a 4-axial milling unit. A rotary cutting instrument with a smaller diameter results in a more accurate milling process. The 2-step mode is not significantly better than the 1-step mode., (Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Objectives: The longevity of dental restorations in patients with amelogenesis imperfecta (AI) is limited. The aim of this paper is to compare oral health and longevity of dental restorations in a group of young patients with AI compared to a control group., Methods: Patients included were 82 patients with AI, 40 boys and 42 girls, 6 to 25 years old (mean age 14.5±4.3 years) and a control group matched in age, gender and residential area. All patients received an examination recording dental caries, gingivitis, previous therapy, replaced restorations, tooth sensitivity, and number of dental visits. Patient dental records, extending from 6 to 10 years before the study, provided data on previous care., Results: Annual mean number of dental visits in the AI group was 2.9±1.7 compared to 1.9±1.2 in the control group (p<0.001). DMFS was 8.1±15.6 in the AI group compared to 1.0±2.0 in the control group (p<0.001). The longevity of dental restorations was significantly lower in the patients with AI, with 24.7±35.1% of the AI group requiring replacement of fillings during the observation period compared to 9.23±23.7% in the control group (p=0.001). Patients with hypomineralized/hypomaturized AI have restorations of shorter longevity than those with hypoplastic AI (p<0.01). Porcelain crowns had significantly longer survival than composite resin materials in the AI group (p<0.001). Clinical Significance This study shows the need for long-lasting restorative solutions for patients with AI. It also shows the importance of establishing an early permanent therapy plan for these patients to avoid frequent dental visits., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Introduction: Experimental studies show that dental pulp cells respond unfavorably to contact with resin composite restorative material. Hypothetically, in a random population, the frequency of apical periodontitis should be higher for teeth restored with resin composite than with amalgam. Therefore, the aim was to compare the periapical status of non-root-filled teeth restored with resin composite, amalgam, or laboratory-fabricated crowns in an adult Swedish population., Methods: The subjects comprised 440 individuals from a randomly selected sample of 1,000 adult residents of a Swedish county. The type, material, and quality of the restorations were recorded for all non-root-filled teeth by clinical examination and intraoral clinical photographs. Periapical status was evaluated on panoramic radiographs. The association between periapical status and type, material, and quality of the restorations was analyzed using the chi-square test and logistic regression analysis., Results: There was no significant difference in the frequency of apical periodontitis (AP) between teeth restored with resin composite or amalgam (1.3% and 1.1%, respectively). The frequency of AP for teeth restored with laboratory-fabricated crowns was significantly higher (6.3%). Regression analysis showed no association between AP and resin composite restorations but a significant association with laboratory-fabricated crowns., Conclusions: The results indicate that the risk of damage to the pulp-dentin complex from exposure to resin composite material and dentin bonding agents shown in experimental studies is not reflected in the clinical setting. However, in the study sample, AP was diagnosed in a significantly higher proportion of teeth restored with laboratory-fabricated crowns., (Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Unlabelled: Minimal Intervention Dentistry (MID) is an effective treatment approach with increasing acceptance among dental professionals., Objective: This study aimed to evaluate the MID impact on Dentistry by analyzing procedures performed on patients treated at a Pediatric Dentistry Graduate Program clinic which implemented MID., Study Design: The number of procedures including sealants, modified atraumatic restorative treatment (mART), resin crowns, direct pulp capping, pulpotomy, pulpectomy, and deciduous/ permanent extractions from 333 pediatric patients treated between the years 2001 to 2003 and 2008 to 2010 in Distrito Federal, Brazil were analyzed. Statistical analysis involved chi-square and G Williams tests., Results: 783 procedures were analyzed and demonstrated that there was a significant reduction of sealant placement in the last triennium when compared to the first one (p<0.0001). Moreover, there was a significant increase in the amount of mART (p<0.0001). This increase in mART procedures resulted in a significant reduction in procedures with pulp involvement: direct pulp capping (p=0.0014), pulpotomy (p=0.0014) and pulpectomy (p=0.0002)., Conclusions: Based on the results, MID represented a positive impact on the intervention on caries lesions in patients, mainly reflected by the significant reduction in the number of direct pulp capping, pulpotomy and pulpectomy.

Introduction: This retrospective study evaluated the survival of endodontically treated teeth (ETTs) and investigated factors influencing restoration and tooth survival., Methods: Data from 795 ETTs were recorded, and success (restoration still intact) and survival (restoration intact or failed/repaired/replaced and tooth still in situ) were analyzed using Kaplan-Meier statistics. A multivariate Cox regression analysis was performed to assess the variables influencing success and survival., Results: At the end of the observation period (mean observation time = 4.48 years), 45 teeth had been extracted (annual failure rate for survival = 1.9% at 9.6 years) and 114 restorations had received a restorative follow-up treatment (annual failure rate for success = 4.9% at 9.6 years)., Conclusions: ETTs showed acceptable survival and success in the long-term. Variables showing significant influence on survival were the number of teeth in the dentition and the presence of decay at the moment the patient entered the practice., (Copyright © 2013 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

With the Internet facilitating access to vast amounts of free information, dental practitioners face providing treatment for an increasingly informed public. However, the available content is not filtered, and it can be difficult for patients to discriminate between research-informed evidence and "glamorised" material of dubious origin. Patients reasonably expect a return for their investment and want to know how long their treatment will last. Clinicians have an obligation to inform their patients so that they can make reasoned decisions about treatment options. Longevity data are also informative for health agencies setting service schedules for publicly funded treatment, and for determining settlements by insurers such as ACC. Historically, much of the prosthodontic treatment performed in practice has relied heavily on dogma, low-level anecdotal evidence, and clinical case reports. This paper considers the literature on fixed and removable prosthodontic restorations and provides a critical review which can be used practically as the basis for informing patients, and to assist decision-makers in making fair and appropriate judgements.

The occurrence of accidental ingestion/aspiration and preventive measures were investigated at Tokyo Dental College Chiba Hospital. In addition, the characteristics of accidents at our hospital were analyzed by surveying the awareness of accidental ingestion/aspiration to utilize the data for prevention. Accidental ingestion accounted for about 30% of accidents that occurred at our hospital in fiscal 2008, but all ingested items were naturally excreted, and no accidental aspiration occurred. Accidental ingestion most frequently occurred when dental restorations were removed. Inlays and crowns were most frequently ingested, and dentists with 5 to less than 10 years of clinical experience tended to be involved in these accidents. According to the results of the questionnaire, removal of restorations was perceived as the treatment least likely to cause accidental ingestion/aspiration. Moreover, dentists who always took preventive measures against accidental ingestion/aspiration accounted for only 40% or less on average. To avoid accidental ingestion/aspiration, repeated courses and individual instruction for repeaters and the establishment of a surveillance system along with manuals to manage the violation should be emphasized.

Aim: This paper describes the database used to assess the survival of indirect restorations and presents general data on survival of these restorations., Methods: Data, based on the complete attendance and treatment history, over the 11 years from 1991 to 2001, of a statistically representative sample of 23,165 General Dental Services' (GDS) patients in England and Wales, all of whom received at least one indirect restoration during the observation period, have been analysed. The patients on the database received a total of 36,397 courses of treatment, and there were 52,481 indirect restorations placed. The method of analysis involved 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: Overall, 75% of indirect restorations remained without re-intervention after 5 years, and 61% after 10. Crowns outperformed other types of indirect restoration. Multi-surface metal inlays, by contrast, had a median interval to re-intervention of less than 8 years., Conclusions: The times to re-intervention for different types of indirect restoration have been successfully estimated and crowns shown to outperform veneers and inlays.

The provision of a joint orthodontic-restorative hospital service is important in providing a quality service for some dental malocclusions. A prospective survey was carried out of the joint orthodontic-restorative clinic at Mayday University Hospital, during the months of January to August 2005. Data was collected using a data collection form. In total 61 patient's attended 4 joint clinics. Fifty per cent of referrals were by general dental practitioners. The commonest referral reasons were spacing and dental trauma. Over one third of patients were seen within 12 weeks of their referral, whilst two thirds start their treatment within 12 weeks of consultation. The commonest restorative treatment was periodontal therapy, crown and bridgework. Over one third of patients required joint orthodontic and restorative treatment. More than 12% of patients require oral surgery in the form of removal of impacted teeth, exposure of unerupted teeth, placement of bone anchors or orthognathic surgery. Consultation and treatment waiting times could be reduced by the introduction of more clinics and employment of more staff A representative in oral surgery maybe useful with the increase use of bone anchors and mini implants to aid joint orthodontic-restorative treatment. Access to an orthodontic and restorative consultant clinic is useful in providing patients with a high quality of multidisciplinary treatment planning in an efficient manner.

Objective: To investigate the quality of root canal fillings and coronal restorations in relation to periapical status in a Greek population., Method and Materials: A total of 320 patients who required full-mouth radiographic examination were included. The quality of root canal fillings and the periapical status, as well as the quality of coronal restorations, were assessed by radiographic criteria. Results were analyzed using random effects logistic regression models., Results: Root canals with adequate filling length had a lower incidence of apical periodontitis than root canals with inadequate filling length (51.7% versus 63.4%, P ;= .002). Root-filled canals with adequate coronal restorations showed a lower incidence of apical periodontitis than those with inadequate restorations (47.3% versus 67.4%, P; < .001). When both root filling and coronal restoration were assessed, the incidence of apical periodontitis ranged from 39.2% to 67.6%., Conclusion: Quality of root canal treatment, as well as quality of coronal restoration, are strongly associated with the incidence of apical periodontitis.

This study was conducted in 533 children with 1,634 treated teeth who visited the Pediatric Dentistry Department at the Chiba Hospital of Tokyo Dental College between January and December, 2003. Restorations on deciduous tooth were categorized by age of patient and tooth type. The following observations were made: Children aged 4 (17.9%) visited the clinic most frequently and this group had the highest number of deciduous restorations (21.3%). Among the 1,634 deciduous teeth restored, metal inlays were provided in 29.4% of total teeth restored, composite resin restorations in 27.2%, stainless-steel crowns in 25.7%, composite resin full crowns in 7.7%, glass-ionomer cement restorations in 6.6%, and amalgam restorations in 3.4%. By age, composite resin was most frequently used in children aged 1 to 3. In children aged 5 to 9, metal inlay was most frequently used. Those aged 4 received mostly stainless-steel crowns. Composite resin restorations were used mostly in anterior deciduous teeth, and metal inlays mostly in deciduous molars. Previous research indicated an increasing trend towards composite resin restorations and composite resin full crowns. The present study also confirmed such a trend. While the use of metal inlays and stainless-steel crowns tended to increase until 1987, the present study indicated a trend to decrease.

The purpose of this study was to compare the longevity of crowns versus large multisurface restorations in posterior teeth. The investigation used the treatment database at Virginia Commonwealth University School of Dentistry. The inclusion criteria for the final data set used for analysis were: only one restored tooth per patient, premolars with three or more restored surfaces, molars with four or more restored surfaces, molars and premolars restored with complete veneer metal crowns, or crowns veneered with metal and porcelain. The Kaplan-Meier approach was used to visualize the survival curves, and the Cox proportional hazards model was used for analysis of predictor variables. The investigation indicates crowns survive longer than large restorations and premolar restorations survive longer than molar restorations. The median survival for crowns exceeded 16.6 years, with the median survival of premolar restorations being 4.4 years and molar restorations 1.3 years. An interaction between age and treatment was discovered, with overall survival decreasing as patient age increases. The doctor supervising the treatment also affected survival with treatment supervised by specialists lasting longer than treatment supervised by nonspecialists.

Background: The authors evaluated the factors associated with the receipt of subsequent treatment by teeth restored with a large amalgam restoration or a large amalgam restoration and crown restoration after 10 years., Methods: The authors used retrospective data from the University of Iowa College of Dentistry (Iowa City, Iowa) administrative database and patient records to evaluate patient and tooth factors for their association with the two primary outcomes: receipt of any subsequent treatment and receipt of catastrophic treatment (extraction, endodontic therapy)., Results: The authors followed 518 teeth over a 10-year period (49 percent with large amalgam restorations and 51 percent with crowns). Sixty-four percent of the large amalgam restorations and 32 percent of the crowns received subsequent treatment during the 10 years. In addition to restoration type, the patient's sex, history of grinding teeth and having a broken tooth were related to the tooth's receiving subsequent treatment. Twenty-two percent of large amalgam restorations and 12 percent of crowns received catastrophic treatment with the odds of teeth with large amalgam restorations receiving a catastrophic treatment being 2.1 times the odds of teeth with crowns receiving catastrophic treatment., Conclusions: Teeth with crowns were less likely to receive any treatment or catastrophic treatment over 10 years than were teeth with large amalgam restorations. Patient and tooth factors also were related to a tooth experiencing subsequent treatment., Clinical Implications: Teeth with crowns received less subsequent treatment than teeth with large amalgam restorations. This could be related to both the difference in longevity between the two restorations, as well as how appropriately treatment was planned for each procedure. Cost differences between the two restorations need to be factored into the decision-making process.

The natural history of posterior teeth treated with a four or more surface amalgam restoration (LA) or a large amalgam restoration and a full-coverage crown (LAC) were compared over five- and 10-year periods. Subsequent treatment information was used to construct Treatment Outcome Trees (TOT), which described treatment that the teeth received after placement of LA and LAC restorations. Data were collected for all treatments provided to patients who received a four or five surface LA in 1987 or 1988 at the University of Iowa, College of Dentistry (UICD). The probability that these teeth would receive subsequent treatment and the type of subsequent treatment were placed into a TOT. In general, a higher percent of teeth with an LA received subsequent treatment and were more likely to receive major treatment (root canals, extractions, crowns) five years post placement than teeth with an LAC. Between five and 10 years, this trend continued, with the percentage of teeth with an LA receiving subsequent treatment increasing more (48% to 64%) than teeth with an LAC (12% to 22%). Regardless of the initial restoration type (LA/LAC), women were less likely to receive subsequent treatment and major treatment compared to men. The use of a TOT was found to be an effective observational approach for evaluating the natural history of teeth with alternative restorative treatment.

Purpose: The objective of this study was to assess the relationship between the number of stainless steel crowns (SSCs) placed, number of surfaces at risk (SAR) post dental surgery, and the risk for relapse in patients treated for Early Childhood Caries (ECC)., Methods: The study population consisted of 57 children treated for ECC under general anesthesia, ranging in age from 2.3 to 7.3 years old at the time of entry. Dental surgery utilized an aggressive approach: teeth that had necrotic pulps or were nonrestorable were extracted; decayed primary mandibular incisors that could not be treated by stripping were extracted; primary maxillary incisors with 3 or more carious surfaces were extracted; single-surface lesions of primary molars that did not compromise cusp integrity were restored with intracoronal amalgam restorations; primary maxillary, incisors and canines with smooth-surface lesions affecting 2 or less surfaces were treated with intracoronal composites; primary molars and canines requiring vital pulp therapy were restored with SSCs; primary molars with caries lesions affecting 2 or more surfaces (including smooth-surface, white-spot lesions) were restored with SSCs; primary canines with caries affecting 3 or more surfaces were restored with stainless steel crowns; topical fluoride was applied after all restorative therapy was completed. The cohort was examined for new caries lesions 6 months post dental surgery. Relapse was defined as the presence of new smooth-surface caries lesions as defined by Radike. Comparisons between relapse (R) and nonrelapse (NR) groups, with respect to the number of SSCs placed and the number of SAR, were performed using t tests and Wilcoxon tests. A 0.05 level of significance was employed in all statistical tests., Results: Twenty-one of the 57 (37%) patients relapsed. No statistically significant difference for the number of SSCs placed or SAR existed between the R group (SSCs: mean = 4.57, median = 4 +/- 2.18; SAR: mean = 39.76, median = 40 +/- 13.62) and NR group (SSCs: mean=5.44, median = 5.5 +/- 2.62; SAR: mean = 39.98, median = 39.5 +/- 15.19)., Conclusions: The risk for relapse in children treated for ECC is not associated with the number of SSCs placed or SAR; aggressive dental surgery for ECC does not result in acceptable clinical outcomes.

Purpose: The failure rates of restorative procedures for children undergoing dental rehabilitation under general anesthesia, performed by pediatric dental residents in advanced educational programs, were evaluated in order to determine treatment outcomes and best practices., Methods: Retrospective review of 504 dental records of children receiving comprehensive dental treatment under general anesthesia at children's hospitals in Boston between 1990-1992 and in Washington, DC, between 1994-1998, were undertaken. Data regarding restoration outcomes were evaluated using chi square tests with correction for continuity. Only records of patients who returned for follow-up at least six months after their rehabilitations were evaluated. T-tests were performed on parametric data., Results: Two-hundred and forty-one (48%) of the records were evaluated. Stainless steel crowns (SSCs) had significantly lower failure rates than amalgams (P<0.001, chi2=63). The highest failure rates were seen in composites (P<0.001, chi2=112) and composite strip crowns (P<0.001, chi2=121)., Conclusions: SSCs are the most reliable restorations while composite restorations are the least durable. Failure of restorations appears to be related to follow-up length.

People in their late fifties in the UK today can expect to live another 20 years and most want to maintain a functional and aesthetically acceptable dentition. However, 50% of the teeth of dentate adults aged 45 years and over are filled and crowned. The challenges for the dental profession in addressing these aspirations are discussed.

Objectives: To investigate the distribution and type of restorative treatment, including re-treatment, provided for adults who attend annually., Methods: In 1991 a selected group of 24 general dental practitioners in the North West of England recruited 4211 of their regularly attending adult patients. Dentists recorded the reason for and type of treatment provided during the following 5 years., Results: Approximately 40% of the participants received treatment (restorations and/ or extractions) at each annual examination. Of the 2293 patients who attended every examination 1959 (85%) had received a restoration and/ or extraction during the 5 years. A total of 8187 teeth, 15% of those present at baseline, received treatment, 3030 (37%) for caries and 5157 (63%) for other reasons. The proportion of adults who received treatment by age group differed significantly with those aged 25-34 years (80%) being least likely and those 35-44 years of age (89%) most likely. Of the 1744 teeth restored in the first year of the study, 170 (10%) were retreated within 1 year and 402 (23%) during the subsequent 4 years. The 4 year survival of amalgam and tooth coloured fillings was 84% and that of crowns 92%., Conclusions: This study documented the extent and type of restorative care provided for regularly attending adults during a 5-year period. The majority of treatment was provided for reasons other than caries. Of the teeth restored over the first year, 23% were retreated in the subsequent 4 years.

Background: The authors evaluated the treatment efficacy of preformed metal crowns, or PMCs, vs. amalgam restorations in primary molars by means of a literature review and meta-analysis., Types of Studies Reviewed: From a literature search, the authors selected clinical studies that evaluated treatment with PMCs vs. amalgam control restorations in primary molars and provided data against which treatment outcomes could be compared., Results: Ten studies with durations ranging from 1.6 to 10 years fulfilled the selection criteria. Their failure rates, based on need for subsequent treatment or retention of the restoration at final evaluation, ranged from 1.9 to 30.3 percent for PMCs and 11.6 to 88.7 percent for amalgam restorations. Overall, PMCs demonstrated greater longevity and reduced retreatment need compared with amalgam control restorations. The odds ratio for all studies fell within the boundary favoring treatment with PMCs., Clinical Implications: Analysis of the literature, though mainly retrospective studies, demonstrated evidence of a more favorable outcome for PMCs than for amalgam restorations in primary molars requiring multisurface restorations.

Objective: To quantify the number of extractions and/or restorations placed in chronically sick children under intubation general anaesthesia and compare these findings with healthy children., Setting: Two large paediatric dentistry units in Central London: a tertiary referral centre dealing with severe chronic sickness in children and an undergraduate dental school with a large commitment to special needs dentistry in children., Design: Prospective comparison of treatment received for (a) chronically sick children and (b) dentally anxious (otherwise fit) children receiving intubation general anaesthesia during July 1991 to June 1996 inclusive. The statistical tests used were the Shapiro-Wilks test for normality and the Mann Whitney U test for non-parametric comparison of independent groups., Main Outcome Measures: Mean total treatment tally (TTT)--the sum of extractions and restorations for each child presented as summary data., Results: Different patterns of dental care were found between the healthy and chronically sick groups. For similar levels of disease, a significantly greater number of extractions were carried out for chronically sick children (P < 0.0001), and significantly fewer restorations (P < 0.0001). The number of pulpotomies and stainless steel crowns provided to sick children was significantly smaller than to healthy children (P < 0.0001). This paper discusses the influences of chronic ill health on dental treatment provided under general anaesthesia., Conclusion: The underlying medical disorder in chronically sick children significantly influences the pattern of treatment when this is provided under general anaesthesia.

Studies of changes in dental health are essential in discussions of national health policy matters. In the Level of Living Survey representative samples of the population aged 18-75 were interviewed in 1968, 1974, 1981, and 1991. In the 1991 survey those aged 76+ were also interviewed. Between all the four waves of the survey edentulousness and partial edentulousness decreased and the proportion of persons with teeth with many fillings, crowns or bridges increased. After 1974 the proportion of persons with teeth in good condition with few or no fillings also increased. The fall in edentulousness indicated a greater improvement in dental health than did the rise of the proportion of people with teeth in good condition. Age-specific comparisons showed that the change affected older people most. The largest fall in edentulousness and partial edentulousness was in ages above 50. This fall led to a nearly equal increase in the same ages of persons that had teeth with many fillings, crowns or bridges. This has meant that dental care needs have risen among older people in particular. The results are discussed in connection with the national dental health insurance scheme which was introduced in 1974.

This prospective study was conducted to determine factors important in predicting which regularly attending adult patients would receive first, restorations or extractions for any reason (receiving treatment) and, second, restorations or extractions undertaken specifically for caries (receiving treatment related to caries). Baseline and incremental clinical data were obtained from 24 general dental practitioners on a group of their regularly attending, dentate adult patients over a 12-month period. The patients completed a postal questionnaire with questions relating to dental health behaviour, attitudes, knowledge, and social factors. Complete data were obtained from 2553 patients. Thirty-one variables were identified as potential predictors for the two dependent variables receiving treatment and receiving treatment related to caries, and logistic regression models were fitted. Receiving treatment was associated with having fewer sound teeth and more anterior fillings, posterior fillings and crowns (P < 0.001). The dentist's prediction of the need for treatment related to caries and the patient's own prediction of the need for a filling were also important in the model (P < 0.001). Some of these variables, together with having received recent medical treatment and taking sugar in tea or coffee were also found to predict treatment related to caries. The model for receiving treatment related to caries was more successful at predicting the patient's individual risk but the model for receiving treatment was slightly better at classifying patients into whether or not they received treatment. It is reassuring that the common assumptions made by the dental practitioners of their patient's risk have received statistical validation.

Objectives: There is very little information available from private dental practices on the comparative survivals of extensive posterior amalgam restorations and posterior crowns placed in the same patient population. Therefore, the present retrospective study examined the performance of such restorations at three long-established Adelaide city practices., Methods: Life-table survival estimates were generated for 160 extensive amalgams, 96 cast gold crowns and 174 ceramometal crowns. The restorations were placed by 20 dentists at various times in 100 patients who attended the practices on a regular basis for around 25 years on average., Results: There were no significant differences found in the survival times for both types of crowns, with around 70% still being present at 20 years. However, the median survival time for the extensive amalgams was much lower, at 14.6 years. Despite these differences in survival times, the extensive amalgam restorations survived for longer than is usually expected., Conclusion: In this present study, the survival findings have implications for the most cost-effective dental treatments of large lesions in posterior teeth.

Very little is known of dentist and patient factors which may influence the survival or longevity of dental restorative materials placed in private practices. The present retrospective study investigated during 1992 the effects of six factors on the long-term survivals of five types of restorations placed by 20 male dentists in 100 adult patients, at 3 selected Adelaide dental practices. There were no significant effects on restoration survival from change, of dentist, and generally only one or two types of restorations had their survivals influenced significantly either by dental practice location, or by patient age, frequency of patient attendance, experience of dentist, and whether or not the restorations were replacements during the study period. Restoration survival was not influenced significantly by whether, or not, any replacements were made by the dentist who placed the initial restorations. The median survival times for amalgams were 22.52 years, resin composites 16.72 years, castings 13.75 years, and crowns an estimated 26 years. For glass-ionomers, 75 per cent were still present at 11.25 years.

Apart from the effects of the frequency of patient attendance for dental examination, and of a change of dentist, little is known of those factors which may influence the amount of treatment provided in dental practice. The present study investigated during 1992 the effects of seven factors on the amount of treatment provided for 100 adult patients treated by 20 male dentists over many years in three selected Adelaide private practices. The amounts of particular types of restorative treatments provided were significantly related to patient age, gender and frequency of attendance, and to practice location, change of dentist and number of changes of dentist, and to the experience or time since graduation of the dentist. These factors were of special significance for the number of crowns provided, most of which were placed in older patients by more experienced dentists. But, there was no evidence of increased numbers of direct placement restorations being received by patients who attended more frequently or who changed their dentists.

An epidemiological survey was carried out in 1992 researching dental caries and treatment needs in an adult population in Oviedo, Spain. A representative sample of 261 subjects, randomly obtained and stratified by age, was examined. Results show a dental decay prevalence of 99.6%; 12.5 DMFT index with 2.9, 7.5 and 2.1 mean values for D, M and F components. Women and the lower social class showed the highest DMFT index. Treatment needs reach a mean value of 12.1 teeth per person. Pontics are the most needed treatment, the mean value increases with age while the differences among age groups and social classes are statistically significant. The next most needed dental treatment is filling of one surface which decreases with age, is the same for men and women and higher among the middle social class; the differences are statistically significant among the social classes.

The DMF index provides one source of information on past and present dental caries experience; however, important limitations hinder its ability to characterize fully the impact of dental caries. The purpose of this paper is to describe a measure of selected restoration and tooth conditions that supplements information from the DMF index and to report on the application of this measure as part of the Third National Health and Nutrition Examination Survey, Phase 1, conducted between 1988 and 1991. Data from this survey were used to estimate the prevalence and severity of selected disaggregated physical and biological oral conditions among dentate adults aged 18 to 74 years. Trained, standardized, and calibrated dentist examiners assessed 28 permanent teeth or tooth spaces for each of 6,767 subjects. Teeth or tooth spaces were classified based on criteria for: defective intracoronal restorations, crowns, or bridges; gross loss of tooth structure associated with a restoration; pulpal involvement; or retained roots. Approximately 40.5%, or 61.6 million, dentate adults had at least one tooth or tooth space that met the criteria. Among all persons, an average of 0.9 teeth or tooth spaces met the criteria for at least one category. Adults with at least one scored tooth or tooth space had an average of 2.2 such teeth or tooth spaces. Data from this assessment supplement information available from the DMF index to provide a broader profile of the impact of dental caries on permanent teeth of US adults.

Effects of materials and techniques on the accuracy of models used to make indirect restorations was measured using a 4-unit posterior model containing a MOD and full crown preparation. Improved stone and fast setting epoxy dies backed with either improved stone or a thermoplastic hot melt stone were made from single-viscosity addition silicone impressions. Technique variations included heating or not heating the impression, cooling and pouring dies and placement of the hot melt stone on set or unset epoxy. The dimensions of the MOD (L, W, H) and of the crown (W, H) dies were measured at 1 and 24 h. No clinically significant changes occurred between 1 and 24 h. The stone control reproduced the dimensions of the master die best, and models made by pouring epoxy into the impression followed by immediate pouring of the hot melt stone gave the poorest reproduction. Other variations in technique using epoxy for the anatomical portion gave no practical differences in accuracy. Of the epoxy dies, those prepared from a previously heated impression with hot melt poured after the epoxy set had the best values; however, epoxy dies were smaller than stone dies. The fast set epoxy was noteworthy for rapid processing and sharp detail, however, negative changes for W and H of the crown and H and L of the MOD showed that a die spacer would be essential in the preparation of indirect restorations.

The purpose of this study was to investigate dentists' treatment recommendations for interproximal surfaces of primary molars based on the type of practitioner (general dentist or pediatric dentist), geographic location, and age of practitioner. Simulated cases, which included histories and pictures of bite-wing radiographs, were mailed to a random sample of 2000 general dentists and 1000 pediatric dentists. Dentists were asked to select their treatment recommendations for eight cases involving the interproximal surface of a specified primary molar. The return rate was 42% (1245) overall, with 36% (723) from general dentists and 52% (522) from pediatric dentists. An amalgam restoration was recommended most often for these eight cases. Dentists in the age 60+ category and pediatric dentists were more likely to recommend treatment for smaller interproximal lesions. Composite resins were recommended infrequently; however, dentists in the 60+ age category and dentists in the Northeast and Southwest were somewhat more likely to recommend composite resin than younger dentists, or dentists in other geographic locations. Dentists in the 40-49 age range, pediatric dentists, and dentists in the Southwest were the most likely to recommend stainless steel crowns. These simulated cases demonstrate differences and similarities in the treatment recommendations for interproximal lesions on primary molars based on age, practice type, and region.

The prevalence of prosthetic reconstructions among 1534 German recruits (mean age 21.8 years) was evaluated. Of the total number of single crowns (n = 552), 72% were found in the upper jaw. Forty-one per cent of the crowns were situated in the upper incisor region. Four per cent of the probands received mostly three-unit-bridges and 0.9% removable partial dentures. In 3.7% of the cases all missing molars of a quadrant were not prosthetically replaced. The number of single crowns and bridges was not associated with the final school education, which in its term is closely associated with the social stratum. Between the level of school education and the need of prosthetic treatment a highly significant association was found.

This is a report on the statistical classification of the prosthetic restorations placed in out-patients of the Tokyo Medical and Dental University Hospital. The data were collected from the laboratory records during the period of January to June of 1986. The results are summarized as follows: 1. The total number of the prosthetic restorations placed in the outpatients were 7355, and 56% of these were covered by the health insurance. 2. Of the total restorations, 29.6% were cast cores, 18.2% were inlays and 17.2% were crowns. Post crowns, jacket crowns and partial veneer crowns were very few, being only 0.3%, 0.4% and 0.5%, respectively. 3. Approximately 50% of the prosthetic restorations were single crowns. 4. Compared to the record from about 20 years ago, the number as well as the ratio of the crowns including the facing crowns was approximately doubled. On the contrary, the number of jacket and post crowns has remarkably decreased. 5. With regard to the single anterior prosthetic restorations, the majority were the porcelain fused to metal crowns which were not popular 20 years ago.

The fate of 1688 amalgam restorations and 716 preformed crowns placed in permanent and primary molars in a specialist paediatric dental practice over a 10-year period by one operator is reported. For primary molar amalgams, the replacement rate, true failure rate and 5-year survival estimates were, for Class 1 restorations, 16.1%, 3.9%, 73.3%, respectively, with an estimated median survival time greater than 8.5 years, and for Class 2 cavities 14.7%, 11.6%, 66.6%, with an estimated median survival time greater than 7.5 years. For permanent molar amalgams, the replacement rate, true failure rate and 5-year survival estimates were for Class 1 restorations 11.5%, 6.5%, 76.8%, respectively, with an estimated median survival time greater than 9.3 years, and for Class 2 restorations 9.8%, 8.0%, 82.2%, with a median survival time greater than 8.5 years. For all preformed crowns, the replacement rate, true failure rate and 5-year survival estimates were 2.8%, 1.9%, 92.0%, and the estimated median survival time greater than 7.64 years. No relationship was observed between the age of the patient and the age of replaced restorations. No significant difference was found between the survival rates of Class 1 and 2 amalgam restorations in primary or permanent molars, nor between first and second primary molars.

During the 30 years that have elapsed since the original report by Buonocore (1955), which demonstrated the increased retention of acrylic resins to an acid-etched enamel surface, the development of composite restorative materials in particular has enabled the clinician to offer a wider range of treatment alternatives to patients who present initially with problems directly related to their anterior teeth. Whilst the problem may be immediately apparent when the teeth erupt, professional advice is most often sought during adolescence. The provision of crowns for patients in this age group is contraindicated for many reasons, including compliance with extensive restorative procedures, large pulp cavities with the possibility of traumatic exposure during tooth preparation and inadequate crown height associated with an immature gingival margin.

No formal analyses comparing the treatment alternatives of replacing a failed amalgam with either another amalgam or crown have been done to determine the optimum treatment strategy based on lifetime costs to the patient. Using decision analysis, a computer model was developed of the lifetime restorative needs of an adult's posterior tooth. A cost-effectiveness analysis of large amalgams vs crowns was then done to determine the optimum strategy. According to the analyses, the optimum treatment decision is to attempt to replace the failed first amalgam with another amalgam, instead of with a crown. When this amalgam restoration fails, then the subsequent replacement may be with a crown. Potential lifetime cost savings were between 11% and 24% if the first replacement was an amalgam. This study concludes that the technique of decision analysis provides the dental community with an effective evaluation tool for the study of clinical decision-making, taking into account all levels of clinical uncertainty.