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This retrospective study evaluated the performance of posterior composites after up to 33 years of clinical service and investigated factors associated with the risk of failures over time including patient- and tooth-related variables.Patients who received at least one Class I or Class II direct composite restoration in a private office in 1986-1992 and had follow-up appointments were included. Failures and interventions over time were investigated using the dental records. A follow-up clinical recall was carried out in 2020. Two scenarios were considered: restorations that did not require any intervention (success) or restorations that were repaired and still functional (survival). Multivariate Cox regression analyses and Kaplan-Meier curves were performed using success and survival rates (p 0.05).One hundred patient records and 683 restorations were included. A total of 353 failures were reported (success rate= 48%). Main reasons for failure were fracture and secondary caries. Most interventions after failures were repairs. Replacements were registered in 183 cases (survival rate= 73%). Annual failure rates were below 2.5% (success) and 1.1% (survival). Larger restorations and maxillary molars had higher failure risks. No significant differences in success rates among different resin composites was observed. A typical observation in this sample of restorations was the presence of moderate to advanced signs of aging, including marginal and surface staining, wear, chipping, changes in anatomical shape and translucency. Clearly aged restorations were still clinically satisfactory.This long-term, practice-based study indicates that resin composites can be used to restore posterior teeth with a long-lasting durability.

Objective This study evaluated the influence of smoking on the oral cells genotoxicity before and after at-home bleaching using 22% carbamide peroxide (CP). Materials and methods This is a prospective observational analytics cohort study which evaluated nonsmokers (NS; n = 24) and smokers (S; n = 16) patients. At-home bleaching was performed using 22% CP gel in individual trays for 1 h per day for 14 days in both groups. Scrapped cells from marginal gums were collected before the bleaching treatment (D0-baseline) and 1 day (D1), 15 days (D15), and 1 month (D30) after its finishing. Cells were stained with Giemsa 10%, and the micronucleus (MN) and metanuclear alterations (MA) were counted by a trained operator in 1000 cells per patient. The collections and data analysis occurred blindly. Data was analyzed by Kruskal–Wallis, Dunn, and Mann–Whitney test (α = 0.05). Results MN frequency was not influenced by smoking or bleaching. An increase of MA was observed between D0 and D30 for both groups (p 0.05) in the evaluation times. Conclusion Smoking associated with 22% carbamide peroxide gel for at-home bleaching does not show genotoxic potential analyzed by the MN counts. However, a significant increase of MA was found for smokers and nonsmokers. Clinical relevance Despite of the increase in MA, smoking associated with 22% CP peroxide at-home bleaching showed no important genotoxic potential (MN) for oral cells. Therefore, at-home bleaching treatment is safe for nonsmokers and smokers even with a high carbamide peroxide concentration of 22%.

Objective To present through a systematic review a qualitative analysis of studies published on stereolithography-based 3D printing of restorative materials and their clinical applicability. Methods The literature search was conducted based on the question: “What is the state-of-the-art of available restorative materials for 3D printing based on stereolithography?" Online search was conducted in three databases (MEDLINE/PubMed, Scopus and Web of Science) with no restriction for year of publication. Data are reported based on PRISMA, including publication details such as authors and their countries, year and journal of publication, and study design. The synthesis is focused on describing the dental restorative materials and properties evaluated, applied methods, 3D printers used and clinical applicability. Results Studies that fit the inclusion criteria were performed in Asia (21), Europe (16) and USA (10), mostly using polymer-based restorative materials (38) for 3D printing constructs. Stereolithographic-printed ceramic-based restorative structures were evaluated by 9 studies. Many studies reported on dimensional accuracy (14), strength (11) and surface morphology (9) of the printed structures. Antibacterial response, cytotoxicity, internal and marginal fit, fracture and wear resistance, density, viscosity, elastic modulus, hardness, structural shrinkage and reliability, degree of conversion, layer cure depth, fatigue, and color were also evaluated by the included studies. Many of them (11) published a proof of concept as an attempt to demonstrate the clinical feasibility and applicability of the technology to print restorative materials, but only 5 studies actually applied the 3D printed restorative structures in patients, which highlights an increasing interest but limited early-stage translation. Significance The fast expansion of stereolithographic-based 3D printing has been impressive and represents a great technological progress with significant disruptive potential. Dentistry has demonstrated an incredible willingness to adapt materials, methods and workflows to this promising digital technology. However, esthetic appearance, wear resistance, wet strength and dimensional accuracy are the main current clinical limitations restricting the progression to functional part production with 3D printing, which may explain the absence of clinical trials and reports on permanent/definitive dental restorative materials and structures.

Caries and periodontal disease may cause tooth losses and chewing difficulty, especially in the elderly. Ingesting poorly chewed food may delay gastric emptying and favour the development of gastroesophageal reflux disease (GERD).This study investigated the association between masticatory dysfunction and GERD in the elderly from a rural area in southern Brazil.This census invited all 489 elderly from a city to participate. The study used a GERD symptoms questionnaire, followed by an oral examination. Masticatory dysfunction was analysed based on the chewing difficulty for some food groups. Tooth loss and chewing self-perception were also considered as exposure variables. Poisson regression determined the association among variables by calculating the prevalence ratio [PR (95% confidence interval)].The response rate was 93.1% (n = 455, average age of 70.9 years, 50.5% men). The prevalence of GERD in this population was 36.9%. GERD was associated with chewing difficulty for vegetables (PR = 1.54), meats (PR = 1.34) and cereals (PR = 1.43) but not with poor chewing self-perception (PR = 0.80) and tooth loss (PR = 1.22). GERD was also associated with xerostomia (PR = 1.63) and the female gender (PR = 1.35).Elderly people from a rural area with a reduced number of teeth present chewing difficulty and a high prevalence of GERD, indicating an association between GERD and masticatory dysfunction.

OBJECTIVES To estimate the incidence of the need for a dental prosthesis during early adulthood and its association with socioeconomic and oral disorder trajectories. METHODS In 1982, in the city of Pelotas, all live births (n = 5914) and their mothers were assessed. A representative sample of this cohort study was examined for oral health conditions at 15, 24 and 31 years (Oral Health Study-OHS). The need for a dental prosthesis was assessed at 24 and 31 years of age, and variables of interest (gender, skin colour, socioeconomic status (SES), use of dental services, caries and periodontal disease) were collected from different waves of this cohort. Longitudinal association between outcome and variables of interest was assessed using multilevel mixed models. RESULTS A total of 539 individuals were assessed in 2013 (60.7% response rate). The need for a dental prosthesis was 28.9% at 24 years. (95% CI 24.9-33.2) and 49.0% at 31 years (95% CI 44.7-53.3). Risk of presenting with a need for a dental prosthesis was higher in users of public services. Downwardly mobile and lower SES trajectory groups presented a higher risk of the need for a dental prosthesis. High-risk caries trajectory group showed a higher risk of presenting with the need for a dental prosthesis from 24 to 31 years. CONCLUSIONS Our findings demonstrate that the need for dental prosthesis from 24 to 31 years old was determined by trajectories of exposure during the life cycle, reinforcing that tackling socioeconomic inequalities at any stage of life can have an effect on an individual's oral health.

Item does not contain fulltext OBJECTIVES: This 10-year practice-based study aimed to compare survival and success of direct resin composite and ceramic veneers placed in a private dental practice, between January 2008 and March 2014. METHODS: Data were retrieved from a clinical practice's records and were anonymized typed into electronic files. All veneer information was recorded, including previous restorations, repairs or failures, materials used, dates, patient, and age. RESULTS: We analyzed 1459 veneer restorations, of which 1043 (71.5%) were direct composite, and 416 (28.5%) were ceramic, placed in 341 patients. The mean patients' age was 47.8 years, and the mean number of restorations per patient was 4.3 restorations. During all follow-up, 957 (65.6%) veneers were successful without any repair, 252 (17.3%) were repaired and still in place, and 250 (17.1%) had a failure that resulted in replacement. Replacements were usually carried out with the same material placed at first. Considering success analysis, annual failure rates (AFR) for veneers in 5 and 10 years were 9.1% and 10% for direct composite and 2.9% and 2.8% for ceramic, respectively. Survival analysis showed AFR of 3.9% and 4.1% for composite and 1.4% and 1.2% for ceramic at the same periods. Cox regression was made for both success and survival outcomes. Composite veneers presented a higher risk of failure than ceramic veneers with higher hazard ratios for survival (HR) [HR 4.00 (2.74-5.83)] and success [HR 5.16 (2.65-10.04)]. SIGNIFICANCE: Ceramic veneers had superior longevity than direct composite veneers in both success and survival analysis.

Background Several restorative materials with specific indications are used for filling cavities in primary teeth. Aim To systematically review the literature in order to investigate the longevity of primary teeth restorations and the reasons for failure. Design Electronic databases were screened, and eligible studies were hand-searched to find longitudinal clinical studies evaluating the survival of restorations (class I, class II, and crown) placed with different materials in primary teeth with at least one year of follow-up. Results Thirty-one studies were included, and a high bias risk was observed. Overall, 12,047 restorations were evaluated with 12.5% of failure rate. A high variation on annual failure rate (AFR) was detected (0-29.9%). Composite resin showed the lowest AFRs (1.7-12.9%). Stainless steel crowns (SSC) had the highest success rate (96.1%). Class I restorations and restorations placed using rubber dam presented better AFR. The main reason for failure observed was secondary caries (36.5%). Conclusions An elevated number of failures were observed due to recurrent caries, highlighting the need for professionals to work with a health-promoting approach. The high variation on failure rate among the materials can be due to children's behavior during the procedure, which demands short dental appointments and a controlled environment.

Clinical research of restorative materials is confounded by problems of study designs, length of trials, type of information collected, and costs for trials, despite increasing numbers and considerable development of trials during the past 50 years. This opinion paper aims to discuss advantages and disadvantages of different study designs and outcomes for evaluating survival of dental restorations and to make recommendations for future study designs. Advantages and disadvantages of randomized trials, prospective and retrospective longitudinal studies, practice-based, pragmatic and cohort studies are addressed and discussed. The recommendations of the paper are that clinical trials should have rational control groups, include confounders such as patient risk factors in the data and analysis and should use outcome parameters relevant for profession and patients.

Objective Literature on edge chipping test applied to dental materials and structures has been systematically reviewed with regard to the evaluation methods and parameters used. Data A systematic search of the literature retrieved 3484 relevant studies. After removing duplicates, 1848 records were screened by titles and abstracts and 1797 were excluded; 51 papers were assessed full text for eligibility. Twenty papers were included in this study and they were organized according to the dental materials and structures tested as follows: 2 studies on human tooth, 9 on dental ceramics, 5 on polymer-based composites, and 4 studies evaluated both ceramic and polymer-based materials. Sources MEDLINE/PubMed, Scopus and Web of Science databases were searched up to June 2019 without restriction on date and language. Study selection In vitro studies using edge chipping test on dental materials and structures were included. Conclusions Different methods have been used for edge chipping test, regardless of reported parameters. There is significant evidence that edge chipping test is a relevant approach to predict chipping behavior of dental materials and tooth tissues because chips produced from most edge chipping studies are similar to clinically reported chipping failures.

Mood disorders such as stress and depression can promote alterations of several hormones Aim: The present study aimed to evaluate if symptoms of depression and stress are associated with halitosis. The hypothesis is that halitosis is associated with stress and depression symptoms. Methods: All university students’ entrants in the Federal University of Pelotas (UFPel) were invited to participate. Self-reported halitosis was measured using a visual analog scale. Students were also asked about the presence of halitosis perceived by close individuals. The stress level was measured using a modified version of the Perceived Stress Scale and symptoms of depression were screened by Patient Health Questionnaire-2. Poisson Regression Models were performed. Results: Of a total of 2,058 students who participated in the study, only 16% of them have reported not having any degree of halitosis and 17.6% were informed of closed individuals having halitosis. After adjustments, stress and depression symptoms remained associated with halitosis selfreported. Individuals from the higher stressed quartile presented higher scores of halitosis (RR 1.37 CI95% [1.24–1.53]). Students who presented depressive symptoms showed higher scores of self-perceived halitosis (RR 1.20 CI95% [1.10–1.32]). When the association of stress and halitosis reported by close individuals was tested, symptoms of depression lost the association in the adjusted model, while individuals from the highest quartile from stress remained associated (PR 1.36 CI95% [1.02–1.81]). Conclusion: Halitosis was associated with stress even after control for oral health and socioeconomic variables.

Contains fulltext : 177157.pdf (Publisher’s version ) (Closed access) This practice-based study investigated the performance of a large set of anterior composite restorations placed by a group of 24 general practices. Based on data from electronic patient files, the longevity of 72,196 composite restorations was analyzed, as placed in 29,855 patients by 47 general dental practitioners between 1996 and 2011. Annual failure rates (AFRs) were calculated, and variables associated with failure were assessed by multivariate Cox regression analysis with shared frailty for 2 age groups (5 to 24 y and >/=25 y). The observation time of restorations varied from 2 wk to 13 y, with a mean of 4.8 y, resulting in a mean AFR of 4.6% (95% confidence interval [95% CI], 4.5% to 4.6%) at 5 y. Among dentists, a relevant variation in clinical performance of restorations was observed, with an AFR between 2% and 11%. The risk for restoration failure increased in individuals up to 12 y old, having a 17% higher risk for failure when compared with the age group of 18 to 25 y (hazard ratio, 1.17; 95% CI, 1.03 to 1.34), and for the age group >65 y, having a 81% higher risk for failure when compared with 25 to 35 y (hazard ratio, 1.81; 95% CI, 1.66 to 1.98). In both multivariate models, there was a difference in longevity of restorations for different teeth in the arch, with fillings in central incisors being the most prone to failure and replacement. It was concluded that anterior composite restorations placed by general dental practitioners showed an adequate clinical performance, with a relevant difference in outcome among operators.

Objectives This study aimed to evaluate the quality of posterior restorations (amalgam or composite) placed in adults from a birth cohort and its association with clinical and socioeconomic determinants experienced during their life course. Methods A representative sample (n = 539) of all 5914 births occurring in Pelotas (Brazil) in 1982 was prospectively investigated. Quality of posterior restorations (satisfactory or unsatisfactory) was assessed at 31 yrs-old, using modified USPHS criteria. Trained and calibrated dentists performed clinical examination. Explanatory variables included demographic and socioeconomic, oral health and dental service utilization patterns during the life course. Tooth related variables (type of tooth, material, size of cavity) were also analyzed. Untreated caries and socioeconomic status were assessed by group-based trajectories analyses. Multilevel Regression models were used to determine factors associated with restoration outcomes. Results In total 2123 restorations (53% composite) were evaluated of which 107 (5%) were assessed as failed. The main reasons for failure were tooth/restoration fracture (50.5%) and secondary caries (30.7%). Failures in posterior restorations showed a significant association with socioeconomic aspects (lower tertile of income at age 30 – prevalence ratio (PR) 2.21 [95% CI 1.19–4.09]), clinical variables (trajectory of higher untreated caries – PR 2.11 [95% CI 1.23–3.61]) and also with tooth-related factors (Restorations involving three or more surfaces – PR 5.51 [95% CI 3.30–9.19]) after adjustment for each other. Conclusions These findings suggest that, although tooth-related variables have an important role in restoration longevity, patient-related factors, such as socioeconomic variables and untreated caries are also associated with failure and should be taken into account when evaluating longevity of posterior restorations. Clinical significance This was the first study assessing long-term trajectory of untreated caries, showing an association between higher experience of caries during the life-course and unsatisfactory restorations. The findings suggest that individual related factors should be considered when planning treatment and in future research evaluating the longevity of dental restorations.

Contains fulltext : 193205.pdf (Publisher’s version ) (Closed access) 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. 01 juli 2018

Objectives The aim of this study was to investigate the validity of assessment of intraoral digital photography in the evaluation of dental restorations. Methods Intraoral photographs of anterior and posterior restorations were classified based on FDI criteria according to the need for intervention: no intervention, repair and replacement. Evaluations were performed by an experienced expert in restorative dentistry (gold standard evaluator) and 3 trained dentists (consensus). The clinical inspection was the reference standard method. The prevalence of failures was explored. Cohen’s kappa statistic was used. Validity was accessed by sensitivity, specificity, likelihood ratio and predictives values. Results Higher prevalence of failed restorations intervention was identified by the intraoral photography (17.7%) in comparison to the clinical evaluation (14.1%). Moderate agreement in the diagnosis of total failures was shown between the methods for the gold standard evaluator (kappa = 0.51) and consensus of evaluators (kappa = 0.53). Gold standard evaluator and consensus showed substantial and moderate agreement for posterior restorations (kappa = 0.61; 0.59), and fair and moderate agreement for anterior restorations (kappa = 0.36; 0.43), respectively. The accuracy was 84.8% in the assessment by intraoral photographs. Sensitivity and specificity values of 87.5% and 89.3% were found. Conclusions Under the limits of this study, the assessment of digital photography performed by intraoral camera is an indirect diagnostic method valid for the evaluation of dental restorations, mainly in posterior teeth. This method should be employed taking into account the higher detection of defects provided by the images, which are not always clinically relevant.

Aim: The aim of this study was to investigate the prevalence of the desire of university students for esthetic treatment and tooth bleaching, and associated factors. Methods: A cross-sectional study was performed in 2016 with first-semester university students in Pelotas. Data was collected via a self-administered questionnaire including demographic, socioeconomic and psychosocial characteristics. Oral Impact on Daily Performance (OIDP) was assessed and Poisson regression models were used to evaluate the association between the following outcomes: prevalence of desire for esthetic treatment and the tooth bleaching, and exposure variables. A p-value of ≤ 0.05 was considered significant. Results: A total of 2,058 students participated in the study. Refusals represented a mere 1.4% of the total sample. Of the individuals interviewed, 16.1% underwent tooth bleaching and 74.4% reported a desire for esthetic dental treatment. Models showed students with higher family income and with the intention to use private dental services had 65% and 47% higher prevalence of tooth bleaching, respectively. Individuals satisfied with dental color and appearance exhibited a higher prevalence of tooth bleaching, as did those who smoked. On the other hand, students satisfied with dental color (PR= 0.77, 95% CI: 0.73-0.80) and with their dental appearance (PR= 0.82, 95% CI 0.78-0.87) demonstrated less desire to undergo esthetic dental treatment. Moreover, individuals who suffered some impact in OIDP reported a greater desire for esthetic treatment (PR= 1.07, 95% CI: 1.02-1.13). Conclusion: General and psychosocial characteristics were associated with the desire for esthetic treatment and tooth bleaching in university students.

Aim: This paper aimed to describe the methodological aspects in the baseline of university students’ cohort in a public university in southern Brazil. Methods: A multidisciplinary study was carried out assessing the psychosocial and oral health conditions of university students at the Federal University of Pelotas (UFPel). All new university students who have entered in in UFPel in the first semester of 2016 year were invited to participate. Two self-administered questionnaires were applied in classrooms. Descriptive analysis was performed using Stata 14.0. Results: A total of 3,237 students were eligible. Of these, 2,089 (64.5%) signed the consent form to participate of the study and answered the general questionnaires, and 2,052 (63.4%) students answered the confidential questionnaire. Refuses represented only 1.4% (n=29) of the total sample. Overall, most of the sample was female (52.2%), with age ranging from 18 to 24 years (66.1%), with white skin color (74.1%) and with mothers with educational level at university course (32.4%). A total, 62% reported a family income between 1001.00 and 5000.00 BRL, while only 16.3% reported being from low-income family (≤ 1000.00 BRL). The UFPel offers 63 classroom-based courses classified in nine areas of knowledge. The Applied Social Sciences area comprised 19% of the sample followed by the Linguistics, Letters and Arts (17%) area and the Health sciences area (13%). Conclusion: To the knowledge of researchers, this was the first cohort study of university students in the South of Brazil including more than two thousand participants. This paper described strategies adopted to optimize and to allow data collection in the baseline and in the next follow-ups.

Item does not contain fulltext OBJECTIVE: This retrospective, longitudinal clinical study investigated the longevity up to 20 years of posterior restorations placed with 3 universal composites (Charisma, Herculite XR, Z100) and of anterior restorations placed with 2 universal composites (Charisma, Herculite XR). METHODS: Records from 90 patients were retrieved from a private practice (374 posterior, 219 anterior restorations). Clinical evaluation was performed by the FDI criteria. Survival analysis was assessed using Kaplan-Meier method and Log-Rank test, and factors associated with failure by multivariate Cox regression with shared frailty. RESULTS: In the first 10 years, almost 95% of the restorations were satisfactory, showing increased failure thereafter. Charisma showed the most failures in anterior and posterior areas. Annual failure rates varied between 0.3% and 2.5%, with slightly better performance for anterior restorations. Fracture (posterior) and aesthetics (anterior) were the main reasons for failure. CLINICAL SIGNIFICANCE: Differences were observed between restorative materials with different properties, but these became apparent only after more than 10 years of clinical service. The present study provides evidence that in a patient group with low caries risk, anterior and posterior restorations placed with universal composites may have excellent long-term clinical performance.

OBJECTIVES: The aims of this study were to verify the occurrence of dental injuries in professional Brazilian soccer players, the level of knowledge of the teams' medical departments about mouthguards, and the conducts adopted in cases of dental trauma during the match. MATERIAL AND METHODS: Closed questionnaires were sent to the physicians in charge of the medical departments of the 40 teams enrolled in the first and second divisions of the Brazilian professional soccer league in 2007. The data obtained were subjected to descriptive analysis to determine absolute and relative frequencies of answers for each one of the questions. RESULTS: Physicians from 38 (95%) of the 40 teams in the first and second divisions answered the questionnaires and 71.1% reported the occurrence of some type of dental injury during soccer practice, dental fractures (74.1%) and avulsions (59.3%) being the most prevalent ones. Regarding emergency conducts, approximately 50% answered that a successful replantation could be obtained in periods from 6 to 24 h after injury, and 27.8% were not able to answer this question. Regarding mouthguard use, 48.6% of the physicians did not know about mouthguards, and only 21.6% usually recommended their use by the soccer players. Among the physicians who do not recommend the use of mouthguards, 50% justified that it was not necessary. Almost 50% of the medical departments do not have a dentist as part of the health professional staff. CONCLUSIONS: It was possible to conclude that dental injuries are common during professional soccer practice and that there is a lack of information in the medical departments related to the emergency conducts and prevention of dental trauma.

Contains fulltext : 171410.pdf (Publisher’s version ) (Open Access) A literature review was conducted to investigate the influence of patient-related factors on restoration survival in posterior permanent teeth as well as to report the methods used to collect these factors. The selection of articles on longitudinal clinical studies investigating the survival of posterior restorations (except full crowns and temporary fillings) and including patient-related factors was performed by applying predefined criteria. The review was organized into two parts, the first describing how patient factors were assessed in the studies (n=45) and the second presenting the statistical significance (n=27) and size of the effect (n=11) of these factors on restoration survival. Patient-related factors mentioned in the studies included age; gender; caries risk; caries activity/severity; decayed, missing, filled teeth; number of restorations; oral hygiene; and bruxism, among others. Sixteen studies included the patient age or age range in the analysis, which was found to be significant in 47% of the studies. Regarding gender, four of 17 reports found a significant effect on survival, showing more failures for men in three studies. The caries risk profile or related variables were included in the analysis of 15 studies, and a significant effect on survival was reported for high-caries-risk individuals (or related variables) in 67% of these studies. Bruxism was also found to influence restoration survival in three of six studies where this variable was investigated. Some issues were found regarding the reporting of methods used to classify patients according to risk and were thoroughly discussed. In view of the information gathered in this review, the assessment of patient factors along with other variables should become part of clinical studies investigating restoration survival, since several of these factors were shown to influence the failure of restorations, regardless of the material type.

Contains fulltext : 172399.pdf (Publisher’s version ) (Closed access) OBJECTIVE: To evaluate prospectively the longevity of ceramic inlay/onlay restorations placed in a web-based practice-based research network and to investigate risk factors associated with restoration failures. MATERIALS AND METHODS: Data were collected by a practice-based research network called Ceramic Success Analysis (CSA). 5791 inlay/onlay ceramic restorations were placed in 5523 patients by 167 dentists between 1994 and 2014 in their dental practices. For each restoration specific information related to the tooth, procedures and materials used were recorded. Annual failure rates (AFRs) were calculated and variables associated with failure were assessed by a multivariate Cox-regression analysis with shared frailty. RESULTS: The mean observation time was 3 years (maximum 15 years) of clinical service, and AFRs at 3 and 10 years follow up were calculated as 1.0% and 1.6%. Restorations with cervical outline in dentin showed a 78% higher risk for failure compared to restorations with margins in enamel. The presence of a liner or base of glass-ionomer cement resulted in a risk for failure twice as large as that of restorations without liner or base material. Restorations performed with simplified adhesive systems (2-step etch-and-rinse and 1-step self-etch) presented a risk of failure 142% higher than restorations performed with adhesives with bonding resin as a separate step (3-step etch-and-rinse and 2-step self-etch). 220 failures were recorded and the most predominant reason for failure was fracture of the restoration or tooth (44.5%). CONCLUSIONS: Ceramic inlay/onlay restorations made from several glass ceramic materials and applied by a large number of dentists showed a good survival. Deep cervical cavity outline, presence of a glass ionomer lining cement, and use of simplified adhesive systems were risk factors for survival.

Item does not contain fulltext OBJECTIVE: In this study the literature was systematically reviewed to investigate the clinical longevity of anterior composite restorations. DATA: Clinical studies investigating the survival of anterior light-cured composite restorations with at least three years of follow-up were screened and main reasons associated with restoration failure were registered. SOURCES: PubMed, Scopus, and Cochrane databases were searched without restriction on date or language. Reference lists of eligible studies were hand-searched. The grey literature search was not made systematically. STUDY SELECTION: Two reviewers screened titles and/or abstracts of 2273 unique studies. In total, 41 studies were selected for full-text reading, from which 17 were included in the qualitative synthesis. The included studies evaluated the clinical performance of Class III and/or IV restorations (10 studies), which were placed due to caries, fracture, or replaced old restorations; veneers and full-coverage restorations placed for aesthetic reasons (five studies); and restorations in worn teeth (two studies). Annual failure rates (AFRs) were calculated for each study. CONCLUSIONS: In total, 1821 restorations were evaluated and the total failure rate was 24.1%. AFRs varied from 0 to 4.1% and survival rates varied from 53.4% to 100%. Class III restorations generally had lower AFRs than the other restorations. Few studies addressed factors associated with failure, which included adhesive technique, composite resin, retreatment risk, and time required to build-up the restoration. Fracture of tooth/restoration was the most common reason for failure, whereas failures related to aesthetic qualities (color, anatomical form, surface stain) were more frequent when restorations were placed for aesthetic reasons.