Title: 1248 - A Practice Based Prospective Study on Direct Class II Restoration Placement
Mark Laske (Presenter)
University of Nijmegen
N.J.M. Opdam, University of Nijmegen
Ewald Bronkhorst, University of Nijmegen
Jozé Braspenning, Radboud University Medical Centre
Marie Huysmans, University of Nijmegen
Objectives: This prospective study aimed to investigate the influence of practice, patient and restoration related factors on direct class II restoration survival, placed routinely by general dental practitioners (GDP) in the Netherlands.
Methods: From digital patient files, data from 31 472 restorations placed in 11 practices by 22 dentists were collected, placed between January 2015 and October 2017. GDPs recorded specific data of patients and placed restorations in their electronic patient files. The following data were retrieved: On patient level: Gender, age, SES, general health score, periodontal condition, oral hygiene, caries risk, presence of parafunctional habits. On tooth/restoration level: Tooth type, used restoration material, used adhesive system, included surfaces, endodontically treated (y/n), reason for restoration placement. The date of placement, date of last check up-visit and when applicable, date and type of intervention. Tooth extraction, endodontic treatment and placement of a crown or a new restoration including the same surfaces as the existing restoration, were considered as failure. Descriptive statistics were used to identify the research group. Restoration survival was explored with Kaplan Meier graphs, Annual Failure Rates (AFR) were calculated and an adjusted Cox regression was applied to calculate the Hazard Ratio's (HR) of the practice, patient and restoration related variables (p< 0.05).
Results: 31 472 restorations were placed in 14 909 patients (7.381 male and 7.528 female; age 5 to 95 y). A wide variation in AFR’s and HR’s are found between practitioners and practices (AFR 3,6% - 11,7%). All patient related factors have a significant influence on restoration survival, whereby high caries risk and presence of parafunctional habits show a major influence. A ≧4 surface restoration, placed due to fracture in an endodontically treated molar, has the highest risk for failure. Characteristics, AFR’s and HR’s of the most notable patient- and tooth/restorations related factors- and reason for restoration placement, are shown in the table.
Conclusions: Restoration survival is influenced by a wide spectrum of variables. Besides the practice, tooth/material factors, individual patient factors should not be underestimated and should be taken into account in survival studies.
|No. of restorations||Annual Failure Rate, AFR (%)||P-value||Hazard Ratio (95% Confidence interval)|
|Patient characteristics, N= 14 909|
|General Health condition|
|Medically compromised||5.641 (17,9%)||10,1||0,034||1,150 (1,010 - 1,310)|
|Severe medically compromised||488 (1,6%)||13,6||0,041||1,399 (1,015 - 1,929)|
|Caries risk and parafunctional habits|
|Low caries risk without parafunctional habits||5.554 (17,6%)||6,0||-||1,00|
|Low caries risk with parafunctional habits||1.754 (5,6%)||8,0||<0,001||1,394 (1,363 - 1,426)|
|High caries risk without parafunctional habits||6.613 (21,0%)||9,3||<0,001||1,674 ( 1,646 - 1,702)|
|High caries risk with parafunctional habits||2.143 (6,8%)||11,8||<0,001||1,996 (1,955 - 2,039)|
|Tooth and restoration characteristics N= 31 472|
|Molar||19.846 (63,1%)||8,5||<0,001||1,387 (1,251 - 1,538)|
|Yes||1.472 (4,7%)||19,2||<0,001||1,846 (1,569 - 2,171)|
|Diagnosis current restoration survival|
|Fracture / Wear||7.395 (23,5%)||10,4||<0,001||1,470 (1,307 - 1,653)|
|Other diagnosis||3.424 (10,9%)||8,6||0,015||1,214 (1,038 - 1,420)|
The submitter must disclose the names of the organizations with which any author have a relationship, the nature of the relationship, and the clinical or research area involved. The following is submitted: NONE