Longevity and associated risk factors in adhesive restorations of young permanent teeth after complete and selective caries removal: a retrospective study
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The aim of this retrospective university-based study has been to evaluate the longevity and factors associated with failures of adhesive restorations performed in deep carious lesions of permanent molars after complete (CCR) and selective caries removal (SCR).
Materials and methods
The sample was composed of composite resin and resin-modified glass ionomer cement (RMGIC) restorations placed in permanent molars of children attending a university dental service who were followed up for up to 36 months. Information collected retrospectively from clinical records was used for analyzing data. The following factors were investigated: gender, caries experience, visible plaque and gingival bleeding indexes, operator’s experiences, number of restored surfaces, and type of capping and restorative materials. The Kaplan-Meier survival test was used to analyze the longevity of the restorations. Multivariate Cox regression analysis with shared frailty was used to assess the factors associated with failures (p < 0.05).
Four hundred seventy-seven restorations carried out in 297 children (9.1 ± 1.7 years) were included in the analysis. The survival of the restorations reached 57.9 % up to 36 months follow-up with an overall annual failure rate of 16.7 %. There was no difference in restoration longevity when CCR or SCR was performed (p = 0.163); however, CCR presented more pulp exposure (p < 0.001). Multi-surface restorations showed more failures than single-surface (HR 3.22, 95 % CI 1.49; 6.97), and teeth restored with RMGIC had a lower survival rate than those restored with composite resin (HR 4.11, 95 % CI 1.91; 8.81). Patients with evidence of gingivitis had more risk of failure in their restorations (HR 2.88, 95 % CI 1.33; 6.24).
Overall, adhesive restorations performed in young permanent molars of high caries risk children presented limited survival, regardless of the caries removal technique. Risk factors for failure were identified as multi-surface fillings, RMGIC restorative material, and poor oral hygiene, reflected by gingival bleeding.
Composite fillings associated with a strict caries preventive regimen may play an important role in the survival of restorations placed in high caries risk children.
KeywordsComplete caries removal Selective caries removal Adhesive restoration Permanent teeth Survival analysis
Compliance with ethical standards
Conflict of interest
Author Alejandra Tejeda Seminario declares that she has no conflict of interest; author Marcos Britto Correa declares that he has no conflict of interest; author Stefanie Bressan Werle declares that she has no conflict of interest; author Marisa Maltz declares that she has no conflict of interest; author Flávio Fernando Demarco declares that he has no conflict of interest; author Fernando Borba de Araujo declares that he has no conflict of interest; and author Luciano Casagrande declares that he has no conflict of interest.
The costs of this retrospective study were funded by the researchers.
All procedures performed in the present research were in accordance with the ethical standards of the Resolution of the National Council on Ethics in Research (n. 466,/2012) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from the parents or guardians of all children included in the study. The protocol of this research was submitted and approved by the Research Committee (n. 26760) and the Ethic Committee (n. 35380414.2.0000.5347) of the Federal University of Rio Grande do Sul, Porto Alegre, RS - Brazil.
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