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Restoration outcomes after restoring vital teeth with advanced caries lesions: a practice-based retrospective study

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Abstract

Objectives

Maintaining pulpal vitality and achieving long-term restoration success are challenging when treating advanced caries lesions. We aimed at assessing success, survival, and influencing factors of treating advanced lesions in general dental practice.

Methods

Patient record databases from six practices in Germany were assessed. Permanent posterior teeth with lesions radiographically extending into inner dentin with sensible (vital) pulps were retrospectively evaluated. Outcome parameters were success (absence of re-treatment) and survival (absence of extraction). Mean success/survival times were estimated, and effect of treatment modifiers assessed using Lee, Wei, and Amato (LWA) regression.

Results

Two hundred thirty-two patients (308 teeth) were assessed. Lesions (93 %) included proximal surfaces. Eight teeth showed preoperative intermitting or provocation pain. Thirty four % of teeth experienced pulpal exposure during excavation. Mean follow-up time was 74 months. Mean success time was 130 months. Teeth (142/308) required re-interventions, mostly due to secondary caries and restorative or endodontic complications. Only 13 teeth required extraction (mean survival time 307 months). Hazard of failure was significantly reduced in younger patients (<40 years) (hazard ratio (HR) [95 % confidence interval (CI)] 0.57 [0.35/0.91]) and teeth without preoperative pain (0.39 [0.17/0.90]). Compared with teeth receiving amalgams, those restored using cements (2.44 [1.05/3.98]) or composites (1.64 [1.15/2.38]) had higher risk of failure. Hazard of extraction was higher in teeth with pulpal exposure (4.90 [1.36/17.7] or cement restorations (23.6 [5.56/100]).

Conclusion

Teeth with advanced lesions had high risk of failure, while risk of extraction was low.

Clinical relevance

Teeth treated for advanced lesions required re-treatment frequently but were retained long term. Age, pulpal exposure, and restoration type were associated with risk of failure or extraction.

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Acknowledgments

We thank the dentists and their staff for allowing screening of databases and data extraction within their premises.

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Authors and Affiliations

  1. Department of Operative and Preventive Dentistry, Charité – Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14199, Berlin, Germany

    Falk Schwendicke, Hannes Krüger & Sebastian Paris

  2. Clinic for Conservative Dentistry and Periodontology, Christian-Albrechts-Universität Kiel, Arnold-Heller-Str. 3,, 24105, Kiel, Germany

    Hannes Krüger

  3. Department of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany

    Peter Schlattmann

  4. Department for Operative and Preventive Dentistry, Charité Centre for Dental Medicine, Aßmannshauser Str. 4-6, 14197, Berlin, Germany

    Falk Schwendicke

Authors
  1. Falk Schwendicke
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  4. Sebastian Paris
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Corresponding author

Correspondence to Falk Schwendicke.

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Funding statement

This study was funded the authors and their institutions.

Conflict of interest

The authors have no conflict of interest to declare.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Approval for database screening and anonymous data extraction was given by the ethics committee of the CAU Kiel (D-414/14).

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Schwendicke, F., Krüger, H., Schlattmann, P. et al. Restoration outcomes after restoring vital teeth with advanced caries lesions: a practice-based retrospective study. Clin Oral Invest 20, 1675–1681 (2016). https://doi.org/10.1007/s00784-015-1654-6

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  • DOI: https://doi.org/10.1007/s00784-015-1654-6

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