Interproximal Restorations Research Articles

Retrospective Study on 57 Direct Interproximal Restorations with Supracrestal Tissue Attachment Violation: Follow-Up Between 10 and 23 Years.

Fifty-seven interproximal restorations invading the supracrestal tissue attachment were evaluated over a mean period of 15 years (10-23 years) in terms of crestal bone loss. The distance from the cavity margin to the bone was measured at T0 and controlled using X-rays and a measurable landmark. The mean bone loss in the vertical dimension was 0.46 mm, with a 96.49% survival rate. Smoking habits (p = 0.02) and tooth type (p = 0.03) significantly affected the bone loss. The proposed technique could help the clinician in adopting a minimally invasive approach in the treatment of heavily compromised teeth. Future research with rigorous study designs would be interesting to guide the clinical decision making.

THE RELATIONSHIP BETWEEN PERIODONTAL HEALTH AND FIXED PROSTETHIC RESTORATIONS

Periodontal health and various types of dental restorations are very closely related. On the one hand, periodontitis is a multifactorial disease. The main etiological factor is the microflora found in dental plaque. Plaque retentive factors - both natural and iatrogenic - are extremely important for the development of an inflammatory process of the periodontium. Among the most common iatrogenic plaque retentive factors are overhanging interproximal restorations (direct and indirect) and not precisely made prosthetic fixed structures. On the other hand, for restorative dentistry to be successful, it is necessary to first achieve periodontal health in the respective area, which should be maintained after the fabrication and placement of the dental restoration.

The associations between dental disease and systemic health.

Understanding the relationship between a patient's systemic and oral health is key for clinicians. The aim of this study was to determine if there is an association between specific findings in a dental exam, such as class V carious lesions, and the American Society of Anesthesiologists (ASA) classification as a proxy for systemic health. A retrospective chart review was performed on all patient charts that met inclusion criteria including detailed, complete, and vetted charts obtained over a three-year period in the predoctoral clinic of a United States dental college. Findings recorded at the initial exam included the decayed, missing or filled teeth (DMFT) score, the location of carious lesions and restorations, the presence of periodontal disease, the number of endodontically treated teeth and the number of fractured teeth or restorations. We found no association found between DMFT score and ASA status but did find that ASA I patients had a higher degree of occlusal carious lesions and that ASA III patients were more likely to have interproximal restorations and fractured teeth. We found associations between a greater number of missing teeth and the presence of periodontal disease with worsening ASA status. Our data suggest that ASA classification cannot be used as a reliable predictor for the health of a patient's dentition or the number of cervical caries. However, the data does demonstrate a positive correlation between the number of missing teeth and ASA status, promoting the idea that the number of missing teeth is a crude prognosticator of systemic health. This information can be used by physicians and dentists to help understand the relationships between a patient's dental and systemic health.

Risk Factors of Dental Caries in the Thai Population: The Retrospective Cohort Study.

The aim of this retrospective cohort study was to determine the risk factors associated with the occurrence of dental caries increments in Thai dental patients. The dental chart records of 500 patients who visited the Department of Advanced General Dentistry, Mahidol University during 2003-2013 were included in this research. Risk factors such as age, gender, medical history, marital status, routine oral checkup, oral appliance usage, initial and final records of decayed (DT)-missing-filled (DMF-T), dental history of tooth extraction due to caries, xerostomia, presence of visible plaque, presence of interproximal restoration, and caries risk level were retrieved from dental records. Cox proportional hazard regression model was used to determine the association of caries risk factors and new dental caries increments. The results indicated that the rate of incidence of new dental caries was 2.1 per 100 person-month. In the multivariate hazard model, past caries experience in more than three teeth (adjusted hazard ratio: 2.29, 95%CI: 1.53-3.44) and xerostomia (adjusted hazard ratio: 4.47, 95%CI: 1.82-10.98) were independent risk factors of dental caries increments. Other factors, such as demographic data, physical factors, clinical factors, and other contributing factors, were not associated with the incidence of new dental caries. The presence of past caries experience and xerostomia were predictors of the occurrence of new dental caries.

Fracture Resistance in Non-Vital Teeth: Absence of Interproximal Ferrule and Influence of Preparation Depth in CAD/CAM Endocrown Overlays-An In Vitro Study.

There is ample evidence to support the use of endocrowns to restore endodontic teeth. However, the influence of the position of the interproximal margins on fracture strength has not yet been studied. The aim was to determine the relationship between the apicocoronal position of the interproximal restorative margins and fracture resistance in nonvital teeth restored with CAD/CAM endocrown overlays. Forty extracted human maxillary premolars were prepared for endocrown overlay restorations without ferrule on the interproximal aspects and classified according to the position of the interproximal restoration margins in relation to the alveolar crest: 2 mm (group A), 1 mm (group B), 0.5 mm (group C), and 0 mm (group D). Fracture strength was measured using a universal testing machine applying a compressive force to the longitudinal tooth axis. Group A had a mean fracture resistance of 859.61 (±267.951) N, group B 1053.9 (±333.985) N, group C 1124.6 (±291.172) N, and group D 780.67 (±183.269) N, with statistical differences between groups. Group C had the highest values for fracture strength compared to the other groups (p < 0.05). The location of the interproximal margins appears to influence the fracture resistance of CAD/CAM endocrown overlays. A distance of 0.5 mm between the interproximal margin and the alveolar crest was associated with increased fracture resistance.

Impact of interproximal composite restorations on periodontal tissue health: Clinical and cytokine profiles from a pre-post quasi-experimental study.

The aim of this study is to clinically and molecularly evaluate the effect of an interproximal iuxta/subgingival direct composite restoration on periodontal tissue healing. Individuals in need of a posterior iuxta/subgingival interproximal restoration were consecutively enrolled. After enrollment, a test (site with tooth decay) and a control site (intact contralateral tooth) were identified. After a periodontal examination (probing depth [PD], clinical attachment level, recession, plaque, and bleeding on probing [BOP]) and a sampling of gingival crevicular fluid, the composite restoration was performed (T0 ). Clinical and molecular assessments were repeated at 3 (T3 ), 6 (T6 ), and 12 (T12 ) months after the restoration. Intragroup pre-post comparisons for quantitative variables were performed either through one-way ANOVA or Kruskal-Wallis test. A multivariate linear regression analysis was then modeled. With α = 0.05, a power of 80% will be reached with the inclusion of 41 individuals. Biometric parameters demonstrated an increased mean PD (ΔPDT0 -T12 = -0.83 mm; P = 0.001) and loss of attachment (AL) (ΔCALT0 -T12 = -0.91 mm; P = 0.005) in the test site at 12 months. Accordingly, in the final multivariate regression model the radiographic distance between the bone crest and the restorative margin at baseline accounted for the dependent variable "attachment loss (AL)" (ΔCALT0 -T12 ) (P <0.05). Iuxta/subgingival interproximal restorative margins jeopardized clinically and molecularly the periodontal tissue healing at least up to 1 year of follow-up.

Retrospective cross-sectional radiographic assessment of the quality of posterior composite restorations and prevalence of associated periodontal changes

Objective: To evaluate the prevalence of the type of errors associated with inadequate restorations and the prevalence of periodontal changes associated with disease in the inadequate restorations. Materials and Method: Two hundred and eighty digital panoramic radiographs were evaluated by two independent observers. Teeth with interproximal restorations being observed on these examinations were classified according to the tooth restored, the quality of interproximal restoration and the presence of periodontal changes. Results: Out of the 4480 teeth evaluated 38% had restorations and among those 47% were considered to be inadequate by the evaluators. The main error detected was an over contoured (42%) followed by under contoured (31%) restoration. Periodontal changes were associated with 69% of the inadequate restorations and more of the molars had problems when compared to premolars. Conclusion: This study has investigated the prevalence of periodontal changes associated with posterior proximal composite resin restorations. It has found a high association between the presence of periodontal changes and proximal restorations and also that the restorations in molars tend to have more problems than premolars.

Long-term stability of retreated defective restorations in patients with vertical food impaction.

Background:Vertical food impaction (VFI) is a common complaint among patients receiving interproximal restorations. However, there is a gap in the literature regarding outcomes of treating defective restorations with VFI. This study sought to determine 10-year stability of retreated defective restorations in patients diagnosed with VFI.Materials and Methods:A total of 150 teeth (75 pair), in 38 patients comprised our study population. All the participants had been diagnosed with VFI due to faulty restorations and treated by means of redoing the restoration to build a stable contact in at least one restored tooth. The criteria for building an optimum dental contact were defined. Demographic characteristics, date and frequency of redoing the restoration, type and material of restoration, number of restored surfaces, occlusal intercuspal relationship, missing adjacent and/or opposing teeth, cemento enamel junction to alveolar crest distance, recurrence of VFI symptoms, recurrent caries, and periapical pathology as well as periodontal variables were recorded.Results:Kaplan–Meier estimator revealed that the mean ± standard deviation of 1, 3, 5, and 10-year stability of reconstructed contacts was 89/2% ± 3/6%, 79/2% ± 5%, 70/7% ± 0/06%, and 66/3% ± 7/1%, respectively. The overall cumulative stability rate was 74/4%. Further analysis predicted that over a 12-year period, restored contacts were stable for 8.86 ± 0.6 years. Cox regression model indicated that having cusp to marginal ridge occlusal relationship (95% confidence interval [CI] for hazard risk (HR) = 1/1–13/9, HR = 3/93), and being over 40 years of age (95% CI for HR = 0/88–17/66, HR = 3/95) were major determinants of contact stability.Conclusions:Long-term stability of retreated and restructured tooth contacts with a history of VFI was 66%–89% in this specific sample.

Effect of iatrogenic factors on periodontal health: An epidemiological study

IntroductionPeriodontitis is a multifactorial disease. Among conglomerate etiological factors, overhanging interproximal restorations are viewed as contributing factors causing gingival inflammation due to their retentive capacity for bacterial plaque leading to periodontal destruction. Hence this study is intended to determine the prevalence of overhanging restorations and its effect on periodontal status of the teeth and to assess the iatrogenic effects of overhanging margins on periodontal health. Materials and methodsA total of 100 subjects of 15–65 years of age were recruited for this study. Dental restorations which affect periodontal health like amalgams, composite or glass ionomer restorations (overhanging margins proximally), fixed prosthesis, cervical abrasions, class V restorations extending sub-gingivally were included in the study. Patients with known systemic diseases, smokers, and on any medication in past 6 months were excluded from the study. Various parameters like bleeding on probing, probing depth, clinical attachment loss, biological width, gingival recession, duration of restoration were assessed according to the site of the restorations. Statistical analysisA commercially available SPSS version 20.0 Software, was used to perform the statistical analysis. The data were distributed normally and it was investigated using paired t-test. The prevalence of overhanging restorations was done through percentages comparison between restorative sites with non-restorative sites. ResultsThe presence of sub-gingival restorations was greater in males than in females. This can be attributed to the oral hygiene maintenance of the subjects. The prevalence of sub-gingival restorations was more prevalent in the age groups between 35 and 45 years of age. ConclusionThis study clearly identified a higher prevalence, 50.8% of sub-gingival restorations causing gingivitis and has shown significant influence on periodontal status of the tooth.

Radiographic assessment of the quality of dental restorations and their relationship with periodontal radiographic changes

INTRODUCION: The quality of dental restorations can be directly related to the maintenance of periodontal health. Particularly in relation to the contour of interproximal restorations, radiographs allow the assessment of possible excess or lack of proximal contact of restorative materials.OBJECTIVE: To evaluate the frequency of adequate and inadequate restorations, the type of restorative material and the relationship of these parameters with periodontal alterations.METHODS: One hundred digital panoramic radiographs were evaluated, with interproximal restorations being observed on these examinations, classifying them according to the material used and the quality of interproximal restoration and the presence of periodontal alterations. Thepossible correlation between these parameters was evaluated.RESULTS: The frequency of adequate restorations was 48% of restored proximal surfaces. Among the inadequate restorations, 46.2% and 53.8% were over-contour and lack of proximal contact, respectively. The restorations were metallic in 64% of cases.CONCLUSIONS: Over-contour were more common among metal restorations and lack of proximal contact was more frequent among non-metal restorations. The presence of restorations was associated with increased prevalence of periodontal alterations.

Long-term stability: Postretention changes of the mandibular anterior teeth

Our objectives were to evaluate the long-term posttreatment changes of orthodontically corrected mandibular anterior malalignment and to determine the factors explaining these changes. The sample consisted of 66 subjects (mean age, 15.4 ± 1.7 years) selected from 7 private practices. The teeth had been retained for approximately 3 years and followed for 15.6 ± 5.9 years posttreatment. Longitudinal study models and cephalograms were analyzed to quantify the malalignment and growth changes that occurred. Crowding (1.2 ± 0.9 mm) and irregularity (1.5 ± 1.8 mm) showed only small average increases over the postretention period; only 26% of the sample had more than 3.5 mm of postretention irregularity. Variation in crowding explained 16% of the differences among subjects in irregularity. Growth variables (posterior facial height and mandibular rotation) and interarch variables (incisor-mandibular plane angle, interincisal angle, overbite, and overjet) were not significantly related to malalignment. Postretention malalignment changes were related to posttreatment anterior arch perimeter, intercanine width, and arch form, together indicating that narrower arch forms are likely to show greater posttreatment malalignment changes. Patients treated with extractions showed significantly greater malalignment than those treated without extractions; this was related to arch form. Patients who received interproximal restorations after treatment also showed significantly greater postretention malalignment than patients who did not. Orthodontic treatment is not inherently unstable. Narrow arch forms and interproximal restorations are potential risk factors for the development of postretention malalignment.

Professionally Applied Topical Fluoride and Restorative Care in Insured Children

This study evaluates the association between use of professionally applied topical fluoride and use of interproximal restorations in primary and permanent teeth of children. Insurance claims from 15,190 children, for treatment provided by 1,556 different dentists, were analyzed to look for associations between frequency of use of professionally applied topical fluoride and use of interproximal restorations. The average follow-up period for the children included in the analysis was 5.3 years, with the range from 3.0 to 7.9 years. Both tabular and regression results failed to demonstrate an association between frequency of use of professionally applied topical fluoride and use of interproximal restorations in either the primary or permanent dentition. The most powerful predictor of restorative care for these children was the overall propensity of the dentist to place restorations in children. In this group of insured children, we were unable to find an association between the frequency of use of professionally applied topical fluoride and restorative care. Further, despite numerous recommendations that professionally applied topical fluorides should be used only in moderate- and high-caries children, approximately two-thirds of these children received topical fluoride at every recall visit, nearly two times per year.

Radiographic periodontal findings in an elderly Finnish population.

By means of panoramic radiography and additional intraoral radiographs, the occurrence of calculus, the extent of horizontal bone loss, the depth and number of infrabony pockets, the number of furcation lesions, and the number of interproximal restoration overhangs were studied in 169 dentate 76-, 81-, and 86-year-old subjects (54 male and 115 females) living at home. Alveolar bone loss (horizontal or vertical) among the participants was common, and in only 8 subjects (5%) was it judged non-existent. It was slight in 30 subjects (18%), moderate in 53 (31%), and advanced in 78 (46%). Infrabony pockets were found in 51% of the subjects and furcation lesions in 28%. The presence of calculus did not correlate with the other parameters. The number of interproximal overhangs was associated with the number of infrabony pockets and of furcation lesions (R=0.3, p<0.001 and p<0.0001) and the number of infrabony pockets with the number of furcation lesions (R=0.4, p<0.0001). Our study shows that periodontal findings are common in the dentate elderly, and associations recently found between periodontal infections and several serious diseases make radiographic examination an integral part of the oral examination of the elderly patient.