Restorations In Primary Teeth Research Articles

Eight‐year study on conventional glass ionomer and amalgam restorations in primary teeth

The aim of this randomized clinical study was to compare the longevity and the cariostatic effects of conventional glass ionomer and amalgam restorations in primary teeth placed in everyday practice in the Danish Public Dental Health Service. All restorations inserted during a 7‐month period by 14 clinicians in 2 municipalities were included in the study. The sample consisted of 515 conventional glass ionomer restorations and 543 amalgam restorations in 666 children aged between 2.8 and 13.5 years. The restorations were in contact with 592 unrestored surfaces in primary and permanent teeth. The study was terminated after 8 years, with 2% of the restorations in function and 7% patient dropouts. Fifty percent of the teeth restored with glass ionomer and 63% of those with amalgam were exfoliated with the restoration in situ, while 42% of the glass ionomer and 20% of the amalgam restorations had been repaired or replaced. Fracture of restoration, endodontic complication, and loss of retention were the major reasons for failure. The 50% survival time for glass ionomer restorations in all cavity types was 42 months, while the median survival time for amalgam restorations could not be estimated but exceeded 7.8 years (P<0.001). Progression of caries lesions on tooth surfaces adjacent to amalgam restorations required operative treatment on 30% of the teeth, while only on 16% of teeth adjacent to glass ionomer restorations. The 75% survival time was 40 months for surfaces in contact with glass ionomer compared to 25 months for surfaces in contact with amalgam (P=0.005). Multivariate analyses were performed in order to assess the influence of a number of factors on the longevity of restorations, occurrence of prevalent failures, and caries treatment of surfaces in contact with the restorations. Owing to the high frequency of failures of the conventional glass ionomer restorations, it was concluded that they are not an appropriate, universal alternative to amalgam for restorations in primary teeth, although they reduce caries progression and the need for operative treatment of adjacent surfaces.

Parental attitudes to the care of the carious primary dentition.

To examine parents' attitudes to the dental care of their children, taking into account the family's socio-economic background, dentally-related behaviour including the child's level of dental anxiety and dental treatment history. A cross sectional study of all 5-year-old children living in Ellesmere Port and Chester. All children were clinically examined; dmft and its components were recorded. A postal questionnaire was sent to the children's parents to measure their preferences for dental care with reference to two scenarios, (1) if their child had a carious but asymptomatic primary tooth, or (2) if their child had a carious primary tooth which was causing toothache. Parents were also asked to provide information on the dental attendance pattern of their child and an assessment of their child's dental anxiety. Family socio-economic status was recorded using the Townsend material deprivation index of the electoral ward in which they resided. Questionnaires were distributed to the home addresses of the 1,745 children who were clinically examined, and 1,437 were returned, giving a response rate of 82%. In both scenarios the majority of parents were happy to leave the decision on treatment to the dentist. In the asymptomatic tooth scenario, approximately one third of parents wanted the tooth to remain untreated but periodically monitored, only 6% expressed a desire to have their child's tooth restored. Multivariate analysis showed that parents of children who had a filling (OR 4.32 95%CI 2.21-8.43) or extraction (OR 2.24 95%CI 1.11-4.53) in the past were significantly more likely to want restorative care for their children. In the scenario where the child had toothache, multivariate analysis confirmed that parents had a preference for an intervention (extraction or filling) if they lived in a deprived area (Townsend score OR 1.10, 95% CI 1.04, 1.16) or if their child had had an extraction (OR 4.35, 95% CI 1.59, 11.88) or filling (OR 2.39, 95% CI 1.05, 5.45) in the past, after controlling for gender, attendance and parentally reported anxiety. When preference for an extraction was considered as the dependent variable, there was no significant relationship with past restorative treatment. In both scenarios there was no association between parentally reported anxiety of the child and parental preferences for treatment. In this part of the UK, there was little explicit support amongst parents for the restoration of asymptomatic carious primary teeth. Parental expectations for the dental care of young children with caries in their primary teeth, were closely related to the treatment experiences of the child. Families living in deprived areas expressed a preference for more interventionist care than their more affluent counterparts. Parentally judged anxiety of the child or their past dental attendance behaviour had no association with parents' preferences for the care of their children.

Direct restorative material use of selected practitioners in the United Kingdom.

To investigate, by questionnaire, the direct restorative materials used by a sample of practitioners from the United Kingdom. A postal questionnaire was distributed to a group of self-selected practitioners, who volunteered to participate in the study. In all 110 practitioners participated in the study. The most used material for the restoration of occlusal (Class I) and approximal (Class II) lesions was amalgam with 61% and 73% of practitioners indicating that they used amalgam in this situation. Adhesive tooth-coloured materials, specifically composites and compomers, were preferred by the majority of practitioners for anterior approximal (Class III) and incisal (Class IV) restorations with compomer preferred for Class V restorations including non-carious cervical lesions and for the restoration of primary teeth. It is concluded that the general practitioners surveyed in this study tend to use amalgam for the restoration of Class I and II lesions as opposed to resin composite. The majority of practitioners in this study used compomers, a relatively new group of restorative materials, with little evidence of traditional glass-ionomer cements being used routinely.

Atraumatic restorative treatment and glass ionomer sealants in Tunisian children:survival after 3 years

We evaluated the survival rates of atraumatic restorative treatment restorations and of glass ionomer sealants after 3 years of usage in primary and permanent teeth in Tunisian children aged 3-15 years attending rural schools, and assessed the presence or absence of dental caries in the restored teeth. After an initial survey of 1949 children, 242 were selected and agreed to undergo treatment. The loss to follow-up after 3 years was about 40%. Of those evaluated, 45.73% of one-surface ART restorations in permanent teeth had survived, 54.96% of one-surface sealants in permanent teeth had survived and 27.85% of one-surface ART restorations in primary teeth had survived. Caries was found in only 19 teeth after 3 years.

Materials for restoration of primary teeth: 2. Glass ionomer derivatives and compomers.

A wide variety of materials have been used for the restoration of primary teeth. Resin-modified glass ionomers and the more recently introduced viscous glass ionomers have been developed from conventional glass ionomer materials in an attempt to overcome the suboptimal properties of conventional glass ionomers. These materials would appear to have the necessary physical characteristics for restorations in load-bearing situations in primary teeth, as have the resin-based compomer materials, which now have well documented success rates in a number of studies. The first of these two articles described 'traditional' restorative materials, including amalgam and conventional glass ionomer, for the restoration of primary teeth. This paper describes materials derived from traditional glass ionomers in an attempt to overcome the suboptimal properties of conventional glass ionomers and resin-based materials such as compomer.

Placement and replacement of restorations in primary teeth

This practice-based study aimed to record the use of restorative materials, the type of restoration by class, and the reason for and the age of failed restorations in primary teeth by means of a survey of placement and replacement of restorations in 1996 and 2000/2001. Written alternative criteria for placement and replacement of restorations were provided for the participating clinicians. Details on 2281 restorations showed that primary caries was the main reason for inserting restorations in primary teeth. Replacements of failed restorations represented 14% of the fillings (n = 2040) in 1996 and 9% in 2000/2001 (n = 241). More than 80% of the fillings in primary teeth were of tooth-colored material, predominantly of the lightcured type. About 50% of failed amalgam and glass ionomer-type restorations were replaced due to secondary caries. The median age of amalgam restorations (3 years) was significantly higher than that of tooth-colored restorations (2 years). Any possible advantage of a cariostatic effect of glass ionomer-type materials is apparently annulled by their short longevity compared with amalgam.

Materials for restoration of primary teeth: I. Conventional materials and early glass ionomers.

This paper demonstrates how the treatment of primary dentition may present the clinician with increased difficulties compared with the preparation and placement of restorations in adult dentition. Established dental materials (dental amalgam and conventional glass ionomer cements) and less well established alternative materials (copper cements) are reviewed. The use of amalgam to restore primary dentition is the subject of concern amongst the dental profession in terms of lack of adhesion and potential toxicity concerns, while the low tensile strength of traditional glass ionomer cements make them less suitable for the restoration of primary dentition.

Clinical Investigation of Two Glass–Ionomer Restoratives Used with the Atraumatic Restorative Treatment Approach in China: Two–Years Results

Objective: To compare the clinical performance of two glass–ionomer cements, ChemFlex (Dentsply DeTrey) and Fuji IX GP (GC), when used with the atraumatic restorative treatment (ART) approach in China. Methods: Eighty–nine school children aged between 6 and 14 years who had bilateral matched pairs of carious posterior teeth were included. A split–mouth design was used in which the two materials were randomly placed on contralateral sides. The performance of the restorations was assessed directly and also indirectly from die–stone replicas at baseline and after 6, 12, and 24 months. Results: The 24–month cumulative survival rates of ART restorations in the primary teeth were 93 and 90% for the ChemFlex and Fuji IX GP class I restorations, respectively, while 40 and 46% of class II restorations placed with the respective materials were satisfactory. In the permanent dentition, only class I restorations were involved and the cumulative survival rates were 95 and 96% for ChemFlex and Fuji IX GP. For the primary teeth after 24 months, net mean occlusal wear was 87 µm for ChemFlex and 85 µm for Fuji IX GP. The occlusal wear in the permanent teeth was 75 µm for ChemFlex and 79 µm for Fuji IX GP. Conclusion: The clinical performance of both materials over a 24–month period was similar and the survival rates of class I ART restorations in both primary and permanent teeth were high.

Clinical performance of resin-modified glass ionomer cement restorations in primary teeth: A retrospective evaluation

The authors retrospectively evaluated the clinical performance of one resin-modified glass ionomer cement as a restorative material in Class I, Class II, Class III and Class V restorations in primary teeth. A total of 306 patients who had received a total of 864 resin-modified glass ionomer restorations, which had been in their mouths for a minimum of three years, were included in this evaluation. The authors assessed the clinical observations recorded in patients' records and used bitewing radiographs to assess Class II restorations. The authors found an overall restoration success rate of 93.0 percent, with Class I restorations having a 92.6 percent success rate, Class II restorations having a 93.3 percent success rate, Class III restorations having a 100 percent success rate, and Class V restorations having a 98.0 percent success rate. The resin-modified glass ionomer cement functioned well as a Class I, Class II, Class III and Class V restorative material in primary teeth. Resin-modified glass ionomer restorative cement is a durable and reliable material to use for Class I, Class II, Class III and Class V restorations in primary teeth. Therefore, dentists have a proven alternative to silver amalgam and resin-based composite for primary tooth restoration.

RESIN-BASED COMPOSITES AND COMPOMERS IN PRIMARY MOLARS

Resin-based composite resins and polyacid-modified resin-based composites (compomers) have become popular for the restoration of primary anterior and posterior teeth. In some European countries, resin-based composites or glass-ionomers are the materials of choice for primary teeth because of the controversy over dental amalgam and its alleged adverse health effects resulting from the release of mercury, although a clear correlation between amalgam restorations and health has not been determined. Another reason for the worldwide increased use of resin-based composites and glass-ionomers in pediatric dentistry could be attributed to the growing demand from parents to provide esthetic restorations to their children. More conservative preparations can be performed maintaining more tooth structure because of the adhesive properties of the composites and compomers. The most conservative treatment planning and meticulous care in the placement of the resin-based composites and compomers would produce long-term satisfactory results. These restorations should be placed in patients with low-to-moderate caries risk, and after placement the restorations should be monitored carefully to avoid complications mainly produced by recurrent caries and wear.

Compomer versus glass ionomer restorations: which material performs better in primary molars?

Objectives To undertake a clinical trial comparing the efficiency of a compomer restoration with a glass ionomer restoration in the management of caries in primary molar teeth. Design Subjects were admitted to the trial if they required at least one pair of restorations in primary molar teeth. Setting Department of Child Dental Health, Newcastle Dental Hospital and School. Subject Twenty nine children, aged 4–9 years, had 56 pairs of restorations placed between January 1995 and November 1997. Method The durability of the restorations was assessed during a 42-month follow-up period using modified United States Public Health Service criteria. Survival analysis and the McNemar paired test were used to compare the performance of the two restorative materials. Results The compomer restorations had a higher mean survival time (42 months, SE 1.40) compared with 37 months (SE 1.90) for the glass ionomer restorations and this was significant at the 5% level. The compomer also performed significantly better in terms of anatomical form, marginal integrity, cavo surface discoloration and maintenance of interproximal contact. Conclusions The present trial demonstrated that Dyract compomer performed significantly better than Chemfil Superior a glass ionomer cement for all modified United States Public Health Service criteria over a period of 42 months.

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.

Painting the future for ART.

The objective of this paper is to review recent research and developments with respect to the atraumatic restorative treatment (ART) approach and to outline future areas of research and development. Areas identified as requiring further investigation include the evaluation of: ART restorations for longer than 3 years duration using recognised evaluation criteria, multi-surface ART restorations, ART restorations in primary teeth and ART sealants. In addition, the possibility and potential dangers of caries remaining after cavity cleaning with hand instruments must be investigated and the findings balanced against the known damage to sound tooth tissue caused by more routine cavity preparation techniques. New bioactive restorative materials which offer the possibility of healing dentinal caries lesions should be developed and evaluated. Finally, behavioural and educational aspects of the ART approach should be investigated.

Microinfiltração em dentes decíduos em função de materiais restauradores e condicionamento ácido

A pesquisa teve como objetivo avaliar a microinfiltração em restaurações de quatro materiais (Dyract, Vitremer, Z100 e Fuji II LC), em dentes decíduos, realizando ou não condicionamento ácido. Foram feitas dez restaurações (5 OM e 5 OD) para cada condição experimental. As cavidades tinham as dimensões (mm): 4 de altura, 3 de largura e 2 de profundidade. Os materiais foram manipulados conforme instruções dos fabricantes. Os dentes restaurados, após sete dias de armazenagem foram submetidos à ciclagem térmica (700 ciclos a 5 e 55ºC, com um minuto em cada banho). Em seqüência os corpos-de-prova foram preparados para a imersão em azul de metileno a 0,5%, pH 7,2, por quatro horas, após o que foram preparados para a avaliação do grau de infiltração. Os resultados permitiram concluir que: foi grande a diferença de escores entre materiais (de infiltração nula, 0, a 4 máxima); médias de 0,1 (Dyract) a 4,0 (Fuji II LC); os materiais Vitremer e Z100 não diferiram entre si e se encontraram com valores entre os outros dois; o condicionamento ácido influiu apenas com o material Fuji II LC.

Effect of Two Disinfecting Agents on the Microleakage of Resin-Based Composite Restorations in Primary Teeth

Introduction: Disinfection of the cavity preparation after caries excavation can lead to the elimination of bacterial remnants that can be responsible for recurrent caries, postoperative sensitivity, and failure of the restoration. The purpose of this study was to evaluate the effects of two disinfectants on microleakage of composite restorations in primary teeth. Methods:In this experimental study, 40 extracted primary canine teeth without caries were randomly divided into four groups of 10 teeth, namely control group (1), pretreatment group with chlorhexidine 2% (2), pretreatment group with sodium hypochlorite 2/5% (3), and pretreatment group with sodium hypochlorite 5% (4). In addition, class V cavities were prepared on all teeth. The cavities were then restored with composite. The teeth were thermocycled and immersed in 2% methylene blue for 24h. Microleakage was assessed by dye penetration in the incisal and gingival surface of the teeth using stereomicroscope. Data were analyzed in SPSS software (version 18) through Kruskal-Wallis and Mann-Whitney U tests. Results: According to the results, the difference among groups was significant (P<0/001). The pair-wise comparison showed significant differences between groups 1 and 2; however, no difference was observed between pretreatment groups with sodium hypochlorite 5% and 2/5%. Furthermore, no statistically significant difference was found in terms of incisal and gingival surfaces. Conclusion:Pretreatment with chlorhexidine and sodium hypochlorite increased microleakage in composite restorations in primary teeth.

Clinical behaviour of glass ionomer restorations in primary teeth

Objective: To compare a silver-reinforced glass ionomer material (cermet) with a resin-modified glass ionomer in minimal Class II preparations in primary teeth. Methods: Matched pairs of primary molars with approximal caries that required operative treatment were used. Each cavity was filled with either Vitremer or Ketac-Silver. The restorations were followed for at least 36 months and examined annually using bitewing radiographs and clinical inspections. Impressions were taken at each recall and models were examined microscopically. Results: After 36 months, one of the resin-modified glass ionomer (RMGI) restorations and 13 (26.5%) of the silver cermet restorations had failed. The RMGI failed because of secondary caries, while most of the failures of the silver cermet fillings were marginal defects alone or in combination with secondary caries. The median survival time (MST) for the silver cermet restorations was 37 months. The RMGI restorations had a MST exceeding 42 months, but MST could not be calculated exactly because of the low failure rate during the study period. Conclusions: The resin-modified glass ionomer had the overall best performance of the two materials under comparison. The silver cermet material cannot be recommended for Class II restorations in primary teeth.

A longitudinal study of schoolchildren's experience in the North Carolina Dental Medicaid Program, 1984 through 1992.

This evaluation of a state Medicaid dental program describes dental treatment received, relates treatment needed to treatment received, and describes enrollment and use over an 8-year period. Three databases were linked: (1) clinical records from a 1986/87 statewide epidemiological survey, providing data on treatment need; (2) Medicaid dental claims from 1984 through 1992, providing data on treatment received; and (3) Medicaid enrollment files from 1984 through 1992. Half of Medicaid-enrolled children never used dental services. Among users of dental services, 45% and 25% of children needed restorations in primary and permanent teeth, respectively. In this group, 29% had all needs met, 28% had needs partially met, and 43% had no needs met. Forty-six percent of children sought care for only 1 year. Federal guidelines for dental care are not met in this typical Medicaid population of short-term enrollees who use services sporadically. Programs should aim to increase use and ensure that all needed services, especially preventive procedures such as sealants, can be completed within the short period of time a child attends for care.

Clinical Study on the Restoration of Primary Teeth

Clinical Study on the Restoration of Primary Teeth

Long term cost of restorative therapy using different materials.

The cost of restorative treatment over a 60-yr period has been assessed, based on the present cost of restorations at the time of insertion and the median longevity of the different types of restorations. Such theoretic extrapolations indicate that the long term cost of two- or three-surface gold and composite restorations in permanent teeth is similar and about 4 times more than for amalgam therapy. The cost of one-surface composite restorations would be about 2-2.5 times that of amalgam restorations, while small gold restorations would cost 5 times more than amalgam restorations. Due to the short median longevity of composite restorations in primary teeth, a 5 times higher cost can be estimated compared to amalgam therapy over a 10-yr period.

Placement and longevity of amalgam restorations in Denmark

A survey has been made of the reasons for placement of 4932 amalgam restorations in Denmark. In patients more than 16 years of age 39% of all restorations were made because of primary caries, and 61% were replacements of failed restorations. In children 74% of the restorations in primary teeth and 84% of those in permanent teeth were inserted because of primary caries. The reasons for replacement of restorations depended on dentition, age of the patient, and type of restoration. Secondary caries was the most frequent reason for replacement of failed restorations in permanent teeth and accounted for 38% of all failures. Marginal discrepancies and bulk fracture of fillings were the other two major reasons. In primary teeth fracture and loss of fillings were the commonest reasons, whereas secondary caries accounted for only a quarter of all restorations replaced. The age of the restorations replaced ranged from 0 to 46 years, and half of the failed restorations in permanent teeth of adults were more than 8 years old. A shorter longevity of failed restorations was noted in primary teeth and permanent teeth of children.