F.J.T. Burke

Ten-year outcome of crowns placed within the General Dental Services in England and Wales

AIM It is the aim of this paper to consider the factors associated with the need for re-intervention on a crown, and the times to re-intervention. METHODS A data set was established consisting of patients, 18 years or older, whose birthdays were included within a set of a randomly selected dates, one of which was chosen in each possible year of birth and whose restoration records contained the placement of one or more indirect restorations on courses of treatment with last date on the claim form after 31st December 1990, and with date of acceptance after September 1990 and before January 2002. For each tooth treated with a crown, the subsequent history of intervention on that tooth was consulted, and the next date of intervention, if any could be found in the extended data set, was obtained. Thus, a data set was created of crowns which have been placed, with their dates of placement and their dates, if any, of re-intervention. RESULTS Data for over 80,000 different adult patients were analysed, of whom 46% were male and 54% female. A total of 47,474 crown restoration occasions were obtained from the data over a period of 11 years. Metal crowns were found to have the longest survival-68% at 10 years, and all-porcelain crowns the shortest-48% at 10 years. Factors which were found to influence outcome of crowns included type of crown, age of patient, patient payment exemption status, patient attendance pattern and placement of a root filling in the same course of treatment as a crown. CONCLUSIONS Full-coverage all-metal crowns have longer survival times before re-intervention than metal-ceramic crowns and all-ceramic crowns. Root fillings are associated with reduced survival time of the crowns examined in this study.

Contemporary dental practice in the UK: aspects of direct restorations, endodontics and bleaching.

Objective To investigate, by postal questionnaire, aspects of the selection and use of direct restorative materials, endodontic techniques and approaches to bleaching by general dental practitioners in the UK, and to compare and contrast the findings with those of a related study reported in 2004.Methods A questionnaire comprising 18 questions, each of a number of elements, was sent to 1,000 general dental practitioners in the UK, selected at random from the Dentists Register. Non-responders were sent a second copy of the questionnaire after a period of four weeks had elapsed.Results A total of 662 useable responses were returned, giving a response rate of 66%. Key findings included: dental amalgam was found to be the most commonly used material in the restoration of occlusoproximal cavities in premolar (59% of respondents) and molar teeth (75% of respondents); glass-ionomer cements and related materials were applied extensively in the restoration of deciduous molars (81% of respondents) and for the luting of indirect restorations (67% of respondents); the use of rubber dam was limited, in particular as an adjunct to procedures in operative dentistry (18% of respondents); relatively few respondents used preformed stainless steel crowns, and among the users only occasionally in the restoration of deciduous molars (23%); and bleaching, predominantly home-based (nightguard) vital bleaching (81% of respondents) was widely practised.Conclusion It is concluded that, for the practitioners surveyed, factors other than best available evidence influenced various aspects of the use of direct restorative materials and the clinical practice of endodontics. As a consequence, many of the features of general dental practice revealed in the process of the investigation were at variance with teaching in dental schools. Bleaching, in particular home-based (nightguard), vital bleaching, was provided by >80% of respondents, indicating widespread interest among patients in enhanced dental attractiveness.

How long do direct restorations placed within the general dental services in England and Wales survive

Aim It is the aim of this paper to consider the factors associated with the need for re-intervention on direct-placement restorations placed within the general dental services of England and Wales.Methods A large age-stratified sample of adult patients and their dental intervention were tracked over 11 years to December 2001. For each tooth treated with a direct restoration the subsequent history of intervention on that tooth was consulted, and the next date of intervention, if any could be found in the extended data set, was obtained. The distribution of times to re-intervention for different types of restoration in different circumstances was obtained using Kaplan-Meier survival analysis.Results Data for over 80,000 different adult patients were analysed, of whom 46% were male and 54% female. A total of 503,965 restoration placements were obtained from the data over a period of 11 years. Single surface amalgam restorations were found to have the longest survival – 58% at ten years, and glass ionomer the shortest – at 38% at ten years.Conclusions Small amalgam restorations have longer survival times before re-intervention than large amalgam restorations such as MOD. Composite and glass ionomer restorations perform less well than amalgam restorations. Restorations placed by older dentists and restorations placed in older patients have shorter time to re-intervention. Patients who changed dentist were found to have restorations which performed less well than those placed in patients who did not change dentist.

A clinical evaluation of all-ceramic bridges placed in UK general dental practices: first-year results

Purpose To report the results at year one of a three-year evaluation of the performance of fixed all-ceramic bridges, constructed with a yttrium tetragonal zirconia polycrystal substructure placed in adult patients in UK general dental practices and cemented using a self-adhesive resin-based cement.Methods Ethical approval was obtained. Four UK general dental practitioners were asked to recruit patients complying with the trial criteria and protocol. After obtaining informed written consent, appropriate vitality and radiographic assessments were completed and the pre-operative status of the gingival tissues noted. The teeth were prepared and bridges constructed using the same technician and laboratory procedures. Each bridge was reviewed within three months of the anniversary of its placement by a calibrated examiner together with the clinician who had placed the restoration. The examiners evaluated the integrity of the restoration, its anatomic form, marginal adaptation, surface quality, sensitivity, the condition of the adjacent gingivae, and the presence or absence of secondary caries.Results All the bridges (n = 38) examined at the first-year review were present, intact and performing well, though one small chip of the veneering porcelain was detected and in two cases an abutment tooth had been endodontically treated through an occlusal access cavity.

Ten-year outcome of porcelain laminate veneers placed within the general dental services in England and Wales

AIM It is the aim of this paper to consider the factors associated with the need for re-intervention on teeth restored with porcelain veneers. METHODS A data set was established consisting of adult patients (18 years or older) whose restoration records contained the placement of one or more porcelain laminate veneers. For each tooth treated with a porcelain veneer, the subsequent history of intervention on that tooth was consulted, and the next date of intervention, if any could be found in the extended data set, was obtained. Thus a data set was created of porcelain veneers which have been placed, with their dates of placement and their dates, if any, of re-intervention. RESULTS Data for over 80,000 different adult patients were analysed, of whom 46% were male and 54% female. A total of 2562 porcelain veneer restoration occasions in 1177 patients were obtained from the data over a period of 11 years. Factors which were found to influence the survival of porcelain veneers include patient gender, patient age, changing dentist, patients treatment need, patient charge-paying status and geographical area. CONCLUSIONS While dentist factors do not appear to play a part, a variety of patient factors have been found to influence veneer survival to re-intervention. Overall, 53% of porcelain veneers in the study survived without re-intervention at 10 years.

A clinical evaluation of all-ceramic bridges placed in patients attending UK general dental practices: Three-year results

OBJECTIVES To report the results at year three of an evaluation of fixed-fixed all-ceramic bridges, constructed in a yttria oxide stabilized tetragonal zirconium oxide polycrystal (Y-TZP) substructure, placed in adult patients in UK general dental practices and luted using a self-adhesive resin-based cement. METHODS Ethical approval was obtained. Four UK general dental practitioners were asked to recruit patients in accordance with the trial protocol. After obtaining informed written consent, appropriate vitality and radiographic assessments were completed and the pre-operative status of the gingival tissues noted. The teeth were prepared and bridges constructed in accordance with the manufacturers instructions. Each bridge was reviewed annually within 3 months of the anniversary of its placement by a calibrated examiner, together with the clinician who had placed the restoration. The examiners evaluated the integrity of the restoration, its anatomic form, marginal adaptation, surface quality, sensitivity, the condition of the adjacent gingivae, and the presence or absence of secondary caries. RESULTS A total of 34 bridges were examined at the three-year review. All Y-TZP frameworks were intact and no bridge retainers had debonded. Two veneering ceramic chips, in total, were detected over the three-year period of observation: the patients in whom this had occurred were unconcerned. A further abutment tooth had been successfully endodontically treated, through an occlusal access cavity, in addition to the two already reported at year one. SIGNIFICANCE At year three, the 34 Lava Y-TZP fixed-fixed bridges, placed in patients attending UK general dental practices, were found to be performing satisfactorily.

Ten-year outcome of root fillings in the General Dental Services in England and Wales.

AIM To consider the survival of root canal treatment provided within the General Dental Services in England and Wales, with failure being defined as re-treating of a root canal, apical surgery or extraction. METHODS A data set was established consisting of patients, 18 years or older, whose birthdays were included within a set of randomly selected dates and whose restoration records contained the placement of one or more direct restorations or crowns in courses of treatment between September 1990 and January 2002. The history of each root canal-treated tooth was consulted, and the next date for an intervention on the root canal of the tooth, defined as a re-treatment, apical surgery or extraction, was obtained. Thus, a data set was created of root canal-treated teeth, with the dates of root canal filling placement and the dates, if any, of re-intervention. RESULTS Data for over 80,000 different adult patients were analysed, and a total of 30,843 root canal-treated teeth identified from the data over a period of 11 years. The proportion surviving without further treatment of the root canal was estimated at 74% within an observation time of up to 10 years, with survival being strongly correlated with the characteristics of the patient, including age and treatment history, with older patients having root canal treatment with earlier re-intervention than those of younger patients. CONCLUSION Within the data set analysed, an estimated 74% of root canal-treated teeth pass through 10 years without re-treatment, apical surgery or extraction.

Contemporary dental practice in the UK in 2008: indirect restorations and fixed prosthodontics

Objectives To investigate, by postal questionnaire, various aspects of primary dental care provision in the United Kingdom. Additionally, to compare the results of this survey with a similar survey completed four years previously.Methods A questionnaire containing 89 questions was sent to 1,000 general dental practitioners selected at random from databases of practitioners throughout the United Kingdom. Non-responders were sent another questionnaire after a period of four weeks had elapsed.Results Overall a response rate of 66.2% was achieved. Amalgam was the preferred material for the core build up of vital teeth for 65% of the respondents. Dentine pins were still being used by practitioners, with stainless steel pins being preferred by 34% of respondents. 39.7% of dentists that had graduated between 0-10 years previously reported using no pins. Indirect posts were still used most widely, by 55% of the practitioners in the study, with increasing use of fibre posts noted (34%). Addition cured silicone impression materials were still the most frequently used impression material (71%) with reduced use (10%) of condensation cured silicone impression materials recorded. Glass ionomer luting cements (48%) and zinc phosphate (28%) were the most commonly used luting cements.Conclusions Within the limitations of this study, the following conclusions can be drawn: amalgam is still the preferred material for the core build-up of vital teeth; dentine pins are still used widely, but not by younger practitioners; fibre posts are being increasingly used by practitioners; addition cured silicone is still the most widely used impression material; traditional glass ionomer cements are still the most widely used luting cements; veneers are still the preferred indirect restoration for restoring anterior teeth; and CAD/CAM systems are increasingly being used by practitioners.

Five-year clinical evaluation of zirconia-based bridges in patients in UK general dental practices

OBJECTIVES This study reported the results at 5 years of fixed-fixed all-ceramic bridges, constructed in a yttria oxide stabilized tetragonal zirconium oxide polycrystal (Y-TZP) substructure, placed in adult patients in UK general dental practices. MATERIALS AND METHODS Four UK general dental practitioners recruited patients who required fixed bridgework and, after obtaining informed written consent, appropriate clinical and radiographic assessments were completed. The teeth were prepared and bridges constructed in accordance with the manufacturers instructions. Each bridge was reviewed annually within 3 months of the anniversary of its placement by a calibrated examiner, together with the clinician who had placed the restoration, using modified USPHS criteria. RESULTS Of the 41 bridges originally placed, 33 bridges were examined at 5 years. All Y-TZP frameworks were intact and no bridge retainers had debonded. Eight chipping fractures in the veneering ceramic were noted over the 5-year period. In five cases the patients were unaware of these and these cases were polished. Of the remaining three cases, in one a repair was attempted but was unsuccessful, but the bridge remained in satisfactory service. However, in the case involving a chipping fracture of the mesial-incisal angle of a central incisor, it was considered that replacement of the bridge was necessary. CONCLUSION 97% (n=32) of the 33 Lava Y-TZP fixed-fixed bridges, evaluated in patients attending UK general dental practices, were found to be performing satisfactorily. CLINICAL RELEVANCE The use of Y-TZP frameworks holds promise.

health policy: Primary and secondary dental care: the nature of the interface

Specialist dental services are scarce resources and are often oversubscribed. A key element is how these services relate to their referral base, in other words the interface between primary and secondary dental care. Dentistry has several unique qualities when compared with medicine and the nature of the interface between primary and secondary dental care is consequently very different to the medical interface, whilst apparently sharing common features. This paper examines the nature of that interface, the drivers for patient flow between services and outlines the properties of an ideal interface. This model can then be used as a way of describing some of the problems facing specialist dental services and of assessing any proposed solutions.