Marcos Britto Correa

Longevity of posterior composite restorations: Not only a matter of materials

Resin composites have become the first choice for direct posterior restorations and are increasingly popular among clinicians and patients. Meanwhile, a number of clinical reports in the literature have discussed the durability of these restorations over long periods. In this review, we have searched the dental literature looking for clinical trials investigating posterior composite restorations over periods of at least 5 years of follow-up published between 1996 and 2011. The search resulted in 34 selected studies. 90% of the clinical studies indicated that annual failure rates between 1% and 3% can be achieved with Class I and II posterior composite restorations depending on several factors such as tooth type and location, operator, and socioeconomic, demographic, and behavioral elements. The material properties showed a minor effect on longevity. The main reasons for failure in the long term are secondary caries, related to the individual caries risk, and fracture, related to the presence of a lining or the strength of the material used as well as patient factors such as bruxism. Repair is a viable alternative to replacement, and it can increase significantly the lifetime of restorations. As observed in the literature reviewed, a long survival rate for posterior composite restorations can be expected provided that patient, operator and materials factors are taken into account when the restorations are performed.

Caries Is the Main Cause for Dental Pain in Childhood: Findings from a Birth Cohort

Aim: The aim of the study was to evaluate the prevalence of dental pain in preschool children and its association with socioeconomic, demographic, clinical, and behavior variables. Subjects and Methods: The study was nested in a population-based birth cohort from Pelotas, Brazil, started in 2004. A sample of 1,129 children aged 5 years was dentally examined, and their mothers were interviewed. Exploratory variables included demographics, socioeconomic status, mothers’ oral health status and associated behaviors, and caries in primary teeth. Data were analyzed using multivariable Poisson regression. Results: The prevalence of dental pain was 16.5% (95% CI: 14.4–18.8). Multivariate analysis showed that dark-skinned children (prevalence ratio, PR = 1.6, 95% CI: 1.1–2.4) from low socioeconomic level (PR 1.9, 1.2–3.0) whose mothers had less than 4 years of education (PR 1.9, 1.0–3.6), from mothers with less than 10 teeth in at least one arch (PR 1.7, 1.2–2.5) and less than 10 in two arches (PR 1.6, 1.0–2.6), and those with high caries prevalence at the age of 5 years (PR 4.8, 3.3–7.1) were more likely to experience dental pain. Conclusions: Unrestored caries is the main factor associated with dental pain in childhood. Socioeconomic aspects and family context in which dental pain occurs should also be taken into account when dental pain preventive measures are implemented.

Is weight gain associated with the incidence of periodontitis? A systematic review and meta-analysis

AIM This study aimed to conduct a systematic review assessing the effects of weight gain on the incidence of periodontitis in adults. METHODS Electronic searches in four databases were performed up to and including February 2015. Only prospective longitudinal studies assessing the association between weight gain and the incidence of periodontitis in adults were eligible to be included in this study. All studies should state a clear description of nutritional status (Body Mass Index; Waist Circumference) as well as the case definition of periodontitis. Pooled relative risks (RR) for becoming overweight and obese on the incidence of periodontitis were estimated by meta-analysis. Quality was assessed with the Newcastle-Ottawa scale for cohort studies. RESULTS Five articles were included in this review and meta-analysis with 42,198 subjects enrolled. Subjects who became overweight and obese presented higher risk to develop new cases of periodontitis (RR 1.13; 95%CI 1.06-1.20 and RR 1.33 95%CI 1.21-1.47 respectively) compared with counterparts who stayed in normal weight. CONCLUSIONS A clear positive association between weight gain and new cases of periodontitis was found. However, these results are originated from limited evidence. Thus, more studies with longitudinal prospective design are needed.

Anterior composite restorations: A systematic review on long-term survival and reasons for failure

OBJECTIVE In this study the literature was systematically reviewed to investigate the clinical longevity of anterior composite restorations. DATA Clinical studies investigating the survival of anterior light-cured composite restorations with at least three years of follow-up were screened and main reasons associated with restoration failure were registered. SOURCES PubMed, Scopus, and Cochrane databases were searched without restriction on date or language. Reference lists of eligible studies were hand-searched. The grey literature search was not made systematically. STUDY SELECTION Two reviewers screened titles and/or abstracts of 2273 unique studies. In total, 41 studies were selected for full-text reading, from which 17 were included in the qualitative synthesis. The included studies evaluated the clinical performance of Class III and/or IV restorations (10 studies), which were placed due to caries, fracture, or replaced old restorations; veneers and full-coverage restorations placed for aesthetic reasons (five studies); and restorations in worn teeth (two studies). Annual failure rates (AFRs) were calculated for each study. CONCLUSIONS In total, 1821 restorations were evaluated and the total failure rate was 24.1%. AFRs varied from 0 to 4.1% and survival rates varied from 53.4% to 100%. Class III restorations generally had lower AFRs than the other restorations. Few studies addressed factors associated with failure, which included adhesive technique, composite resin, retreatment risk, and time required to build-up the restoration. Fracture of tooth/restoration was the most common reason for failure, whereas failures related to aesthetic qualities (color, anatomical form, surface stain) were more frequent when restorations were placed for aesthetic reasons.

Amalgam or composite resin? Factors influencing the choice of restorative material

OBJECTIVES This study aimed to investigate the patient and tooth factors associated with selection of restorative material in direct posterior restorations in young adults from a population-based birth cohort. METHODS A representative sample (n=720) of all 5914 births occurring in Pelotas in 1982 were prospectively investigated, and posterior restorations were assessed in 2006, when the patients were 24 years old. Tooth-related variables (individual level) included restorative material (amalgam or composite), type of tooth, size of cavity, and estimated time in mouth. Data regarding demographic and socio-economic characteristics, oral health, and service utilization patterns during the life course were also assessed (contextual level). RESULTS Logistic Regression Multilevel models showed that individuals who have accessed dental services by private insurance by age 15 [odds ratio (OR)=1.66 (0.93-2.95)] and who had a higher dental caries index at age 15 (high DMFT tertile) [OR 2.89 (1.59-5.27)] presented more amalgam restorations in the posterior teeth. From tooth-level variables, the frequency of amalgams decreases with increasing number of surfaces enrolled in the cavity preparation (p<0.001) and was almost 5 times greater in molars than in premolars. CONCLUSIONS The present findings suggest that variables related to type of dental service, dental caries (higher DMFT index), and cavity characteristics (tooth type, size) determine the choice of dentists for restorative materials. Other individual characteristics such as demographic and socioeconomic status have not influenced this choice. CLINICAL SIGNIFICANCE This is the first population-based study that assesses the determinant factors for the choice of dentists for composite or amalgam in posterior direct restorations, showing that, independently of socioeconomic and demographic characteristics, type of payment of dental services and clinical factors are associated with this choice.

Are there universal restorative composites for anterior and posterior teeth

OBJECTIVE This retrospective, longitudinal clinical study investigated the longevity up to 20 years of posterior restorations placed with 3 universal composites (Charisma, Herculite XR, Z100) and of anterior restorations placed with 2 universal composites (Charisma, Herculite XR). METHODS Records from 90 patients were retrieved from a private practice (374 posterior, 219 anterior restorations). Clinical evaluation was performed by the FDI criteria. Survival analysis was assessed using Kaplan-Meier method and Log-Rank test, and factors associated with failure by multivariate Cox regression with shared frailty. RESULTS In the first 10 years, almost 95% of the restorations were satisfactory, showing increased failure thereafter. Charisma showed the most failures in anterior and posterior areas. Annual failure rates varied between 0.3% and 2.5%, with slightly better performance for anterior restorations. Fracture (posterior) and aesthetics (anterior) were the main reasons for failure. CLINICAL SIGNIFICANCE Differences were observed between restorative materials with different properties, but these became apparent only after more than 10 years of clinical service. The present study provides evidence that in a patient group with low caries risk, anterior and posterior restorations placed with universal composites may have excellent long-term clinical performance.

Influence of microleakage, surface roughness and biofilm control on secondary caries formation around composite resin restorations: an in situ evaluation

This study was carried out to evaluate in situ the influence of microleakage, surface roughness and biofilm control on caries formation around composite resin restorations. During 28 days, 12 volunteers wore palatal devices containing bovine enamel slabs restored with composite resin. Restorations were made without leakage, when the adhesive system was applied, or with leakage, when adhesive system was omitted. Half of the restorations in each group were finished and the remaining were finished and polished. In one side of the palatal device, biofilm was left to accumulate over the restored slabs, and in the other side dental slabs were brushed, to allow biofilm removal. There was an extraoral application of 20% sucrose solution (8x/day) over the enamel slabs. The formation of caries lesions (white spots) was evaluated by visual inspection under stereomicroscopy. Additionally, the dental slabs were sectioned and observed under polarized light microscopy. Data were submitted to Kruskal-Wallis test and Spearmans correlation test at 5% significance level. Polishing and bonding were not significant factors regarding white spot formation (p>0.05). Biofilm control (brushing) was associated with reduction of caries formation close to the restorations (p<0.01). Polarized light microscopy confirmed the visual inspection findings. These results suggest that while microleakage and surface roughness did not influence caries lesion formation, biofilm control may prevent the enamel demineralization.

Do socioeconomic determinants affect the quality of posterior dental restorations? A multilevel approach

OBJECTIVES This study aimed to evaluate posterior restorations placed in young adults, investigating the association between social determinants experienced during the life course and the quality of tooth fillings. METHODS A representative sample (n=720) of all 5914 individuals who were born in Pelotas in 1982 was prospectively investigated, and posterior restorations were assessed at 24 years of age. Exploratory variables included demographic and socioeconomic, oral health and dental service payment mode during the life course. Tooth-related variables (type of tooth, material and size of cavity) were also analysed. RESULTS Multilevel logistic regression models showed that individuals who were always poor from birth to age 23 [odds ratio (OR) 2.35 (1.38-4.00)] and whose mothers had less years of education at their birth (OR 2.60 (1.44-4.68)) were with unsatisfactory restorations in posterior teeth more often. In addition, caries presence at age 15 (high decayed, missing, filled teeth (DMFT) tertile) (OR 1.95 (1.25-3.03)) and cavities with four or more surfaces (OR 18.67 (9.25-37.68)) were associated with the outcome. CONCLUSIONS These results show that socioeconomic characteristics of the individuals play an important role in restoration failures, reinforcing the need for preventive dental strategies and public policies to reduce inequalities as a major topic of oral health. In addition, the size of cavity appears as the most important determinant for restoration failure. CLINICAL SIGNIFICANCE Individual socioeconomic characteristics were associated with failure in posterior restorations in detriment of other clinical variables such as restorative material and type of tooth.

Validity of Partial Protocols to Assess the Prevalence of Periodontal Outcomes and Associated Sociodemographic and Behavior Factors in Adolescents and Young Adults

BACKGROUND Most studies comparing prevalence of periodontal disease and risk factors by using partial protocols were performed in adult populations, with several studies being conducted in clinical settings. The aim of this study is to assess the accuracy of partial protocols in estimating the prevalence of periodontal outcomes in adolescents and young adults from two population-based birth cohorts from Pelotas, Brazil, and to assess differences in the estimation and strength of the effect measures when partial protocols are adopted compared to full-mouth examination. METHODS Gingival bleeding at probing among adolescents (n = 339) and young adults (n = 720) and dental calculus and periodontal probing depth among young adults were assessed using full-mouth examinations and four partial protocols: Ramfjord teeth (RT), community periodontal index (CPI), and two random diagonal quadrants (1 and 3, 2 and 4). Socioeconomic, demographic, and periodontal health-related variables were also collected. Sensitivity, absolute and relative bias, and inflation factors were calculated. Prevalence ratio for each periodontal outcome for the risk factors was estimated. RESULTS Two diagonal quadrants showed better accuracy; RT had the worst, whereas CPI presented an intermediate pattern when compared to full-mouth examination. For bleeding assessment in adolescence, RT and CPI underestimated by 18.4% and 16.2%, respectively, the true outcome prevalence, whereas among young adults, all partial protocols underestimated the prevalence. All partial protocols presented similar magnitude of association measures for all investigated periodontal potential risk factors. CONCLUSION Two diagonal quadrants protocol may be effective in identifying the risk factors for the most relevant periodontal outcomes in adolescence and in young adulthood.

Prevalence and treatment demand after traumatic dental injury in South Brazilian schoolchildren

BACKGROUND Evaluation of the frequency and need for treatment of dental trauma is critical for both planning and establishing dental services and preventive programs. AIM This cross-sectional study evaluated the prevalence of dental trauma, need for treatment and factors associated with dental visits after an injury. SUBJECTS AND METHODS A multistage sample of children aged 8-12 years, from 20 private and public schools in Pelotas/Southern Brazil, was considered. Socioeconomic information was collected from parents, and data regarding traumatic events were obtained from the children. Clinical examinations were conducted using validated criteria. Descriptive analysis and logistic regression were used to assess the factors associated with search for treatment after injury. RESULTS A total of 1210 children were included, 153 (12.6%, 95% CI 10.8-14.6) of whom suffered dental trauma, with a total of 175 traumatized teeth. The most frequently observed type of injury was enamel fracture, affecting 129 (73.7%) teeth, of which 107 did not require restorative treatment. A total of 68 (38.8%) teeth required care, of which 24 (13.7%) received treatment. Of the children who recalled the trauma, 39 (36.5%) sought treatment, which was significantly associated with both higher maternal education (OR 2.75; 95% CI 1.18-6.41) and trauma severity (OR 7.71; 95% CI 3.17-18.75). CONCLUSIONS The prevalence of traumatic injuries was relatively high in this population. Although most of the traumatized teeth did not require treatment, dental care was neglected, as most of the children were not taken to a dentist for evaluation. Also, there was a considerable demand for treatment, most of them of low complexity. Special attention should be given to children whose mothers have completed fewer years of education, as the mothers level of education was an important predictor of evaluation by a dentist after injury.