Restoration of the worn dentition should be undertaken in an 'additive,' minimally invasive manner; this approach may also help to facilitate contingency planning. Direct resin composite can offer an acceptable medium-term option for the treatment of severe, generalized tooth wear; molar restorations may require higher maintenance, a recent study reported.
The study is published in the Journal of Dentistry.
Shamir B.Mehta et al from the Department of Dentistry, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands carried this study to evaluate the 5.5-year performance of direct resin composite restorations, prescribed for patients with severe tooth wear, requiring full-mouth rehabilitation.
A convenience sample of 34 patients were recruited to a prospective trial. The participants were provided 1269 full-mouth direct resin composite restorations (Clearfil AP-X) by 5 experienced operators, using the Direct Shaping by Occlusion (DSO)-technique.
Treatment resulted in an increase in the vertical dimension of occlusion (VDO). Failure was assessed at three levels. Frequencies of failure were analyzed using Kaplan Meier survival curves and the effects of the relevant variables calculated with a multifactorial Cox regression (p < 0.05).
The study revealed that the annual failure rates (for all levels of failure, 'Level 3- ') of ≤ 2.2% and ≤ 2.9% were respectively reported for the anterior and posterior restorations with a mean observation time of 62.4 months.
Also, the completion of an anterior restoration with the need for further appointments resulted in significantly more Level 2- & 3- failures. An evaluation of the performance of the premolar and posterior maxillary restorations showed significantly lowered risks of certain types of failures, compared to the molar and posterior mandibular restorations.
As a result, the authors concluded that "at 5.5 years, 2.3% of the overall restorations displayed catastrophic, (Level 1) failures. Molar restorations, posterior mandibular restorations and the anterior restorations requiring two further sessions for completion, were associated with significantly higher risks for failure."
Hence, the researchers inferred that for patients with severe tooth wear, where full mouth rehabilitation was undertaken by the placement of direct resin composite restorations at an increased vertical dimension of occlusion, at 5.5 years, 2.3% of the overall restorations displayed catastrophic, (Level 1) failures.
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https://doi.org/10.1016/j.jdent.2021.103743