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.     

Placement and longevity of tooth-colored restorations in Denmark

A survey has been made of the use of materials and the reasons for placement of 2542 tooth-colored restorations in Denmark. In adults 38% of all the restorations were inserted because of primary caries, and 62% were replacements of failed restorations. In children primary caries was the reason for placing 68% of the restorations in deciduous teeth and 77% of those in permanent teeth. Resin-based materials were the most frequently used tooth-colored restorative, except in the treatment of deciduous teeth, for which glass ionomer cement was used preferentially. Silicate cement was used for less than 2% of the tooth-colored restorations, and the few old silicate cement restorations were most often replaced with resin materials. The reasons for replacement of resin restorations were dependent on dentition, age of the patient, and type of restoration. Secondary caries, fracture of restoration, and loss of fillings were the most frequently recorded failures. The age of the resin restorations replaced ranged from 0 to 19 years, and half of the failed restorations in adults were more than 6 years old. In permanent teeth in children half of the failed resin restorations were replaced within 2 years, whereas half of those in primary teeth were replaced within 1 year.     

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% or the fillings in primary teeth were of tooth-colored material, predominantly of the light-cured 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.     

A survey of amalgam restorations in a south-western Nigerian population

The present survey assessed the proportion of replacement restorations in comparison with new restorations because of primary caries in a setting where the caries experience had been reported to be low but probably on the increase. Also the relative importance of the main reasons for the replacements among other things was established. A total of 488 amalgam restorations were surveyed. About 25% of all restorations were replacements of failed restorations. The main reason for the replacement was bulk amalgam fracture, which accounted for 47.1% of all restorations. These show a reversal of what had been reported in settings where the caries experience was high but now is on the decrease. The importance of bitewing radiograph of all failed restorations was emphasized in order to minimize under or over treatment. The median age of failed restorations was 5.0 years. More than half (60.3%) of replaced restorations had failed during the first 5 years of use.     

Reasons for replacement and the age of failed restorations in posterior teeth of young Finnish adults

Using dentist characteristics, our aim was to evaluate the reasons for replacements of fillings, the age of failed restorations in the posterior teeth of young adults, and replacement rates. Altogether 205 patient records from the Public Oral Health Service of the City of Vantaa, Finland were evaluated. Patient age was restricted to between 25 and 30 years and type of tooth to posterior teeth only (third molars excluded). Information collected from the records included the patient's date of birth, latest DMFS and DMF, and the code for background data on the dentist. Details of each filled premolar and molar included the restorative material, location, and surface coverage of filling(s). The age of replacement of filling in premolar(s) or molar(s) was screened retrospectively from patient records. The total number of filled premolars and molars was 1873, with 1969 fillings. Forty percent of the patients had undergone replacement of filling in premolar(s) or molar(s). In all, 140 replacements had been made, accounting for 6.9% of amalgam fillings and 8.5% of tooth-colored fillings. Secondary caries, along with fractures, overhangs, and marginal discrepancy, was the most common reason for replacement. The mean age of failed amalgam fillings was 8.9 years (SD 5.2) and of failed tooth-colored fillings 2.4 years (SD 1.6). In the public sector, female dentists form the majority and their replacement rate for amalgam fillings was twice that of male dentists (7.6% vs 3.2%; P = 0.01).     

Reasons for placement and replacement of amalgam restorations in Jordan

AIMS: To record the reasons for placement and replacement of amalgam restorations in Jordan, to determine the use of amalgam restorations in common cavity types and to collect data on the age of the replaced amalgam restorations. SUBJECTS AND SETTING: Dentists in Jordan (n=241). METHOD: Cross-sectional study using postal survey backed up with personal contact. Data was recorded for all restorations placed or replaced over a period of one month. RESULTS: Information was collected on 3,166 restorations from patients aged 9 to 66 years. Of all restorations, 54.8% were first time placements while 45.2% were replacements of old restorations. The major reason for the first time restorations was primary caries, while that for replacement was secondary caries (28.5%) followed by broken and lost restorations (20.4%), root canal therapy (17%), tooth fracture (12%), pain or sensitivity (8.8%), poor margins (8.5%). CONCLUSIONS: In Jordan, the main reason for first placement of amalgam restoration is primary caries, the main reason for replacement is secondary caries.     

Quality assessment of amalgam restorations provided for primary school children

This study was based on the examination of 726 amalgam restorations of the permanent molar teeth, 331 teeth from boys and 395 teeth from girls. The age distribution of amalgam restorations was 6-30 months, and the age of children was 6-12 years when teeth to be filled. The purpose of the study was to assess the prevalence of recurrent caries of teeth restored and quality of amalgam restorations rendered by dentists. The results showed that the age of majority of children whose teeth restored was 9 years old, 28.7 percent of all. 91.1 percent of the restorations were one surface fillings, 68.30 and 22.8 percent were occlusal and other single surface respectively. The recurrent caries found in both fracture and sound fillings were 19.42 percent. The rate of fracture was 48.10 percent and increased with the increasing age of restorations. At 19-24 months the fracture rate was highest, 54.1 percent. The defect of surface was 51.52 percent, that did not increase with the increase of restoration age. A statistically significant correlation was found between the defect of surface texture and fracture of restoration.     

Reasons for replacement and the age of failed restorations in posterior teeth of young Finnish adults

Using dentist characteristics, our aim was to evaluate the reasons for replacements of fillings, the age of failed restorations in the posterior teeth of young adults, and replacement rates. Altogether 205 patient records from the Public Oral Health Service of the City of Vantaa, Finland were evaluated. Patient age was restricted to between 25 and 30 years and type of tooth to posterior teeth only (third molars excluded). Information collected from the records included the patient's date of birth, latest DMFS and DMF, and the code for background data on the dentist. Details of each filled premolar and molar included the restorative material, location, and surface coverage of filling(s). The age of replacement of filling in premolar(s) or molar(s) was screened retrospectively from patient records. The total number of filled premolars and molars was 1873, with 1969 fillings. Forty percent of the patients had undergone replacement of filling in premolar(s) or molar(s). In all, 140 replacements had been made, accounting for 6.9% of amalgam fillings and 8.5% of tooth-colored fillings. Secondary caries, along with fractures, overhangs, and marginal discrepancy, was the most common reason for replacement. The mean age of failed amalgam fillings was 8.9 years (SD 5.2) and of failed tooth-colored fillings 2.4 years (SD 1.6). In the public sector, female dentists form the majority and their replacement rate for amalgam fillings was twice that of male dentists (7.6% vs 3.2%; P = 0.01).     

The post-amalgam era: a selection of materials and their longevity in the primary and young permanent dentitions

Summary. Objectives. During the last decade there has been a rapid change in the selection of dental restorative materials as the use of amalgam has decreased. The aim of this study was to obtain information on children's restorative dental care in Finland and to analyse the longevity of failed restorations. Design. A random sample of public dental health care centres was drawn from the registers and the dentists working there were asked to record information for each restoration they placed during a three‐day period. The survey data comprised a total of 2186 restorations in patients younger than 17 years. Results. Of the children in need of restorative treatment, only a few had previous amalgam restorations. Primary caries was the main reason for restorative treatment in both primary and permanent dentitions (80% and 83%, respectively). In primary teeth, the most common restorative material was resin‐modified glass ionomer cement (57·4%), whereas in permanent teeth, composite resin dominated (58·7%). Amalgam was not used at all in the primary dentition and in only 0·6% of permanent teeth. Eighteen per cent of treatments in primary and 12% in permanent teeth were replacements of previous fillings. The mean age of failed glass ionomer restorations was 2·8 years (n = 101) in the primary dentition, and 3·5 years (n = 54) in the permanent dentition. Conclusions. Until better restorative materials are developed, more attention should be paid to the prevention of dental caries as well as to the proper handling of alternative materials.     

Reasons for replacement of restorations in permanent teeth in general dental practice

OBJECTIVE: The analysis of reasons for the replacement of 9,805 amalgam, composite, glass ionomer, resin modified glass ionomer and 'other' restorations in permanent teeth in general dental practice. DESIGN: The data were subdivided on the bases of age and gender of the patients, the types of restorations and the clinicians' gender, experience and practice setting. RESULTS: The clinical diagnosis of secondary caries was the main reason for replacement of all types of restorations studied, followed by fracture of restorations, especially bulk fracture, irrespective of patient's age. Bulk discoloration was the third most common reason for replacement of resin based materials in adults, but it rarely occurred in adolescents 18 years and younger. The reasons for replacement of restorations were not associated with the gender of the patients. Subgroupings based on the clinicians' gender showed that female clinicians diagnosed secondary caries more often than male clinicians. Otherwise, the reasons for replacements were similar for both genders of clinicians. Subdivision of restorations based on the years since graduation of the clinicians resulted in small groups. The youngest group of clinicians diagnosed relatively more secondary caries both for amalgam and composite restorations than the most experienced group. CONCLUSION: The clinical diagnosis secondary caries was the main reason for replacement of all types of restorations studied.     

Reasons for replacement of Class II amalgam restorations in private practice

In a series of postgraduate courses in Cariology for dentists in the period 1980-84, a total of 102 private practitioners participated in a study of the reasons for replacing amalgam restorations. Twelve reasons were specified on a form and the dentist was asked to mark one or more of them for each filling replaced. The total number of fillings evaluated was 2033. In 87.9% of the restorations only one reason was given for the replacement; two, three, four and five reasons were registered in 10.5, 1.1, 0.4 and 0.1%, respectively. The six most frequent reasons were: "secondary caries" (34.0%), "fracture of the filling" (15.5%), "primary caries" (12.1%), "fracture of the tooth" (10.2%), "marginal ditching" (7.2%), and "caries under the filling" (5.6%). The restorations replaced for a combination of two reasons (N = 213) were studied separately. The three most frequent combinations were: "secondary caries + fracture of the filling" (17.8%), "secondary caries + marginal ditching" (14.1%), and "secondary caries + caries under the filling" (11.3%). - Thus, the main conclusion from this study is that approximately half of the replacements of class II amalgam restorations were occasioned by caries disease.     

The longevity of amalgam versus compomer/composite restorations in posterior primary and permanent teeth: findings From the New England Children's Amalgam Trial

BACKGROUND: Limited information is available from randomized clinical trials comparing the longevity of amalgam and resin-based compomer/composite restorations. The authors compared replacement rates of these types of restorations in posterior teeth during the five-year follow-up of the New England Children's Amalgam Trial. METHODS: The authors randomized children aged 6 to 10 years who had two or more posterior occlusal carious lesions into groups that received amalgam (n=267) or compomer (primary teeth)/composite (permanent teeth) (n=267) restorations and followed them up semiannually. They compared the longevity of restorations placed on all posterior surfaces using random effects survival analysis. RESULTS: The average+/-standard deviation follow-up was 2.8+/-1.4 years for primary tooth restorations and 3.4+/-1.9 years for permanent tooth restorations. In primary teeth, the replacement rate was 5.8 percent of compomers versus 4.0 percent of amalgams (P=.10), with 3.0 percent versus 0.5 percent (P=.002), respectively, due to recurrent caries. In permanent teeth, the replacement rate was 14.9 percent of composites versus 10.8 percent of amalgams (P=.45), and the repair rate was 2.8 percent of composites versus 0.4 percent of amalgams (P=.02). CONCLUSION: Although the overall difference in longevity was not statistically significant, compomer was replaced significantly more frequently owing to recurrent caries, and composite restorations required seven times as many repairs as did amalgam restorations. CLINICAL IMPLICATIONS: Compomer/composite restorations on posterior tooth surfaces in children may require replacement or repair at higher rates than amalgam restorations, even within five years of placement.     

Placement and replacement of restorations in a military population

The purpose of this study was to investigate the reasons for placement and replacement of restorations provided to military personnel by all 34 dentists stationed in the four Atlantic provinces of Canada. All dentists who participated in this study are salaried. Over a period of 30 working days, each dentist recorded information on all restorations performed. Data were collected on dentists' year of graduation, patient age, treatment requirements, tooth number, restoration class, materials used and reasons for placement and replacement. All dentists used the same data collection form which was pilot tested. Information was collected on 2,280 restorations from 643 adults, 18 to 57 years of age. Of all restorations, 54.3% were placements and 45.7% were replacements. No difference in placement and replacement rates between amalgam and composites was reported. The major reason for placement was primary caries (90%). The major reasons for replacements were recurrent caries (40.0%), primary caries of interproximal surfaces (18.9%), and fractured restorations (12.3%). Of the 297 MOD restorations, 74.3% were replacements and of the 1,140 Class I + III + V restorations, 27.8% were replacements. This study showed that about half of the restorative work carried out were replacements. Caries is the primary reason for placement and replacement of restorations in adults.     

Placement and replacement of amalgam restorations in Italy.

The reasons for placement and replacement and the longevity of amalgam restorations were recorded by 62 Italian private practitioners. The survey compiled 1935 amalgam restorations inserted due to primary caries (59%) and failed restorations (41%). The clinical diagnosis of secondary caries constituted 59% of failures of amalgam restorations. The age of 46% of the restorations needing replacement was noted. The median longevity was 4.7 years.     

Selection of dental materials and longevity of replaced restorations in Public Dental Health clinics in northern Sweden

Objectives

To investigate the selection of direct restorative materials and longevity of replaced restorations in relation to operator and patients characteristics.

Methods

A cross-sectional study of treatment in practice, recording all new placements and replacements of direct restorations was performed during 2 weeks comprising all dentists within the Public Dental Health clinics in the county council of Västerbotten.

Results

A total of 2834 data collection sheets, one for each placed restoration, were received with a dropout of 10%. Restorations analyzed in the study were placed in permanent teeth in patients older than 15 years. First restorations placed due to primary caries were 671 and replacements 1536. Class II was the most frequently treated cavity followed by class I. The median longevity of replaced restorations was for amalgam, resin based composite and glass ionomer 16, 6 and 11 years, respectively. High caries risk patients showed shorter longevity for resin based composite restorations than low or moderate risk patients. Secondary caries as reason for failure for class II resin based composite restorations occurred significantly later than loss or fracture. Significantly longer longevity was observed for replaced restorations executed by more experienced dentists.

Conclusions

The use of amalgam was negligible and the material was predominantly replaced by resin based composites in first and replaced restorations. Class II was the most frequent placed and replaced restorations. Caries risk and experience of operator influenced longevity of replacements.     

Influence of patient factors on age of restorations at failure and reasons for their placement and replacement

OBJECTIVE: This study examined the reasons given by a selected group of dental practitioners for placement and replacement of restorations and correlated the data provided with patient factors, such as patients' age and gender, caries risk, occlusal function and oral hygiene, with restoration longevity. METHOD: A group of general dental practitioners (GDPs) were recruited to take part in the study. Each participant was asked to record the reason for placement or replacement of restorations from a list of potential reasons. The age and Class of the restoration being replaced was also recorded, as also was the material being used and the material being replaced. RESULTS: Details of reason for placement/replacement was received on 3196 restorations from 32 GDPs. Of the restorations placed, 54% were amalgam, 32% composite, 8% compomer and 7% glass ionomer. The reasons for placement/replacement of the restorations were principally primary caries (28%), secondary caries (29%), margin fracture (10%), tooth fracture (7%), and non-carious defects (6%). Overall, the mean age of restorations at failure was 7.1 years. Of the patients who received glass ionomer restorations, 29% were rated as having poor oral hygiene, compared with 18% of the patients who received amalgam restorations, 18% of the patients who received composite restorations and 23% of the patients who received compomer restorations. Of the patients who received glass ionomer restorations, 35% were rated as having high caries susceptibility, compared with 27% of those receiving amalgam restorations, 21% of those receiving composite restorations and 30% of those receiving compomer restorations. CONCLUSION: Primary caries was the principal reason for initial restorations. Secondary caries was the most prevalent reason for replacement of restorations. The results also indicate a selective application of different materials for different patients.     

Clinical evaluation of reasons for replacement of amalgam vs composite posterior restorations

BackgroundThe aim of the present study is to evaluate the most common reasons for replacing posterior amalgam and resin composite restorations in patients attending the university dental restorative clinics.MethodsA total of 318 restorations which needed to be replaced were clinically and radiographically evaluated in a period of nine months. The frequencies of reasons for replacing posterior amalgam and resin composite restorations were calculated; secondary caries, restoration/tooth fracture, marginal discoloration/ditching, proximal overhang/open margin, loss of anatomy, pain/sensitivity, and esthetics.ResultsThe sample population comprised of 191 females and 106 males. The majority of the sample population fell in the age group of 40–50 years (n = 110). 318 restorations (n = 318) were examined in this study. 82% of examined teeth were restored with amalgam (n = 261), while posterior composite restorations comprised 18% of the examined teeth (n = 57). Among all restorations demanded to be replaced by the patients (n = 318), aesthetic need was the most common reason (n = 98), followed by Ditching or discoloration (n = 64), secondary caries (n = 57), and fracture (n = 44). Loss of anatomy was the least common cause to replace both amalgam and resin composite restorations (n = 5). The different reasons of failure were all significant between amalgam and resin composite restorations as shown in (Fig. 1) (p < 0.005). The most common reason for amalgam replacement was aesthetic. The most common reason for composite replacement was secondary caries and marginal ditching.ConclusionBoth amalgam and composite had different reasons for replacement. Amalgam had lesser risk of developing secondary caries and higher longevity than composite.     

Faculty differences in replacement decisions for amalgam restorations

During a 15-week period, six full-time faculty members supervised the replacement of amalgam restorations by clinical dental students. The tooth numbers, the amalgam surfaces replaced, the reasons for replacement, and the instructors were compared. The students removed 956 surfaces of amalgam from 436 teeth. The primary reasons cited for replacement were marginal breakdown (69%) and caries (33%).     

A controlled clinical study of amalgam restorations: survival, failures, and causes of failure

The survival and modes of failure of amalgam restorations were investigated retrospectively. 2660 Class I or II lesions were restored and evaluated yearly or half-yearly for failures during the 30- to 84-month follow-up. Restorations with unacceptable margins were not counted as failures if no traces of secondary caries could be seen. 8% of the restorations were lost because of patient drop-out. Of the remaining restorations, 1% was replaced due to primary caries. Of the remaining number (2431), 9% failed because of all other reasons. The leading mode of failure was bulk fracture (4.6%), followed by tooth fracture (1.9%), and marginal ridge fracture (1.3%). For all other reasons, 0.8% of the restorations failed. Only two restorations were replaced because of secondary caries. The alloy selection in both conventional and high-copper categories significantly influenced the survival of the restorations for reasons directly related to the restoration.     

Restoration longevity and analysis of reasons for the placement and replacement of restorations provided by vocational dental practitioners and their trainers in the United Kingdom.

OBJECTIVE: This study examined the reasons given by vocational dental practitioners and their trainers for placement and replacement of restorations. METHOD AND MATERIALS: Each participant was asked to record the reason for placement or replacement of restorations. The age and class of the restoration being replaced were also recorded, as was the material being used and the material being replaced (if known). RESULTS: Details of the reason for placement or replacement was received on 9,031 restorations. Of the restorations placed, 53.9% were amalgam, 29.8% were resin composite, and 16.3% were glass-ionomer cement. The reasons for placement or replacement of the restorations were principally primary caries (41.3%), secondary caries (21.9%), tooth fracture (6.4%), marginal fracture or degradation (6.1%), and noncarious defects (5.8%). Of the amalgam restorations, most were placed to restore Class II and Class I preparations (65.8% and 29.9%, respectively). Of the composite restorations, most were placed in Class III and Class V cavities (35.5% and 26.3%, respectively). Glass-ionomer cement was used predominantly to restore Class V cavities (63.5%). CONCLUSION: Secondary caries was the most prevalent reason for replacement of restorations, regardless of material. Statistical analysis indicated that amalgam provided significantly greater longevity than composite or glass-ionomer materials.