Replacement Clinical Trial
Official title:
Can Repair Increase the Useful Life of Composite Resins? Clinical Trial: Triple-blind Controlled - 10 Year Follow-up
Objectives: The aim of this prospective, randomized, triple-blind cohort study was to assess the longevity of repairs to localized clinical defects in composite restorations that were initially scheduled to be treated with a restoration replacement Methods: 28 patients aged 18 to 80 years with 50 composite restorations were recruited.Restorations with clinically diagnosed secondary caries (Charlie) or undercontoured anatomical form defects (Bravo) were randomly assigned to the Repair (n = 25) or Replacement (n = 25) group, the quality of the restorations was scored according to the modified USPHS criteria. A Wilcoxon test was performed for comparisons between the same groups (CI=0.05). A Friedman test was utilized for multiple comparisons between different years of the same group.
A cohort of 28 patients aged 18 to 80 years of both females (58%) and males (42%) with 50
composite restorations were recruited at the Operative Dentistry Clinic at the Dental School
of the University of Chile. All participants presented with one or more clinical features
that deviated from the ideal and were rated Bravo or Charlie according to the modified
United States Public Health Service (USPHS) criteria 6. The protocol was approved by the
Institutional Research Ethics Committee of the Dental School at the University of Chile
(Project PRI-ODO-0207). All of the patients signed informed-consent forms and completed a
registration form. The selection criteria are summarized below.
2.2 Treatment Group Criteria Initially, 356 restorations (28 patients) were evaluated and
assigned in accordance with the modified USPHS criteria, from which 50 were selected in
accordance with the inclusion criteria. Restorations with clinically diagnosed secondary
caries (Charlie) or undercontoured anatomical form defects (Bravo) were randomly assigned to
the Repair (n = 25) or Replacement (n = 25) group (Figure 1). The randomization was
performed by the Power Analysis and Sample Size System (PASS software v. 2008, Keysville,
UT, USA), and diagnosis of active secondary caries was made based on Ekstrand criteria.
2.3 Restoration Assessment The quality of the restorations was scored according to the
modified USPHS criteria. Two examiners underwent calibration exercises each year (JM and
EF). The Cohen's Kappa inter-examiner coefficient was 0.74 at the baseline and 0.87 at ten
years. Immediately after the treatment (baseline) and 10 years later, the examiners assessed
the restorations independently by direct visual and tactile examination with mouth mirror
number 5 and explorer number 23 (Hu Friedy Mfg. Co. Inc., Chicago, IL, USA) and indirectly
by radiographic examination (bite wing). The five parameters examined were marginal
adaptation, anatomic form, surface roughness, secondary caries, and lustre. If a difference
was recorded between the two examiners, and if they could not reach an agreement, a third
clinician, who also underwent the calibration exercises (GM), made the final decision.
2.4 Treatment Groups 2.4.1 Repair The clinicians (PV - GM) used carbide burs (330-010 Komet,
Brasseler GmbH Co., Lemgo, Germany) to explore the defective margins of the restorations,
beginning with the removal of part of the restorative material adjacent to the defect to act
as an exploratory cavity; this allowed a proper diagnosis and evaluation of the extent of
the defect. Provided that the defect was limited and localized, the clinician then removed
any defective tooth tissue. Once this material was removed, an exploratory cavity
preparation was done that included removal of any demineralized and soft tooth tissue. A
self-priming resin bonding system was used (Adper Prompt L-Pop; 3M ESPE, St. Paul, MN, USA),
followed by restoration with a resin-based composite (RBC) restorative material (Filtek
Supreme; 3M ESPE). A rubber dam isolation was used for this procedure.
2.4.2 Replacement The clinicians totally removed and replaced the defective restorations.
After completing the cavity preparations, it was restored with a new resin composite (RC;
Filtek Supreme; 3M ESPE). The elimination of the soft tooth tissue caries infection was done
using carbide burs at high speed under full water irrigation. During the cavity preparation,
no preventive extension or undercutting areas were created, and all of the cavity angles
were rounded. In the deep dentin, a glass-ionomer liner was used (Vitrebond; 3M ESPE; USA).
Adper Prompt L-Pop, (3M ESPE) was used per the manufacturer instructions, and RBC (Filtek
Supreme; 3M ESPE) was applied by the incremental technique. The occlusion was checked, and
the restorations were finished and polished following the manufacturer instructions.
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Observational Model: Case Control, Time Perspective: Retrospective
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