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International Poster Journal of Dentistry and Oral Medicine
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Int Poster J Dent Oral Med 12 (2010), No. 4     15. Dec. 2010

Int Poster J Dent Oral Med 2010, Vol 12 No 4, Poster 508

The clinical performance of the occlusal minimally invasive restorations in primary molars

Language: English
 

Authors:
Anca Maria Raducanu, PhD, Associate Professor, Ion Victor Feraru, PhD candidate, Teaching Assistent, Cristea Irina, Teaching Assistant,
Paediatric Dentistry Department, U.M.F. "Carol Davila", Faculty of Dental Medicine, Bucharest, Romania
Claudiu Herteliu, Lecturer,
Department of Statistics and Econometrics, University of Economics, Bucharest, Romania

Date/Event/Venue:
17-20 June 2009
The 22nd congress of the International Association of Paediatric Dentistry
Munich, Germany
 

Introduction

Techniques used to restore carious primary molars have changed over the past decade as new adhesive materials have been developed [1]. Adhesive dental materials make it possible to conserve tooth structure using minimally invasive cavity preparations [2, 3].
Although Fuks (2002) considers that generally, for small occlusal lesions, a conservative preventive resin restoration, using composite or compomer in conjunction with sealant, would be more appropriate than the classic Class I amalgam preparation [4], amalgam remains the filling material of first choice for Class I cavities in primary molars in Eastern Europe [5] because of its durability (MST=52.8 months, Ferranti and Day, 2006) [6].
 

Aims

- To assess the durability of the class I minimally invasive restorations compared to class I classic amalgam restorations in primary molars in accordance with gender and age, over a period of 6 years,
- To assess the proportion and causes of failure of the restorations in both treatment methods.
 

Material and Methods

Material
Initial sample: 336 restorations placed in 185 children.
Study sample: 258 direct class I restorations in primary molars applied in 144 patients (mean age = 5y, 5m) resulted after applying the exclusion criteria: partially/totally uncooperative children according to Frankl's scale, mentally disabled patients or under age of 2 years, restorations on teeth with pulp involvement.

Methods
Data were obtained from the patients' observation charts. Restorations were evaluated according to the USPHS criteria and codes [7] (Table 1, 2). The restorations sample was subdivided in two groups:
- 134 composite resin restorations placed in minimally invasive cavities (MI)
- 124 amalgam restorations placed in conventional classic cavities (C).

Criteria/Code Rating*** % A B C D
Marginal integrity 107 (86.3%) 9 (7.3%) 3 (2.4%) 5 (4%)
Secondary caries 117 (94.4%) n.a. 7 (5.6%) n.a.
Anatomical form 124 (100%) - - n.a.
Sensitivity 118 (95.2%) - 6 (4.8%) n.a.
Surface texture 122 (98.4%) - 2 (1.6%) n.a.
* Ag= amalgam (Katalloy Nonzinc + Hg Degussa)
** Unites States Public Health Service
*** Codes=Alfa (A) clinically ideal; Bravo (B) clinically acceptable; Charlie (C) unacceptable; Delta (D) missing partially/totally
n.a. = not applicable
Tab 1: Clinical results of evaluation data for class I classical restorations Ag* (according to USPHS** criteria and codes***)
 
Criteria/Code Rating*** % A B C D
Marginal discoloration 126 (94.1%) 5 (3.7%) 3 (2.2%) n.a.
Marginal integrity 125 (93.3%) 3 (2.2%) 2 (1.5%) 4 (3%)
Secondary caries 127 (94.8%) n.a. 7 (5.2%) n.a.
Anatomical form 128 (95.6%) 3 (2.2%) 3 (2.2%) n.a.
Sensitivity 129 (96.3%) 1 (0.7%) 4 (3%) n.a.
Surface texture 124 (92.5%) 8 (6%) 2 (1.5%) n.a.
* RC= self cure resin composite (Charisma Heraeus Kultzer)
** Unites States Public Health
*** Codes=Alfa (A) clinically ideal; Bravo (B) clinically acceptable; Charlie (C) unacceptable; Delta (D) missing partially/totally
n.a. = not applicable
Tab 2: Clinical results of evaluation data for class I minimally invasive restorations RC* (according to USPHS** criteria and codes***)

The durability of the restorations was evaluated in relation with: the restoration technique, patient's sex and age. The survival function was constructed by two methods Kaplan-Meier (KM) and survival table (ST), using a 95% statistical probability. The statistical analysis was performed using SPSS 15.0 [8, 9].
 

Results

- The study sample of patients according to gender: 52.8% girls (n=76) and 47.2% boys (n=68) and the study sample of molars according to gender: 53.1% in girls (n=137) and 46.9% in boys (n=121).
- The study sample of molars according to the treatment method was: 48.1% classic restorations (n=124) and 51.9% minimally invasive restorations (n=134).
- The survival functions according to the treatment method(C/MI) calculated by both statistic method (KM/ST), are presented in Fig. 1a,b.
- The median survival times according to the treatment method and gender, calculated by both statistic methods are presented in Table 3.

Fig. 1a: The survival function by the treatment method KM method Breslow: p=0.0235; Tarone Ware: p=0.0305
 
Fig. 1b: The survival function by the treatment method ST method
Statistic method MST*/CI** Classic Minimally invasive
Global F M Global F M
KM method MST 4.55 5.5 4.2 4.02 5.1 4.01
CI 4.51 n.c. n.c. 1.8-6.2 3.3-6.9 n.c.
ST method MST 4.55 5.4 4.23 4.02 5.08 4
*MST = median survival time
**CI = confidence interval
n.c. = not calculable
Tab 3: Results of the survival analysis according to the treatment method and gender by both statistic methods (years)

- The confidence interval of the probability of the 4 years survival of the resto-rations according to the treatment method and globally are presented in Table 4.

  Classic Minimally invasive
Global F M Global F M
Confidence interval* 56.0%-83.6% 74.4%-100% 34.2%-74.6% 24.9%-74.6% 44.1%-80.8% n.c.
* constructed using the normated quantile of the normal repartition corresponding to a 95% probability
n.c. = not calculable
Tab 4: The confidence interval of the probability of the 4 years survival of the restorations

- The restorations in girls survive better in both treatment methods but this survival was statistically proven only for the classic treatment method (p<0.05); the median survival time was superior in girls (MST=5.5 years) when compared to boys (MST =4.2 years) Table 3.
- The survival functions for the classic method according to gender are presented in Fig. 2 a, b.
- The survival function showed no significant difference concerning the durability of the restorations in accordance with the patients' age regardless to the treatment method (p>0.5).
- Global proportion of failure = 18.2% (n=47):19.4% (n=26) in minimally invasive restorations, 16.9% (n=21) in the classic restorations.
- The main causes of failure: global - loss of marginal integrity (5.4%, n=14), secondary caries (5.4%, n=14);minimally invasive restorations - secondary caries (5.2%, n=7); classic restorations - loss of marginal integrity (6.4%, n=8).

Fig. 2a: Survival curves classic method (ST) Fig. 2b: Survival curves classic method (KM)1
 

Conclusions

The restorations realised by the classic method have a higher longevity (MST 4.55 years) than those realised by the minimally invasive method (MST 4.02 years).These results are supported by both the statistical methods. The superior durability of amalgam restorations is not a great enough advantage to justify the pointless sacrifice of hard dental tissue during the cavity preparation in small occlusal carious lesions, where the use of adhesive materials would be more appropriate.
 

Literature

  1. Kilpatrick NM, Durability of restorations in primary molars. Journal of Dentistry 1993 Apr; 21(2): 67-73.
  2. Murdoch-Kinch CA; Mclean ME, Minimally invasive dentistry, Journal of the American Dental Association, January 2003, 134:87-95.
  3. Freedman G., Goldstep F, Seif T, Pakroo J., Ultra-Conservative Resin Restorations, Journal of the Canadian Dental Association, 1999; 65:579-81.
  4. Fuks AB, The use of amalgam in pediatric dentistry, Pediatric Dentistry 2002 Sep-Oct; 24(5):448-55.
  5. Buerkle V; Kuehnisch J; Guelmann M; Hickel R Restoration materials for primary molars-results from a European survey. Journal Of Dentistry 2005 Apr; 33(4):275-81.
  6. Ferranti Wong FSL, Day SJ, Life-span of amalgam restorations in primary molars: some results and comments on statistical analyses, Community Dentistry and Oral Epidemiology, 2006, May, 17(5):248-51.
  7. Ersin NK, Candan U, Aykut A, OncaO, Eronat C, and Kose T, A clinical evaluation of resin-based composite and glass ionomer cement restorations placed in primary teeth using the ART approach; Results at 24 months, Journal of the American Dental Association, 2006, 137(11):1529-1536.
  8. Kaplan EL and Meier P, Nonparametric estimation from incomplete observations, Journal of American Statistical Association, 53 1958: 457-48.
  9. Martin Bland J and Altman GD, Survival probabilities (the Kaplan-Meier method), BMJ, 1998 dec.; 317:1572.
     

This Poster was submitted by Prof. Dr. Anca Maria Raducanu.
 

Correspondence address:
Prof. Dr. Anca Maria Raducanu
U.M.F. Carol Davila
Clinica de Pedodontie
Str. Ionel Perlea Nr. 12
Bucuresti, Romania