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This practice-based study investigated the performance of a large set of anterior composite restorations placed by a group of 24 general practices. Based on data from electronic patient files, the longevity of 72,196 composite restorations was analyzed, as placed in 29,855 patients by 47 general dental practitioners between 1996 and 2011. Annual failure rates (AFRs) were calculated, and variables associated with failure were assessed by multivariate Cox regression analysis with shared frailty for 2 age groups (5 to 24 y and ≥25 y). The observation time of restorations varied from 2 wk to 13 y, with a mean of 4.8 y, resulting in a mean AFR of 4.6% (95% confidence interval [95% CI], 4.5% to 4.6%) at 5 y. Among dentists, a relevant variation in clinical performance of restorations was observed, with an AFR between 2% and 11%. The risk for restoration failure increased in individuals up to 12 y old, having a 17% higher risk for failure when compared with the age group of 18 to 25 y (hazard ratio, 1.17; 95% CI, 1.03 to 1.34), and for the age group >65 y, having a 81% higher risk for failure when compared with 25 to 35 y (hazard ratio, 1.81; 95% CI, 1.66 to 1.98). In both multivariate models, there was a difference in longevity of restorations for different teeth in the arch, with fillings in central incisors being the most prone to failure and replacement. It was concluded that anterior composite restorations placed by general dental practitioners showed an adequate clinical performance, with a relevant difference in outcome among operators.

Contemporary minimally invasive treatment concepts for restorative treatment of primary caries lesions include both delayed intervention and smaller-sized preparations restricted to removal of carious tissue. The aim of this study was to investigate whether these concepts have resulted in a trend towards a more conservative choice made by dentists regarding treatment thresholds and restorative techniques. The results from previously conducted, precoded questionnaires developed by Espelid and Tveit, as well as from a recent Dutch questionnaire, were collected and analysed. A worldwide trend towards more minimally invasive strategies in the operative treatment of caries lesions could not be observed, neither for the initiation of operative treatment nor for the preparation techniques. However, in some countries, changes over time could be assessed, especially in Norway, where a reduction in the proportion of interventions is visible for both occlusal and approximal lesions, indicating that more dentists are postponing interventions until the lesions have progressed to a deeper level. From the Dutch national survey, it could be concluded that operators that intervene at an earlier stage of approximal lesioning (stage ≤4) also intervene at an earlier stage of occlusal caries (stage ≤3) (p = 0.012; OR = 2.52; 95% CI: 1.22–5.22). Generally, it can be concluded that dentists worldwide still tend to operatively intervene at a too early stage of caries, although variations exist between countries. A worldwide shift could be observed in the restorative material applied, since composite resin has almost completely replaced amalgam for restoring primary caries lesions.

To improve patient dental care, it is necessary to identify possible risk factors for the failing of restorations. This practice-based cohort study investigated the performance and influence of possible risk factors at the level of the practice, patient, tooth, and restoration on survival of direct class II restorations. Electronic patient files from 11 Dutch general practices were collected, and 31,472 restorations placed between January 2015 and October 2017 were analyzed. Kaplan-Meier statistics were performed; annual failure rates (AFRs) were calculated; and variables were assessed by multivariable Cox regression analysis. The observation time of restorations varied from 0 to 2.7 y, resulting in a mean AFR of 7.8% at 2 y. However, wide variation in AFRs existed among the operators, varying between 3.6% and 11.4%. A wide range of patient-related variables is related to a high risk for reintervention: patient age (elderly: hazard ratio [HR], 1.372), general health (medically compromised: HR, 1.478), periodontal status (periodontal problems: HR, 1.207), caries risk and risk for parafunctional habits (high: HR, 1.687), restorations in molar teeth (HR, 1.383), restorations placed in endodontically treated teeth (HR, 1.890), and multisurface restorations (≥4 surfaces: HR, 1.345). Restorations placed due to fracture were more prone to fail than restorations placed due to caries. When patient-related risk factors were excluded, remaining risk factors considerably changed in their effect and significance: the effect of operator, age of the patient, and endodontic treatment increased; the effect of the diagnosis decreased; and the socioeconomic status became significant (high: HR, 0.873). This study demonstrated that a wide variation of risk factors on the practice, patient, and tooth levels influences the survival of class II restorations. To provide personalized dental care, it is important to identify and record potential risk factors. Therefore, we recommend further clinical studies to include these patient risk factors in data collection and analysis.

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The aim of this retrospective practice-based study was to investigate the survival of direct class II restorations placed by a group of general dental practitioners (GDPs) and to analyze the effect of practice-, patient-, and tooth/restoration-related factors. Electronic patient files of 24 general dental practices were used for collecting the data for this study. From the patient files, survival rates of 222,836 composites, amalgams, glass ionomers, and compomers placed in 61,121 patients by 67 GDPs between 1999 and 2011 were analyzed by Kaplan-Meier statistics and a multiple Cox regression. The investigated group of GDPs placed restorations with a satisfactory survival (mean AFR 10 , 4.9%; 95% confidence interval, 2.1 to 7.7), although a wide variation in annual failure rate (AFR) existed between the different operators, varying between 2.6% and 7.0%. Restorations placed in young adults (21-30 y old) survived longest, whereas they showed a shorter survival in children (hazard ratio [HR], 1.553) and the elderly (HR, 1.593). Restorations in molar teeth, restorations placed in endodontically treated teeth, and multisurface restorations are more at risk for reintervention. However, restoration size (included surfaces) has a greater impact on restoration survival in premolar teeth. For the future, improved data collection at the practice/operator, patient, and tooth/restoration level (e.g., risk assessment and diagnoses) will provide the opportunity to evaluate even more extensively the risk factors involved. Knowledge Transfer Statement: The results of this study give insight into the long-term survival of direct dental restorations and the influencing practice-, patient-, and tooth/ restoration-related variables.

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