Survival rate of sealed, refurbished and repaired defective restorations: 4-year follow-up

Abstract

The most common treatment in general dental practice is the replacement of restorations affected by secondary caries or marginal deficiencies. Alternative treatments to replacement of defective restorations, such as marginal sealing, refurbishment and repair, have demonstrated improvement of their clinical properties with minimal intervention. The aim of this clinical study was to estimate the median survival time (MST) of marginal sealing, repair and refurbishment of amalgam and resin-based composite restorations with localized defects as a treatment to increase the restoration longevity. A cohort of 66 patients, with 271 class I and II restorations clinically diagnosed with localized defects was longitudinally assessed. Each restoration was assigned to one of the following 5 groups: Marginal Sealing (n=48), Refurbishment (n=73), Repair (n=27), Replacement (n=42), and Untreated (n=81). Two calibrated examiners assessed the restorations at baseline and annually during 4 years, using the modified Ryge criteria: marginal adaptation, anatomic form, roughness, secondary caries and luster. Fifty-two patients with 208 restorations were assessed after 4 years; the distribution of restorations in the groups was as follows: Marginal Sealing (n=36), Refurbishment (n=63), Repair (n=21), Replacement (n=28) and Untreated (n=60). Kaplan Meier test indicated that the Sealed margins group showed the lowest MST while the Repair group showed the highest MST for restorations examined after 4 years of follow up. Defective amalgam and resin-based composite restorations treated by sealing of marginal gaps, refurbishment of anatomic form, luster or roughness, and repair of secondary caries lesions, had their longevity increased.

Longitudinal Results of a 10-year Clinical Trial of Repair of Amalgam Restorations

“…Another difference is that Smales' study 47 was carried out retrospectively in private practice and the present investigation was prospectively conducted in a university environment. This study agreed with other studies when it suggested repairing restorations instead of replace- This cohort includes data of restorations previously reported 25,27,29,30,46 and patients subsequently recruited. In a study by Fernandez et al 49 data of resin composites restorations was reported with similar methodology.…”

“…The papers are related to the repair of restorations, 35 and many laboratory and clinical studies have shown that repairing amalgam restorations is possible and successful. 17,25,[36][37][38][39][40] This is the first prospective study that compared repair and replacement of localized restoration defects, and it was observed that both groups presented a similar level of quality after 10 years with the exception of the anatomic form parameter. This is easily explained, because repair included only a partial correction area of the restorations, and it is not possible to recover the total anatomy.…”

“…4,17,25,41 Most of the restorations were assessed as clinically acceptable (Alpha or Bravo) after 10 years, and only a small percentage of restorations showed a Charlie value at the end of the study.…”

“…Repairing a restoration with a modified surgical approach that includes creating smaller tooth preparations and modifying the cavity-prep design could be, in many cases, the most conservative treatment option. 13,[24][25][26][27][28][29][30] Repair is an option for the treatment of defective amalgam restorations that present with localized defects. It involves the removal of the part of the restoration that is defective and any carious tissue adjacent and subjacent to the defective area and the remaining restoration of the prepared site.…”

“…It involves the removal of the part of the restoration that is defective and any carious tissue adjacent and subjacent to the defective area and the remaining restoration of the prepared site. 25 The aim of this prospective, blind, randomized cohort study was to assess the effectiveness of repairing localized clinical defects in amalgam restorations that were initially scheduled for restoration replacement.…”