There is an increasingly large movement advocating for repairing damaged dental restorations such as tooth-colored fillings rather than replacing them. Advocates say that repairing restorations allows for the use of fewer materials, takes less time, and removes less natural tooth material than replacing the restorations. But there is some question about which approach leads to better results. Now a new study indicates that replacing restorations has a significantly higher success rate, though when failures occur, they tend to be more serious.
A Large, Multi-Practice Study
The data for this study comes from a large network of nearly 200 dentists known as the Dental Practice-Based Research Network (DPBRN). This network lets the dentists pool their data to create a more statistically significant sample size than any of them would be able to achieve on their own.
This means that dentists can answer questions about best practices that they would never be able to tackle on their own. The DPBRN also has the advantage of being data from real practicing dentists scattered across the country. This means that the data reflects real-world situations and real-world events, not a theoretical construct or procedures carried out under ideal conditions.
Unfortunately, the downside of it being real practice data is that there are sometimes too many variables to establish real cause-and-effect relationships.
Which Is Better?
To determine the relative benefit of repairing or replacing restorations, researchers looked at nearly 6000 restorations reported by the DPBRN from nearly 4500 patients. Of these restorations, about 4400 were replaced, and about 1500 were repaired.
After a year, the restorations were evaluated to see which ones were acceptable and which ones needed additional work. About 7% of repaired restorations needed additional work, compared to only 5% of replaced restorations.
But the picture wasn’t all good for replaced restorations. When they did need additional work, it was more likely to be serious, such as another replacement, a root canal, or even extraction of the tooth.
Other Factors to Consider
Of course, repair or replace weren’t the only things that had a significant impact on the state of a restoration after a year. The study showed that the need for additional work was influenced by:
- Cause of initial retreatment
- Size of the restoration
- Location of the restoration
- Type of the restoration
- Dental practice
Restorations subjected to heavy chewing action the molars were more likely to need additional work, as were larger restorations. Metal amalgam fillings were more likely to need additional work. And restorations that were replaced or repaired in a large group practice were more likely to need additional work.
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