An up to 50-year follow-up of crown and veneer survival in a dental practice.

STATEMENT OF PROBLEM: Indirect restorations are an important treatment in dental practice, but long-term survival studies are lacking. PURPOSE: The purpose of this retrospective study was to report on the outcome of indirect restorations, which were followed up annually for up to 50 years in a dental practice. MATERIAL AND METHODS: A retrospective survival study was undertaken at a mixed National Health Service (NHS)/private dental practice in London, UK. Data were collected for restorations placed between 1966 and 1996 by 1 experienced operator. It was a requirement that patients had been followed up annually with clinical and radiographic examinations for up to 50 years. Patients were enrolled on a strict preventive policy and had excellent oral hygiene. Oral hygiene, restoration location, sensitivity, occlusion, and other details (preparation design, taper, cement used) were recorded. Restoration outcome was recorded as successful and surviving, unknown, or failed. The data were described descriptively. Kaplan-Meier survival curves and hazard curves were used to assess the survival of crowns and the probability of failure over time. RESULTS: A total of 223 restorations were placed in 47 patients between 1966 and 1996 and reviewed annually for up to 50 years (until 2016). These restorations included 154 metal-ceramic crowns (101 posterior and 53 anterior), 25 posterior gold crowns, 22 anterior ceramic veneers, and 22 anterior ceramic crowns. Restorations were in occlusion. The mean survival for metal-ceramic crowns was estimated as 47.53 years (95% confidence interval [CI]: 45.59-49.47 years). Failures in metal-ceramic crowns (n=6, 3.9%) were due to periapical periodontitis. The remaining restoration types had 100% survival at 50 years. CONCLUSIONS: This study showed that the survival of crowns and veneers is high over 50 years in clinical practice with annual follow-up and good oral hygiene. The proportion of teeth with loss of vitality, confirmed clinically and with radiographs, was minimal.

Ron Gain and his dental practice before and during the Second World War.

A history of Ronald Gain's dental practice is described including his service during the Second World War. An account is given of the bomb damage in and around the practice in Peckham Rye.

The extensively restored posteriortooth has a high incidence of tooth fracture.

A multicentred practice based study was established to test the hypothesis that the extensively restored tooth has a high incidence of posterior tooth fracture (PTF). All patients who presented with PTF in 23 general dental practices over a period of 14 weeks were included in the study. 764 PTF restorations were placed out of a total of 7551, an incidence of 10%. A novel classification proposing increased severity of fracture from I-IV was used. Class I = 19%, II = 54%, III = 22% and IV = 5%. Primary PTFs accounted for 67%, secondary 33%. 92% offractured teeth had a Class 2 restoration in situ. The heavily restored tooth has been shown to have a high incidence of PTF and it is suggested that this is a major restorative problem in general dental practice in the UK.

An audit on the placement and replacement of restorations in a general dental practice.

OBJECTIVES: To determine the reasons for placing and replacing restorations in a general dental practice amongst a group of patients. METHODS: This study used the method devised by Mjör and later modified by Burke and others. Instruction and data collection sheets were sent out to general dental practitioners (GDPs) for participation in a multicentre study. The GDPs were asked to record consecutively all restorations placed over a period of one month. The author is presenting his data collected over a period of six months using the same methodology. The author's results will be compared with a VDP study and the multicentre study. RESULTS: 779 restorations were placed during the six months of the study. Three hundred and sixty-four (47%) were initial placements and 415 (53%) replacements. Primary fractured teeth totalled (16%) of the restorations. Other reasons for restoration placement were marginal fracture/degradation (31%), non-carious defects (13%) and both primary and secondary caries (9%). The proportion of glass-ionomer restorations increased with the age of the patient compared with amalgam and composites (chi-square: p < 0.001), averaging 64% in age groups between 35 and 75 years, increasing to 88% in those patients over 75 years. CONCLUSIONS: The principal reasons for placement and replacement of restorations in this study were repairs to tooth fractures. The proportion of amalgams and composites decreased with age while the proportion of glass ionomers increased.

Difficulties in dental prescribing of saliva substitutes for xerostomia.

The value of salivary substitutes for many elderly patients is indicated by a simple web search which found 2,470 references, with references to prescribing across the globe. To contain the public expense, prescribing medicaments within the National Health Service in England is limited to approved lists. The only salivary substitute currently prescribable by dentists has not been produced for 18 months. It is argued that: the prescription of this symptomatic therapy should be based on potential benefit for the xerostomic patient and not, as now, primarily on the pathological aetiology of the oral dryness. Secondly, that the professional caring for that oral problem--the dentist, is best placed to manage the prescribing as part of the overall management of the patient, independent of any reference to the patients physician that may be appropriate as part of the overall management of the patient.