Longevity of Indirect and Direct Restorations in Anterior Teeth.

It is the aim of this paper to present data on the survival of direct and indirect restorations in anterior teeth. Two sources of information are used: previously-published analysis of data from 1990 to 2006 from a 13 million restoration dataset from England and Wales; and evidence from published literature from 2011 to the time of writing (March 2022). The findings suggest that: (1) directly-placed resin composite materials may provide satisfactory survival of restorations in anterior teeth; (2) crowns provide better survival to re-intervention: however, crowning an incisor or canine tooth, as opposed to placement of a direct restoration, will lead to an earlier time to extraction of the restored tooth; (3) veneers perform more favourably than other restorations in terms of time to extraction of the restored tooth, but may have a less favourable time to re-intervention than crowns; (4) lithium disilicate crowns may be considered to perform satisfactorily with regard to time to re-intervention when placed in anterior teeth, but less satisfactorily in posterior teeth; and (5) operator factors influence survival of restorations.

Canine guidance on crowned teeth: time for a rethink?

This paper aims to discuss the concept of canine guidance in light of recent research with regard to time to extraction of the restored canine tooth, with crowns representing the worst performing restoration at 15 years (66% cumulative survival). Given that the upper canine tooth may be considered the 'cornerstone' of the arch, reasons for this poor performance are discussed by examination of the existing literature on canine guidance and other aspects relating to the preparation of an upper canine tooth for a crown. The authors question previous recommendations that canine teeth should be placed into canine guidance when restored with crowns, given that the previously-published data indicate that survival of upper canine teeth which have been crowned is worse than when they are restored with any other restoration. It is also suggested that, if clinicians wish to prolong the life expectancy of an upper canine tooth, they must try to avoid crowning it.

Patient history as a predictor of future treatment need? Considerations from a dataset containing over nine million courses of treatment.

Aim It is the aim of this paper to consider whether overall patient treatment history per se and what length of patient history, matters in predicting future treatment need.Methods This study used a data set (SN7024, available from UKDataService), consisting of treatment records for General Dental Services' (GDS) patients, this being obtained from all items of service payment records for patients treated in the GDS of England and Wales between 1990 and 2006. For the purpose of this study, the GDS dataset for patients attending in 2003 was restricted to adult patients (aged 18 or over on 31 December 1990; that is, year of birth earlier than 1973) who attended in both two-year periods 1991/2 and 2004/5. Each course of treatment was classified as 'active' (eg restoration, extraction, prosthesis) or 'not active' (eg prevention, diagnosis). Treatment costs for 2001-2005 (outcome), 2000 (one-year history), 1999-2000 (two-year history) and so on until 1991-2000 (ten-year history) were determined, and history and outcome correlated.Results A total of 455,844 patients met the inclusion criteria, namely adults with a full history. They received 9,341,583 courses of treatment, of which 49% were classified as 'active' and 51% as 'not active'. The analysis indicated that both total costs and active treatment costs are positively correlated with their historical values, with the correlation coefficients increasing from 0.24 and 0.25 with one year of history to 0.42 and 0.44 with ten years of history. Overall, therefore, future treatment cost is correlated with past treatment costs.Conclusions Treatment history may provide an important correlate of future dental treatment needs and the more history the better, at least up to five years. However, active treatment is the important component and should be distinguished from preventive and diagnostic treatments.

Dental practice in the UK in 2015/2016. Part 4: changes since 2002?

Objectives To determine, by means of anonymous self-report questionnaires, the changes in demographic profile, practising details and utilisation of clinical techniques/materials of general dental practitioners (GDPs) in the UK between 2002 and 2015. Method A wide-ranging, validated questionnaire, designed to elicit information on the practising arrangements and techniques and materials used, was distributed to UK-based GDPs in 2002, 2008 and 2015 with a request that they complete the questionnaire and return it by post in the reply-paid envelope to the corresponding author. Results Questionnaires were distributed by post to 1,000 UK-based GDPs in 2004 and 2008, with an additional 500 questionnaires being distributed at postgraduate meetings in 2015. Response rates of 70%, 66% and 78% were achieved, respectively. Of the respondents, 73% were male in 2002, while 67% and 60% were male in 2008 and 2015, respectively. In 2002, 65% were practice principals, falling to 51% in 2015. Regarding how patients paid for their dental care, 86% of respondents in 2002 treated patients within the NHS arrangements, compared with 57% and 50% in 2008 and 2015, respectively. The data collected in 2015 indicated that 55% of respondents had an intra-oral camera; while, with regard to recently introduced concepts and techniques, 80% used nickel-titanium files, 47% used zirconia-based bridgework, 25% used tricalcium silicate, and 17% used CAD/CAM restoration. Of great interest, perhaps, is the response to digital radiography/imaging, with the results indicating that, by 2015, 74% of respondents used this form of radiography. Conclusion Results from the three surveys indicated that NHS service provision has dropped to 50%. Regarding the staffing of dental practices, just over half the respondents were practice principals. The results also indicated that UK dentists continue to be innovative and forward-looking in the techniques that they employ.

Dental practice in the UK in 2015/2016. Part 3: aspects of indirect restorations and fixed prosthodontics.

Objective: This paper reports data which helps identify changes and trends in the provision of indirect fixed prostheses in general dental practice in the UK. To determine by means of an anonymous, self-report questionnaire, the current trend in the provision of fixed prosthodontic treatments, with a special emphasis on the choice of treatment modalities, techniques and materials. Methods: The data presented were extracted from the data obtained from a validated,121-question questionnaire distributed at random to general dental practitioners in the UK attending postgraduate meetings in 2015/2016, with a wide distribution of locations. Results: A response rate exceeding 66% was achieved. Amalgam and light-cured composite were the preferred material for core build-up of vital teeth for around 62% of the respondents. Dentine pins were still being used by 66% of the respondents. The vast majority of respondents (92%) used a post and core to restore root-treated teeth. Fibre posts were the most commonly used (63%) type of preformed post among the respondents. Using the opposing and adjacent teeth as a reference to control tooth structure reduction during vital tooth preparation was the most common method, used by 42% of the respondents. Addition-cured silicone impression materials were the most frequently used impression material (78%). The surveyed practitioners were equally split between precious and non-precious metals as the substructure for indirect restorations. Glass-ionomer luting cements (47%) and resin-based cements (52%) were the most commonly used to cement porcelain fused to metal and zirconia indirect restorations, respectively. Laboratory made aesthetic veneers were prescribed by half of the respondents, while a third of them preferred direct resin composite as a veneer material. Conclusion: Within the limitations of the study, it was concluded that there has been an increase in the use of adhesive bonding and metal-free restorations. Amalgam and dentine pinscontinued to be used, contrary to international trends. Studies of the type reported are considered important in investigating trends and developments in dentistry.

Contemporary dental practice in the UK. Part 1: demography and practising arrangements in 2015.

Objectives: To determine, by means of an anonymous, self-reported questionnaire, the demographic profile and practising details of general dental practitioners in the UK in 2015. Methods: A previously-piloted and validated 121-question questionnaire was distributed during 2015 to 500 dentists at UK dental meetings with a request that they complete the questionnaire and return it by post in the reply-paid envelope to the corresponding author. Results: Three hundred and eighty-eight useable questionnaires were returned, giving aresponse rate of 77.6%. Of the respondents, 60.2% were male and 39.8% female. Theirmean age since graduation was 19.7 years. Just over half of the respondents (50.9%) replied that they were practice principals, 35.8% were associates and 10.6% were foundation dentists. A quarter of the respondents were in single-handed practices, the remainder being in a partnership or group practice. There was a mean of 4.2 dentists per practice, while the mean number of dental therapists in each practice was 0.3 and 1.2 hygienists. Regarding the first available NHS appointment in the respondents' practices for non-urgent care, 23.4% could provide this on the same day, the equivalent figure for private care being 40.1%. The mean percentage of patients receiving NHS treatment was 50%, with 33.8% receiving private treatment. Just over half of respondents considered that Care Quality Commission inspections were 'valuable for fostering patient trust and confidence in dental care.' The collected data indicated that 55.4% of respondents had an intra-oral camera, while, with regard to recently-introduced concepts and techniques, 80.4% used nickel-titanium files, 47.4% used zirconia-based bridgework and 24.9% used tricalcium silicate. Of great interest, perhaps, is the response to digital radiography/digital imaging, with the results indicating that 74.1% of respondents used this form of radiography. Regarding checking the light output of the light curing units, 53.1% stated that they did check the output, but in some cases this might be at a six-monthly interval. Conclusion: Results from this survey indicated that NHS service provision has dropped toapproximately 50% amongst the respondents. Regarding the staffing of dentalpractices, just over half the respondents were practice principals and there was a mean of 4.2 dentists per practice. The results also indicated that UK dentists continue to be innovative in the techniques that they employ.

The ultimate guide to restoration longevity in England and Wales. Part 10: key findings from a ten million restoration dataset.

Introduction: This paper defines key points from a ten million restoration dataset in order to compare and contrast the data from the previous nine papers, identifying common themes and/or differences in the factors affecting the survival of restored teeth to next intervention or extraction. Aim: It is the aim of this paper to present data on the survival of restorations in teeth by analysis of the time to re-intervention on the restorations and time to extraction of the restored tooth, and to discuss key findings regarding this. Methods: A data set was established, consisting of General Dental Services (GDS) patients, this being obtained from all records for adults (aged 18 or over at date of acceptance) in the GDS of England and Wales between 1990 and 2006. The data consist of items obtained from the payment claims submitted by GDS dentists to the Dental Practice Board (DPB) in Eastbourne, Sussex, UK. This study examined the key findings with regard to recorded intervals between placing a restoration in any tooth and re-intervention on the tooth, with the size of the dataset also permitting examination of the time to extraction of the restored tooth. Results: Data for more than three million different patients and more than 25 million courses of treatment were included in the analysis. Included were all records for adults (aged 18 or over at date of acceptance). Overall, 13,896,048 tooth restorations were included in the analysis. With regard to time to re-intervention, overall, between 32% and 42% of restorations, depending on tooth type, had survived at 15 years, and with regard to time to extraction of the restored tooth, the range was from 77.8% to 84.2%. Conclusions: The analysis confirms that larger restorations of all types and in all types of teeth generally performed less well than smaller restorations. Crowns perform better in time to re-intervention than direct restorations, but worse, particularly for younger patients, in time to extraction. Patient treatment history, measured as the average annual spend on treatment, is a major factor in the survival of restored teeth, both to re-intervention and to extraction. The greater the spend, the worse the survival. Regarding dentists, there is little difference in the survival of restorations placed by dentists of different gender, but dentists' age has been shown to play a part in the present investigation, with restorations placed by younger dentists performing better for all types of restoration except crowns. For direct restorations, the older the patient the poorer the survival of the restoration, whether to re-intervention or to extraction. The prognosis of a tooth which receives a root filling in the same course of treatment as the other restoration is much poorer than for teeth without such a root filling.

The ultimate guide to restoration longevity in England and Wales. Part 9: incisor teeth: restoration time to next intervention and to extraction of the restored tooth.

Aim: It is the aim of this paper to present data on the survival of restorations in incisor teeth by analysis of the time to re-intervention on the restorations and time to extraction of the restored incisor tooth, and to discuss the factors which may influence this. Methods: A data set was established, consisting of General Dental Services patients, this being obtained from all records for adults (aged 18 or over at date of acceptance) in the GDS of England and Wales between 1990 and 2006. The data consist of items obtained from the payment claims submitted by GDS dentists to the Dental Practice Board (DPB) in Eastbourne, Sussex, UK. This study examined the recorded intervals between placing a restoration in an incisor tooth and re-intervention on the tooth, and the time to extraction of the restored tooth. Results: Data for more than three million different patients and more than 25 million courses of treatment were included in the analysis. Overall, 2,526,576 restorations of incisor teeth in adults were included. At 15 years, survival of restorations in incisor teeth without re-intervention was 35%, and for restored incisor teeth survival to extraction was 81%. Conclusions: Approximately 35% of restorations in incisor teeth survived without re-intervention at 15 years, and 81% of restored incisor teeth survived for 15 years without extraction. Factors influencing survival include patient age, dentist age, and patient treatment need. Crowning an incisor tooth leads to an earlier time to extraction of the restored tooth.

The ultimate guide to restoration longevity in England and Wales. Part 8: Canine teeth: time to next intervention and to extraction of the restored tooth.

Aim: It is the aim of this paper to present data on the survival of restorations in canine teeth by analysis of the time to re-intervention on the restorations and time to extraction of the restored tooth, and to discuss the factors which may influence this. Methods: A data set was established, consisting of General Dental Services (GDS) patients, this being obtained from all records for adults (aged 18 or over at date of acceptance) in the GDS of England and Wales between 1990 and 2006. The data consist of items obtained from the payment claims submitted by GDS dentists to the Dental Practice Board (DPB) in Eastbourne, Sussex, UK. This study examined the recorded intervals between placing a restoration in a canine tooth and re-intervention on the tooth, and the time to extraction of the restored tooth. Results: Data for more than three million different patients and more than 25 million courses of treatment were included in the analysis. Included were all records for adults (aged 18 or over at date of acceptance). Overall, 1,232,052 restorations involving canine teeth were included in the analysis. With regard to time to re-intervention, 33% of restorations had survived at 15 years, and with regard to time to extraction of the restored tooth, cumulative survival was 78% at 15 years. Veneers and crowns performed best in terms of time to re-intervention, but crowns performed worst when time to extraction was analysed. Conclusions: Overall, crowns and porcelain veneers placed on canine teeth perform best to re-intervention after 15 years, but crowns perform worst when the time to extraction of the restored tooth is examined and veneers perform best, with a 20 percentage point difference in cumulative survival at fifteen years between crowns and the best performing restoration in the under-40 year age group, this effect being accentuated in the over-40 year age group. Other factors influencing restoration longevity in canine teeth include: patient age, dentist age and the patient's annual need for dental treatment.