Re-Treatment Decisions for Failed Posterior Restorations among Dentists in Kuwait

ABSTRACT

Objective: To compare re-treatment choices for MOD amalgam or resin composite restorations with or without cusp fracture among dentists in Kuwait.

Methods: A random sample of 158 dentists completed a questionnaire designed to obtain sociodemographic, educational and work-related information and their choices for re-treatment of four scenarios of failed restorations on lower first molars: 1. MOD amalgam restoration; 2. MOD composite restoration; 3. MOD amalgam restoration with cuspal fracture; 4. MOD composite restoration with cuspal fracture. Re-treatment options were: re-treating with amalgam; re-treating with composite; placing an onlay; or, placing a crown. For the purpose of analysis, responses were dichotomized into re-treatment with a direct or indirect restoration.

Results: For cases 1 and 2, most participants chose to re-treat with amalgam restoration and for cases 3 and 4, most chose to place an indirect restoration. In general, an increased tendency towards the indirect option was associated with increased age, being a male and being a specialist. Tendencies to place an indirect restoration did not differ between cases 1 and 2 (P=1.0) or cases 3 and 4 (P=0.317), although the tendency to do so was significantly greater in case 3 than 1 (P=0.000) and case 4 than 2 (P=0.000).

Conclusions: The variation noted among dentists regarding their stated choices for re-treating failed posterior restorations appeared to be associated with gender, education and experience factors. A tendency towards indirect restorations was seen when the restoration is associated with a fractured cusp. (Eur J Dent 2010;4:41-49)

Key words

Re-treatment - Amalgam - Resin composite - Decision making

• References

• 1 Pink FE, Minden NJ, Simmonds S. Decisions of practitioners regarding placement of amalgam and composite restorations in general practice settings. Oper Dent 1994; 19: 127-132
• 2 Friedl KH, Hiller KA, Schmalz G. Placement and replacement of amalgam in Germany. Oper Dent 1995; 20: 34-38
• 3 Mjör IA, Moorhead JE, Dahl JE. Reasons for replacement of restorations in permanent teeth in general dental practice. Int Dent J 2000; 50: 360-366
• 4 Mjör IA, Shen C, Eliasson ST, Richter S. Placement and replacement of restorations in general dental practice in Iceland. Oper Dent 2002; 27: 117-123
• 5 Elderton RJ. Clinical studies concerning re-restoration of teeth. Adv Dent Res 1990; 4: 4-9
• 6 Tveit AB, Espelid I. Class II amalgams: interobserver variations in replacement decisions and diagnosis of caries and crevices. Int Dent J 1992; 42: 12-18
• 7 Narby B, Kronstrom M, Soderfeldt B, Palmqvist S. Prosthodontics and the patient: What is oral rehabilitation need? Conceptual analysis of need and demand for prosthodontic treatment. Part 1: Conceptual analysis. Int J Prosthodont 2005; 18: 75-79
• 8 Maupomé G, Sheiham A. Clinical decision-making in restorative dentistry. Content-analysis of diagnostic thinking processes and concurrent concepts used in an educational environment. Eur J Dent Educ 2000; 4: 143-152
• 9 Braga SR, Vasconcelos BT, Macedo MR, Martins VR, Sobral MA. Reasons for placement and replacement of direct restorative materials in Brazil. Quintessence Int 2007; 38: e189-94
• 10 Heft MW, Gilbert GH, Dolan TA, Foerster U. Restoration fractures, cusp fractures and root fragments in a diverse sample of adults: 24-month incidence. J Am Dent Assoc 2000; 131: 1459-1464
• 11 Bader JD, Shugars DA, Roberson TM. Using crowns to prevent tooth fracture. Community Dent Oral Epidemiol 1996; 24: 47-51
• 12 Shugars DA, Hayden Jr WJ, Crall JJ, Scurria MS. Variation in the use of crowns and their alternatives. J Dent Educ 1997; 61: 22-28
• 13 Kolker JL, Damiano PC, Jones MP, Dawson DV, Caplan DJ, Armstrong SR, Flach SD, Kuthy RA, Warren JJ. The timing of subsequent treatment for teeth restored with large amalgams and crowns: factors related to the need for subsequent treatment. J Dent Res 2004; 83: 854-858
• 14 Omar R, Al-Kokani M, Abu Nassif L, Khan NB. Influence of dentist-related factors on the time spent on providing prosthodontic services among general dentists. Saudi Dent J 2003; 15: 2-10
• 15 Bader JD, Shugars DA. What do we know about how dentists make caries-related treatment decisions?. Community Dent Oral Epidemiol 1997; 25: 97-103
• 16 Marinho VC, Richards D, Niederman R. Variation, certainty, evidence, and change in dental education: employing evidence-based dentistry in dental education. 2001; 65: 449-455
• 17 Brennan DS, Spencer AJ. Factors influencing choice of dental treatment by private general practitioners. Int J Behav Med 2002; 9: 94-110
• 18 Mjör IA, Moorhead JE, Dahl JE. Selection of restorative materials in permanent teeth in general dental practice. Acta Odontologica Scandinavia 1999; 57: 257-262
• 19 Kay EJ, Blinkhorn AS. A qualitative investigation of factors govering dentist’s treatment philosophies. Brit Dent J 1996; 180: 171-176
• 20 Kronström M, Palmqvist S, Soderfeldt B. Prosthodontic decision making among general dentists in Sweden. I: The choice between crown therapy and filling. Int J Prosthod 1999; 12: 426-431
• 21 Söderfeldt B, Palmqvist S, Eriksson T, Kronström M, Carlsson GE. A questionnaire instrument to assess clinical decision- making in prosthodontics among general practitioners. Acta Odontol Scand 1996; 54: 314-319
• 22 Kronström M, Palmqvist S, Söderfeldt B, Eriksson T, Carlsson GE. Congruence between self-reported and actually provided prosthodontic services among Swedish dentists. Acta Odontol Scand 1999; 57: 9-15
• 23 Helminen SE, Vehkalati M, Murtomaa H. Dentists’ perception of their treatment practices versus documented evidence. Int Den J 2002; 52: 71-74
• 24 Brennan DS, Spencer AJ. Longitudinal comparison of factors influencing choice of dental treatment by private general practitioners. Aust Dent J 2006; 51: 117-123
• 25 Bader JD, Shugars DA. Incidence rates for complete cusp fracture. Community Dent Oral Epidemiol 2001; 29: 346-353
• 26 McDaniel RJ, Davis RD, Murchison DF, Cohen RB. Causes of failure among cuspal-coverage amalgam restorations: clinical survey. J Am Dent Assoc 2000; 131: 173-177
• 27 Maupomé G. Cumulative assessment of factors leading top restorative decisions in an educational environment. A graphical demonstration using an in vitro case. Oper Dent 2000; 25: 336-343
• 28 Al-Ali Al-Ali K, Marghalani H, Al-Yahya A, Omar R. An assessment of endodontic re-treatment decision-making in an educational setting. Int Endodont J 2005; 38: 470-476
• 29 Knutsson K, Lysell L, Rohlin M. Dentsuts’ judgement strategies on prophylactic removal of mandibular third molars. J Dent Res 2000; 79: 1989-1995
• 30 Omar R, Abu Nassif L, Al-Kokani M, Khan N. Factors influencing prosthodontic decision-making among general dentists. Saudi Dent J 2003; 15: 62-71
• 31 Heinikainen M, Vehkalahti M, Murtomaa H. Re-treatment decisions for failed posterior fillings by Finnish general practitioners. Community Dent Health 2002; 19: 98-103
• 32 Witter DJ, Kreulen CM, Creugers NH. Fracture risk judgment and crown indication by teachers in a dental school: a pilot study. Int J Prosthodont 2005; 18: 161-162
• 33 Wahl MJ, Schmitt MM, Overton DA, Gordon MK. Prevalence of cusp fractures in teeth restored with amalgam and with resin-based composite. J Am Dent Assoc 2004; 135: 1127-1132
• 34 Kolker JL, Damiano PC, Caplan DJ, Armstrong SR, Dawson DV, Jones MP, Flach SD, Warren JJ, Kuthy RA. Teeth with large amalgam restorations and crowns: factors affecting the receipt of subsequent treatment after 10 years. J Am Dent Assoc 2005; 136: 738-748
• 35 Martin JA, Bader JD. Five-year treatment outcomes for teeth with large amalgams and crowns. Oper Dent 1997; 22: 72-78
• 36 Van Nieuwenhuysen JP, D'Hoore W, Carvalho J, Qvist V. Long-term evaluation of extensive restorations in permanent teeth. J Dent 2003; 31: 395-405
• 37 el Mowafy OM, Lewis DW. Restorative decision making by Ontario dentists. J Can Dent Assoc 1994; 60: 305-310
• 38 Brennan DS, Spencer AJ. The role of dentist, practice and patient factors in the provision of dental services. Community Dent Oral Epidemiol 2005; 33: 181-195
• 39 Akeel R. Influence of educational background on stated retreatment choices for sub-optimal fixed prosthodontic conditions. J Prosthodont 2008; 17: 156-164
• 40 Traebert J, Marcenes W, Kreutz JV, Oliveira R, Piazza CH, Peres MA. Brazilian dentists' restorative treatment decisions. Oral Health Prev Dent 2005; 3: 53-60