Extent of Tooth Decay in the Mouth and Increased Need for replacement of Dental Restorations: the New England Children’s Amalgam

Author(s): Trachtenberg et al
Journal: Pediatric Dentisry
Volume (number): (30) 5
Month, Year: Sept/Oct 2008
Major topic / Purpose of Study: To investigate the association between the rate of restoration replacement and the number of decayed and filled surfaces / teeth in both primary and permanent dentition combined at the time of restoration placement, using collected data prospectively as part of the 5-year New England Children’s Amalgam Trial.
Methods and Materials
598 children participated; patients were 6-10 year olds from two geographic areas (urban and rural) with no prior amalgam restorations, 2 or more posterior teeth with dental caries requiring restorations on occlusal surfaces, and no evidence of psychological or physiological disorders
Complete dental exam every 6 months, restorations placed as needed; children randomized to receive either composite (267) or amalgam (267) during the course of the trial; for the “composite” group compomer was placed in primary dentition and composite in the permanent
Clinical variability minimized by centralized training of all participating personnel; rubber dam used for all restorations
Restorations requiring replacement categorized in the following way: new caries, recurrent caries, fracture, restoration loss, or other reason
Each restoration “contributed” follow-up from the date of initial placement to the date of replacement (for any reason)
Outcome of this study was survival of restoration (if replaced) or available follow-up time of restoration (if not replaced)
Results
Increase in replacement rates occurred with increasing dft/DFT in mouth at the time of restoration placement
No correlation between the actual number of restorations placed at each visit and longevity
Association between dft/DFT and the need for restoration replacement did not depend on the type of restorative material used
Compomer and composite materials had significantly higher rates of replacement independent of decay
Need for restoration replacement significantly increased with age
Conclusions
Children with high caries rates are at higher risk for replacement restorations
Dental restorations are susceptible to failure due to factors related to tooth decay, such as bacteria, diet, and poor oral hygiene
Restoration longevity did not vary significantly by the number of surfaces or primary vs. permanent dentition after controlling decay in the mouth
Assessment of article Great study. Would have been interesting to know what patient strep mutans levels were at each subsequent follow-up visit.