The influence of medical history on restorative procedure failure rates following dental rehabilitation

Resident’s Name: Jessica Wilson

Program: Lutheran Medical Center - Providence

Article title: The influence of medical history on restorative procedure failure rates following dental rehabilitation.

Author(s): Ng et al.

Journal: Pediatric Dentistry

Year. Volume (number). Page #’s: 2001. 23:6. 487-490.

Overview of method of research: Scientific Article

Purpose:
To evaluate the relationship between patient medical history and success of restorative treatments performed under general anesthesia.

Methods:
Dental records of 504 patients who received comprehensive dental treatment under general anesthesia at either Children’s Hospital in Boston (1990-1992) or Children’s National Medical Center in DC (1994-1998) were reviewed. All treatment was performed by pediatric dental residents under the supervision of attending. Only patients who returned at least 6 months after treatment for follow-up were used in the study (241 patients). Failure was defined as need for restoration replacement due to structural breakdown (including perforation of SSCs due to wear-through), pulpal/dentoalveolar infection or recurrent decay.
Patients were grouped into 2 different categories: healthy or having a significant medical history (having a classified developmental disability, asthma requiring chronic meds, bleeding disorders, cancer, cleft lip/palate, diabetes, endocrine disorders, GI/liver disease, heart disease requiring meds, HIV infection, kidney disease, seizure disorder, sickle cell disease or any syndrome). Patients were also categorized as having a developmental disability (autism, cerebral palsy, emotional disability, learning disability or mental retardation) or having no developmental disability.
In addition, a subgroup of records was reviewed to determine the association between medical history and failure of restorations placed on patients in full primary dentition (FPD) (206 patients).

Findings for patients in FPD:
Amalgam restorations had a significantly higher failure rate than SSCs and the highest failure rates were found in composite restorations.
Although there was a slightly higher failure rate of restorations in patients with significant medical histories that healthy patients, the only statistically significant finding was a 16% failure rate of SSCs in patients with developmental disabilities compared to a 7% failure rate in patients without disabilities. It was reported that the majority of the failures in patients with developmental disabilities was due to excessive occlusal wear leading to perforation.
There were no significant differences found in amalgam or composite failure rates in patients with or without significant medical histories or developmental disabilities. There was also no statistical difference when comparing DC and Boston patients.

Key points/Summary:
1. SSCs are the most reliable restorations for primary teeth in patients treated under GA with amalgam restorations being slightly less reliable and composite restorations including strip crowns the least reliable.
2. Amalgam and composite restorations have similar failure rates in patients with or without significant medical histories or developmental disabilities.
3. SSC failures are more likely to occur in patients with developmental disabilities, but not necessarily significant medical histories than healthy patients.
4. SSC failure rates in patients with developmental disabilities were similar to that of amalgam restorations.

Assessment of Article:
I am not sure why they only evaluated patients in the subgroup (FPD) rather than all patients who were present for follow-up appointments. Nevertheless, these were interesting findings that I will keep in the back of my mind as I am treatment planning.