Restorations Don’t Always Reduce Caries Risk



When a caries lesion appears on one tooth, the risk for developing caries in sound surfaces on the adjacent teeth increases. The risk could get even higher, though, when restorations are involved depending on the patient’s history and the dentist performing the repair.

Dr. S.E. Kopperud of the Nordic Institute of Dental Materials and his researchers evaluated 750 surfaces in contact with newly placed Class II composite restorations using standardized clinical and radiographic criteria when the restoration was placed (baseline) and after 5 years. At baseline, contact surfaces were categorized as being initially sound (n = 417) or as having caries confined to enamel (n = 333).

After the observation period, 38.8% of the initially sound contact surfaces remained sound, 34.0% had caries confined to enamel, and 27.2% showed caries into dentine. The lesion remained in the enamel in 57.3% of the surfaces with caries confined to enamel present at baseline, while it progressed into dentine for 42.7% of the surfaces.

Logistic regression analyses assessed risk factors for dentine caries development. The risk of developing caries on surfaces that were initially sound at baseline was significantly higher in patients with poor or medium oral hygiene, in patients with a high previous caries experience, in maxillary teeth, and on contact surfaces in the patients’ right sides. Also, the risk of developing dentine caries for surfaces with enamel caries already present at baseline was significantly higher in patients with high previous caries experience.

The researchers additionally found significant dentist-related differences in caries development on contact surfaces in both regression analyses. Surfaces adjacent to restorations placed by some dentists showed significantly higher risk, while surfaces adjacent to restorations placed by other dentists showed significantly lower risk of dentine caries development.

Kopperud and his team concluded that clinicians should be aware of a notable risk of caries development on the adjacent tooth surface, especially when placing approximal restorations in high-caries-risk patients. Clinicians should consider a greater use of preventive strategies, they noted, after placing approximal restorations. These strategies should be evaluated and repeated at every recall as well.

“Restorations are not without shortcomings. However, in many cases they remain the best available treatment for tooth decay, and I would urge patients not to avoid necessary dental treatment,” said Mick Horton, dean of the Faculty of General Dental Practice, United Kingdom.

“There is no idea substitute for an unrestored intact dentition, so by promoting good oral hygiene, maintaining a healthy diet, and ensuring the appropriate use of preventative measures, dentists and patients together can help maintain a healthy smile,” he said.

The study, “Risk Factors for Caries Development on Tooth Surfaces Adjacent to Newly Placed Class II Composites—A Pragmatic, Practiced Based Study,” was published by the Journal of Dentistry.

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