Risk factors for caries development on tooth surfaces adjacent to newly placed Class II composites – a pragmatic, practice based study
Abstract
Objectives
To
assess risk factors for caries development on approximal surfaces in
contact with newly placed Class II composite restorations.
Methods
750
surfaces, either sound or with caries confined to enamel, in contact
with newly placed Class II composite restorations, placed by PDS
dentists in Norway were evaluated by clinicians, using standardised
clinical and radiographic criteria.
Results
After
the observation period (mean 4.9 year, SD 0.67), 38.8% of the initially
sound contact surfaces (n=417) remained sound, 34.0% developed caries
confined to enamel and 27.2% developed caries into dentine. Of surfaces
with caries confined to enamel present at baseline (n=333), 57.3%
remained in enamel, while 42.7% progressed into dentine. Risk factors
for dentine caries development were assessed by logistic regression
analyses. The risk of developing caries on surfaces that were initially
sound at baseline was higher in patients with poor or medium oral
hygiene (OR 1.53; CI 1.10-3.68), higher DMFT at baseline (OR 1.12; Cl
1.04-1.20). Maxillary teeth (OR 2.01; Cl 1.14-3.56) and surfaces on the
right side of the mouth (OR 1.65; Cl 1.01-2.72) were also risk factors.
For surfaces with enamel caries present at baseline, the risk of dentine
caries was higher in patients with higher DMFT (OR 1.06; CI 1.00-1.13).
In both analyses the treating dentists had a significant impact on the
caries development.
Conclusions
Both
patient- and dentist related variables are risk factors for caries
development on approximal surfaces in contact with newly placed Class II
composite restorations.
Clinical significance
All
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, and should consider greater
use of preventive strategies or non-operative treatment that should be
evaluated and repeated at every recall.
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