10 Year Prospective Survival Analysis Of Composite Dahl Restorations

Objectives: The restorative management of localised anterior tooth wear is often complicated by lack of interocclusal space due to dento-alveolar compensation. Composite resin restorations placed at an increased occlusal vertical dimension using the principles of the Dahl appliance have been used with success in the short to medium term. It was the objective of this prospective 10 year follow up study to provide clinical evidence about the long-term survival rates and modes of failure of these restorations. Methods: The clinical performance of 283 composite resin restorations on 26 patients with localised anterior tooth wear was reviewed after a 10-year follow up period. The study used modified United States Public Health Service (USPHS) criteria for assessing the restorations. Survival of the restorations was determined using the Kaplan-Meier survival analysis. Results: The results indicate that the median survival time for composite resin restorations is 5.8 years when all failures are considered. At the major failure level which requires replacement of a given restoration, the median survival time is 7.0 years. The restorations provided as replacements have a lower median survival times of 4.75 years. The restorations commonly failed as a result of wear, fracture and marginal discoloration. It was not uncommon for all these to occur in combination. The failure modes of the restorations exposed the materials' limited mechanical and physical properties and reflect the technique sensitivity involved. However, maintenance is not complicated as replacements, repairs or refinishing can be easily carried out. Conclusions: The factors that significantly influenced the survival of these restorations were the incisal relationship, aetiology, material used, and the nature of opposing dentition. With some degree of maintenance, repeated use of composite resin restorations to treat localised anterior tooth wear at an increased occlusal vertical dimension is a viable treatment option over a 10 year period.