IADR Abstract Archives
Treatment of vital, deeply carious teeth: A retrospective practice-based cohort study
Objectives: Maintaining pulpal vitality and achieving long-term restoration success is challenging when treating deep caries lesions, whilst has not been not been evaluated so far. We aimed at assessing success, survival and influencing factors of treating deep lesions in general dental practice.
Methods: Patient-record databases from six private practices in Germany were assessed. Permanent posterior teeth with lesions radiographically extending into the inner dentin with sensible, asymptomatic pulps were retrospectively evaluated. Outcome parameters were success (absence of re-treatment) and survival (absence of extraction). Mean success and survival times were estimated using Kaplan-Meier curves, and effect of treatment modifiers assessed using Cox regression.
Results: 232 patients (mean age 28) with 308 teeth (62% molars) were evaluated over a mean of 74 (range: 0-333) months. 35% of teeth experienced pulpal exposure leading to direct capping. Most restorations were multi-surfaced and used amalgam (47%) or composite resins (35%). 142/308 teeth failed (mean [95% CI] success time: 130 [112/147] months), requiring restorative (54%) or endodontic (37%) re-treatments. Risk of failure was increased in patients aged ≥40 years (Hazard Ratio [95%CI]: 2.06 [1.31/3.07]), teeth restored with glass ionomer or other cements (HR: 1.67 [1.04/2.67], and teeth with pulp exposure (HR: 1.45 [1.00/2.11]). Only 13 teeth required extraction (survival time: 307 [391/324] months). Extraction occured >10-fold more often in teeth restored using cement materials.
Conclusions: Teeth with deep lesions had high risk of failure, whilst risk of extraction was low. Avoiding pulpal exposure and immediately placing definitive restorative materials could reduce risk of failure.
Methods: Patient-record databases from six private practices in Germany were assessed. Permanent posterior teeth with lesions radiographically extending into the inner dentin with sensible, asymptomatic pulps were retrospectively evaluated. Outcome parameters were success (absence of re-treatment) and survival (absence of extraction). Mean success and survival times were estimated using Kaplan-Meier curves, and effect of treatment modifiers assessed using Cox regression.
Results: 232 patients (mean age 28) with 308 teeth (62% molars) were evaluated over a mean of 74 (range: 0-333) months. 35% of teeth experienced pulpal exposure leading to direct capping. Most restorations were multi-surfaced and used amalgam (47%) or composite resins (35%). 142/308 teeth failed (mean [95% CI] success time: 130 [112/147] months), requiring restorative (54%) or endodontic (37%) re-treatments. Risk of failure was increased in patients aged ≥40 years (Hazard Ratio [95%CI]: 2.06 [1.31/3.07]), teeth restored with glass ionomer or other cements (HR: 1.67 [1.04/2.67], and teeth with pulp exposure (HR: 1.45 [1.00/2.11]). Only 13 teeth required extraction (survival time: 307 [391/324] months). Extraction occured >10-fold more often in teeth restored using cement materials.
Conclusions: Teeth with deep lesions had high risk of failure, whilst risk of extraction was low. Avoiding pulpal exposure and immediately placing definitive restorative materials could reduce risk of failure.