Clinical evaluation of glass-ionomer and composite restorations in radiation patients

Objectives: To investigate whether there is less secondary caries at the margins of Class V glass-ionomer restorations compared with Class V resin composite restorations in high-caries-risk and xerostomic adult patients who had undergone head and neck irradiation. Methods: 35 high-risk adult post-radiation xerostomic patients who had 3 cervical carious lesions in the same arch were selected. Every patient received a restoration with the following filling material: Ketac-Fil (KF), Photac-Fil (PF) and Herculite XRV (HX). Patients were instructed in daily use of a neutral sodium fluoride gel in custom trays. Recall appointments were made at 6 and 12 months, and the restorations were examined for material loss, marginal integrity and recurrent caries at the restoration margin. Fluoride compliance was determined at each recall period and recorded as the percentage of recommended use during that interval [compliance of 50% or less = NFU, greater than 50% = FU]. Results: 30 patients were available for follow-up at 6 months, and 28 at 12 months (i.e. 15 patients in the NFU-group, in the FU-group 15 at 6 months and 13 at 12 months). In the NFU-group no recurrent caries was found for KF, 3 PF-fillings and 4 HX-fillings at 6 months, and 5 HX-fillings at 12 months failed due to recurrent caries. In the FU-group no recurrent caries was found for KF and HX, 1 PF-filling failed at 12 months. Fishers exact test (p=0.05) showed statistically significant differences for recurrent caries between KF and HX at 6 and 12 months in the NFU-group. There were statistically significant differences in restoration failure due to marginal adaptation and/or anatomical form in the FU-group between KF and HX, KF and PF at 6 and 12 months. Conclusion: Glass-ionomers provide clinical caries inhibition but are susceptble to fluoride gel erosion, composite resin provides greater structural integrity.