Van Nieuwenhuysen J-P, D'Hoore W, Carvalho J, Qvist V
School of Dentistry, Catholic University of Louvain, 15 Hippocrate Avenue, B-1200, Brussels, Belgium.
J Dent. 2003 Aug;31(6):395-405. doi: 10.1016/s0300-5712(03)00084-8.
The present prospective, longitudinal study assessed the outcome of posterior extensive restorations and identified risk factors for failure of the restorations.
The sample consisted of 722 amalgam restorations, 115 composite resin restorations and 89 crowns placed in 428 adults by one dentist from 1982 to 1999 in Belgium. Well-defined criteria were used for cavity preparation design, type of retention and selection of restorative material.
At the closure of the study 48% of the restorations were well functioning, 24% were lost to lack of follow-up, and 28% had failed. The most frequent reasons for failure were fracture of restoration (8%), secondary caries (6%) and fracture of cusp (5%). Failures were more often found in premolar teeth (34%) than in molars (27%) (P=0.05) and occurred in 28% of the amalgam restorations, 30% of the resin restorations and 24% of the crowns (P=0.55). Molar restorations were more frequently repaired than replaced in contrast to premolar restorations. The highest percentage of extractions was related to complete amalgam restorations in premolars. The Kaplan-Meier median survival times were 12.8 years for amalgam restorations, 7.8 years for resin restorations, and more than 14.6 years for crowns, considering all retreatment as failures (P=0.002). The survival was influenced by extension of restoration, age of patient, pulpal vitality, 3-year period of treatment, use of base material and dentinal retentive pins.
Within the limits of the study the data support the view that extensive amalgam restorations but not composite resin restorations can be used as an appropriate alternative to crowns, with due consideration to the longevity of the restorations.
本前瞻性纵向研究评估了后牙大面积修复的效果，并确定了修复失败的风险因素。
样本包括1982年至1999年期间由比利时一名牙医为428名成年人进行的722次汞合金修复、115次复合树脂修复和89次牙冠修复。在窝洞预备设计、固位类型和修复材料选择方面采用了明确的标准。
研究结束时，48%的修复体功能良好，24%因缺乏随访而失访，28%的修复体失败。最常见的失败原因是修复体折断（8%）、继发龋（6%）和牙尖折断（5%）。前磨牙修复体的失败率（34%）高于磨牙（27%）（P = 0.05），汞合金修复体的失败率为28%，树脂修复体为30%，牙冠为24%（P = 0.55）。与前磨牙修复体相比，磨牙修复体更常进行修复而非替换。拔牙比例最高的与前磨牙的全汞合金修复有关。将所有再治疗视为失败的情况下，汞合金修复体的Kaplan-Meier中位生存时间为12.8年，树脂修复体为7.8年，牙冠超过14.6年（P = 0.002）。修复体的生存受修复范围、患者年龄、牙髓活力、治疗的3年周期、基底材料的使用和牙本质固位钉的影响。
在本研究的范围内，数据支持以下观点：在适当考虑修复体寿命的情况下，大面积汞合金修复而非复合树脂修复可作为牙冠的合适替代方案。
