College of Dentistry, Department of Operative Dentistry, University of Florida, Gainesville, FL, USA.
Oper Dent. 2009 Nov-Dec;34(6):664-73. doi: 10.2341/08-131-C.
To (1) identify and quantify the types of treatment that dentists use to manage defective dental restorations and (2) identify characteristics that are associated with these dentists' decisions to replace existing restorations. The Dental Practice-Based Research Network (DPBRN) consists of dentists in outpatient practices from five regions: AL/MS: Alabama/Mississippi; FL/GA: Florida/Georgia; MN: dentists employed by HealthPartners and private practitioners in Minnesota; PDA: Permanente Dental Associates in cooperation with Kaiser Permanente's Center for Health Research and SK: Denmark, Norway and Sweden.
A questionnaire was sent to all DPBRN practitioner-investigators who reported doing some restorative dentistry (n = 901). Questions included clinical case scenarios that used text and clinical photographs of defective restorations. Dentists were asked what type of treatment, if any, they would use in each scenario. Treatment options ranged from no treatment to full replacement of the restoration with or without different preventive treatment options. The authors of the current study used logistic regression to analyze associations between the decision to intervene surgically (repair or replace) and the specific dentist, practice and patient characteristics.
A total of 65% of dentists would replace a composite restoration when the defective margin was located on dentin and 49% would repair it when the defective margin was located on enamel. Most (52%) dentists would not intervene surgically when the restoration in the scenario was amalgam. Dentists participating in a solo or small private practice (SPP) chose surgical intervention more often than dentists participating in large group practices (LGP) or in public health practices (PHP) (p < .0001). Dentists who do not routinely assess caries risk during treatment planning were more likely to intervene surgically and less likely to choose prevention treatment (p < .05). Dentists from the SK region chose the "no treatment" option more often than dentists in the other regions.
Dentists were more likely to intervene surgically when the restoration was an existing composite, compared to an amalgam restoration. Treatment options chosen by dentists varied significantly by specific clinical case scenario, whether the dentist routinely performs caries risk assessment, type of practice and DPBRN region.
（1）确定并量化牙医用于处理有缺陷的牙科修复体的治疗类型，（2）确定与牙医决定更换现有修复体相关的特征。牙科实践基础研究网络（DPBRN）由来自五个地区的门诊医生组成：AL/MS：阿拉巴马州/密西西比州；FL/GA：佛罗里达州/佐治亚州；MN：明尼苏达州的 HealthPartners 雇佣的牙医和私人从业者；PDA：Permanente Dental Associates 与 Kaiser Permanente 的健康研究中心合作以及 SK：丹麦、挪威和瑞典。
向所有报告从事一些修复性牙科治疗的 DPBRN 从业者调查员（n = 901）发送了一份问卷。问题包括使用有缺陷的修复体的文字和临床照片的临床病例场景。牙医被问到在每种情况下他们会使用哪种治疗方法（如果有）。治疗方案从不治疗到完全更换修复体，包括不同的预防治疗方案。当前研究的作者使用逻辑回归分析了手术干预（修复或更换）与特定牙医、实践和患者特征之间的关联。
共有 65%的牙医会在有缺陷的边缘位于牙本质时更换复合修复体，而 49%的牙医会在有缺陷的边缘位于牙釉质时修复它。大多数（52%）牙医不会对场景中的银汞合金修复体进行手术干预。参与个体或小型私人执业（SPP）的牙医比参与大型团体执业（LGP）或公共卫生执业（PHP）的牙医更倾向于选择手术干预（p<0.0001）。在治疗计划期间不常规评估龋齿风险的牙医更有可能进行手术干预，而不太可能选择预防治疗（p<0.05）。来自 SK 地区的牙医比其他地区的牙医更倾向于选择“不治疗”选项。
与银汞合金修复体相比，牙医更倾向于对现有复合修复体进行手术干预。牙医选择的治疗方案因具体临床病例场景、牙医是否常规进行龋齿风险评估、执业类型和 DPBRN 地区而有显著差异。
