Department of Operative Dentistry, Faculty of Dentistry, Federal University of Pelotas, RS, Brazil.
J Dent. 2012 Sep;40(9):703-10. doi: 10.1016/j.jdent.2012.04.020. Epub 2012 Apr 28.
This study aimed to investigate the patient and tooth factors associated with selection of restorative material in direct posterior restorations in young adults from a population-based birth cohort.
A representative sample (n=720) of all 5914 births occurring in Pelotas in 1982 were prospectively investigated, and posterior restorations were assessed in 2006, when the patients were 24 years old. Tooth-related variables (individual level) included restorative material (amalgam or composite), type of tooth, size of cavity, and estimated time in mouth. Data regarding demographic and socio-economic characteristics, oral health, and service utilization patterns during the life course were also assessed (contextual level).
Logistic Regression Multilevel models showed that individuals who have accessed dental services by private insurance by age 15 [odds ratio (OR)=1.66 (0.93-2.95)] and who had a higher dental caries index at age 15 (high DMFT tertile) [OR 2.89 (1.59-5.27)] presented more amalgam restorations in the posterior teeth. From tooth-level variables, the frequency of amalgams decreases with increasing number of surfaces enrolled in the cavity preparation (p<0.001) and was almost 5 times greater in molars than in premolars.
The present findings suggest that variables related to type of dental service, dental caries (higher DMFT index), and cavity characteristics (tooth type, size) determine the choice of dentists for restorative materials. Other individual characteristics such as demographic and socioeconomic status have not influenced this choice.
This is the first population-based study that assesses the determinant factors for the choice of dentists for composite or amalgam in posterior direct restorations, showing that, independently of socioeconomic and demographic characteristics, type of payment of dental services and clinical factors are associated with this choice.
本研究旨在调查人群基础出生队列中年轻成年人后牙直接修复中与修复材料选择相关的患者和牙齿因素。
前瞻性调查了 1982 年在佩洛塔斯出生的所有 5914 名婴儿的代表性样本（n=720），并在 2006 年（患者 24 岁时）评估了后牙修复情况。牙齿相关变量（个体水平）包括修复材料（汞合金或复合树脂）、牙齿类型、龋洞大小和预计使用时间。还评估了与人口统计学和社会经济特征、口腔健康以及整个生命过程中的服务利用模式相关的数据（背景水平）。
多水平逻辑回归模型显示，15 岁时通过私人保险获得牙科服务的个体（比值比[OR]为 1.66（0.93-2.95））和 15 岁时牙本质龋指数较高（高 DMFT 三分位数）（OR 2.89（1.59-5.27））在后牙中更有可能使用汞合金修复。从牙齿水平的变量来看，随着窝洞预备所涉及的牙面数量增加，汞合金的频率降低（p<0.001），且磨牙的发生率几乎是前磨牙的 5 倍。
本研究结果表明，与牙科服务类型、龋齿（更高的 DMFT 指数）和窝洞特征（牙齿类型、大小）相关的变量决定了牙医对修复材料的选择。其他个体特征，如人口统计学和社会经济地位，并没有影响这种选择。
这是第一项评估人群基础上后牙直接复合树脂或汞合金修复选择决定因素的研究，表明独立于社会经济和人口统计学特征，牙科服务的支付类型和临床因素与这种选择相关。
