Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, AL, USA.
J Am Dent Assoc. 2013 Jun;144(6):583-93. doi: 10.14219/jada.archive.2013.0169.
Knowing which factors influence restoration longevity can help clinicians make sound treatment decisions. The authors analyzed data from The National Dental Practice-Based Research Network to identify predictors of early failures of amalgam and resin-based composite (RBC) restorations.
In this prospective cohort study, the authors gathered information from clinicians and offices participating in the network. Clinicians completed a baseline data collection form at the time of restoration placement and annually thereafter. Data collected included patient factors, practice factors and dentist factors, and the authors analyzed them by using mixed-model logistic regression.
A total of 226 practitioners followed up 6,218 direct restorations in 3,855 patients; 386 restorations failed (6.2 percent) during the mean (standard deviation) follow-up of 23.7 (8.8) months. The number of tooth surfaces restored at baseline helped predict subsequent restoration failure; restorations with four or more restored surfaces were more than four times more likely to fail. Restorative material was not associated significantly with longevity; neither was tooth type. Older patient age was associated highly with failure (P < .001). The failure rate for children was 4 percent, compared with 10 percent for people 65 years or older. Dentist's sex and practice workload were associated significantly with restoration longevity.
In this prospective cohort study, these factors were significantly predictive of failure for amalgam and RBC restorations: patient's age, a higher number of surfaces restored at baseline, the dentist's sex and the practice workload. Material choice was not significantly predictive in these early results. Practical Implications. If clinicians can recognize and identify the risk factors associated with early restoration failure, more effective treatment plans may be offered to the patient.
了解哪些因素会影响修复体的长期使用效果，有助于临床医生做出合理的治疗决策。作者分析了来自全国牙科实践基础研究网络的数据，以确定汞合金和树脂基复合材料（RBC）修复体早期失败的预测因素。
在这项前瞻性队列研究中，作者从参与该网络的临床医生和诊所收集信息。临床医生在修复体放置时填写基线数据收集表，并在随后每年进行一次随访。收集的数据包括患者因素、实践因素和牙医因素，并使用混合模型逻辑回归进行分析。
共有 226 名从业者随访了 3855 名患者的 6218 个直接修复体；在平均（标准差）23.7（8.8）个月的随访中，有 386 个修复体失败（6.2%）。基线时修复的牙面数量有助于预测随后的修复体失败；有四个或更多修复牙面的修复体失败的可能性是四倍多。修复材料与寿命无显著相关性；牙位也无显著相关性。患者年龄越大，失败的风险越高（P<.001）。儿童的失败率为 4%，而 65 岁及以上人群的失败率为 10%。牙医的性别和工作负荷与修复体的长期使用效果显著相关。
在这项前瞻性队列研究中，这些因素对汞合金和 RBC 修复体的失败具有显著预测性：患者年龄、基线时修复牙面数量较多、牙医的性别和工作负荷。在这些早期结果中，材料选择并没有显著的预测作用。实际意义。如果临床医生能够识别和确定与早期修复体失败相关的风险因素，可能会为患者提供更有效的治疗计划。
