Milosevic A, Burnside G
Department of Restorative Dentistry, Liverpool University Dental Hospital, Pembroke Place, Liverpool, Merseyside L3 5PS, UK.
The University of Liverpool, Dental Research Wing, Daulby Street, Liverpool, L69 3GN, UK.
J Dent. 2016 Jan;44:13-9. doi: 10.1016/j.jdent.2015.10.015. Epub 2015 Nov 2.
Survival of directly placed composite to restore worn teeth has been reported in studies with small sample sizes, short observation periods and different materials. This study aimed to estimate survival for a hybrid composite placed by one clinician up to 8-years follow-up.
All patients were referred and recruited for a prospective observational cohort study. One composite was used: Spectrum(®) (DentsplyDeTrey). Most restorations were placed on the maxillary anterior teeth using a Dahl approach.
A total of 1010 direct composites were placed in 164 patients. Mean follow-up time was 33.8 months (s.d. 27.7). 71 of 1010 restorations failed during follow-up. The estimated failure rate in the first year was 5.4% (95% CI 3.7-7.0%). Time to failure was significantly greater in older subjects (p=0.005) and when a lack of posterior support was present (p=0.003). Bruxism and an increase in the occlusal vertical dimension were not associated with failure. The proportion of failures was greater in patients with a Class 3 or edge-to-edge incisal relationship than in Class 1 and Class 2 cases but this was not statistically significant. More failures occurred in the lower arch (9.6%) compared to the upper arch (6%) with the largest number of composites having been placed on the maxillary incisors (n=519).
The worn dentition presents a restorative challenge but composite is an appropriate restorative material.
This study shows that posterior occlusal support is necessary to optimise survival.
在样本量小、观察期短且材料不同的研究中，已有关于直接放置复合树脂修复磨损牙齿的存留情况的报道。本研究旨在评估由一名临床医生放置的混合复合树脂在长达8年随访期内的存留情况。
所有患者均被转诊并纳入一项前瞻性观察队列研究。使用了一种复合树脂：Spectrum(®)（登士柏德特雷）。大多数修复体采用达尔方法放置在上颌前牙。
共为164例患者放置了1010颗直接复合树脂修复体。平均随访时间为33.8个月（标准差27.7）。1010颗修复体中有71颗在随访期间失败。第一年的估计失败率为5.4%（95%置信区间3.7 - 7.0%）。年龄较大的受试者失败时间显著更长（p = 0.005），且存在后牙支持不足时也是如此（p = 0.003）。磨牙症和咬合垂直距离增加与失败无关。3类或切缘对切缘切牙关系的患者失败比例高于1类和2类病例，但差异无统计学意义。与上牙弓（6%）相比，下牙弓的失败更多（9.6%），放置复合树脂修复体数量最多的是上颌切牙（n = 519）。
磨损的牙列带来修复挑战，但复合树脂是一种合适的修复材料。
本研究表明后牙咬合支持对于优化存留情况是必要的。
