Casagrande Luciano, Seminario Alejandra Tejeda, Correa Marcos Britto, Werle Stefanie Bressan, Maltz Marisa, Demarco Flávio Fernando, Araujo Fernando Borba de
Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
Federal University of Pelotas, Pelotas, RS, Brazil.
Clin Oral Investig. 2017 Apr;21(3):847-855. doi: 10.1007/s00784-016-1832-1. Epub 2016 Apr 22.
The aim of this retrospective university-based study has been to evaluate the longevity and factors associated with failures of adhesive restorations performed in deep carious lesions of permanent molars after complete (CCR) and selective caries removal (SCR).
The sample was composed of composite resin and resin-modified glass ionomer cement (RMGIC) restorations placed in permanent molars of children attending a university dental service who were followed up for up to 36 months. Information collected retrospectively from clinical records was used for analyzing data. The following factors were investigated: gender, caries experience, visible plaque and gingival bleeding indexes, operator's experiences, number of restored surfaces, and type of capping and restorative materials. The Kaplan-Meier survival test was used to analyze the longevity of the restorations. Multivariate Cox regression analysis with shared frailty was used to assess the factors associated with failures (p < 0.05).
Four hundred seventy-seven restorations carried out in 297 children (9.1 ± 1.7 years) were included in the analysis. The survival of the restorations reached 57.9 % up to 36 months follow-up with an overall annual failure rate of 16.7 %. There was no difference in restoration longevity when CCR or SCR was performed (p = 0.163); however, CCR presented more pulp exposure (p < 0.001). Multi-surface restorations showed more failures than single-surface (HR 3.22, 95 % CI 1.49; 6.97), and teeth restored with RMGIC had a lower survival rate than those restored with composite resin (HR 4.11, 95 % CI 1.91; 8.81). Patients with evidence of gingivitis had more risk of failure in their restorations (HR 2.88, 95 % CI 1.33; 6.24).
Overall, adhesive restorations performed in young permanent molars of high caries risk children presented limited survival, regardless of the caries removal technique. Risk factors for failure were identified as multi-surface fillings, RMGIC restorative material, and poor oral hygiene, reflected by gingival bleeding.
Composite fillings associated with a strict caries preventive regimen may play an important role in the survival of restorations placed in high caries risk children.
本项基于大学的回顾性研究旨在评估在恒牙深龋病变中进行完全龋去除（CCR）和选择性龋去除（SCR）后粘结修复体的存留时间及失败相关因素。
样本由放置于一所大学牙科诊所儿童恒牙中的复合树脂和树脂改性玻璃离子水门汀（RMGIC）修复体组成，对这些儿童进行了长达36个月的随访。从临床记录中回顾性收集的信息用于数据分析。研究了以下因素：性别、龋病经历、可见菌斑和牙龈出血指数、操作者经验、修复面数量以及覆盖和修复材料类型。采用Kaplan-Meier生存检验分析修复体的存留时间。使用具有共享脆弱性的多变量Cox回归分析评估与失败相关的因素（p < 0.05）。
分析纳入了297名儿童（9.1 ± 1.7岁）的477个修复体。随访至36个月时修复体的存留率达到57.9%，总体年失败率为16.7%。进行CCR或SCR时修复体的存留时间无差异（p = 0.163）；然而，CCR出现更多的牙髓暴露（p < 0.001）。多面修复体比单面修复体显示出更多的失败（风险比3.22，95%置信区间1.49；6.97），用RMGIC修复的牙齿比用复合树脂修复的牙齿存留率更低（风险比4.11，95%置信区间1.91；8.81）。有牙龈炎证据的患者修复体失败风险更高（风险比2.88，95%置信区间1.33；6.24）。
总体而言，无论龋病去除技术如何，在高龋风险儿童的年轻恒牙中进行的粘结修复体存留时间有限。确定的失败风险因素为多面充填、RMGIC修复材料以及牙龈出血所反映的口腔卫生不良。
与严格的龋病预防方案相关的复合充填材料可能在高龋风险儿童修复体的存留方面发挥重要作用。
