Department of Restorative, Preventive and Pediatric Dentistry, zmk bern, University of Bern, Switzerland.
Department of Biohybrid and Medical Textiles, Institute of Applied Medical Engineering, RWTH Aachen University, Aachen, Germany.
J Dent Res. 2020 Aug;99(9):1039-1046. doi: 10.1177/0022034520924390. Epub 2020 May 21.
The aim of this retrospective noninterventional multicenter practice-based study was to analyze factors influencing the survival of direct restorations. Records from patients who visited 5 private practices regularly were searched for the presence of direct restorations. Data were recorded from 7,858 patients with 27,407 direct restorations being detected at least 6 mo before the last recall visit. Multilevel Cox proportional hazard models were used to evaluate the association between clinical factors and time until failure. Within 228 mo, 5,493 failures could be observed. Median survival time was 207 mo. The annual failure rates were 3.8%, 4.0%, 4.6%, 4.9%, and 3.9% for class I, II, III, IV, and V restorations, respectively. Class II and IV restorations showed a 1.1-times (95% CI, 1.0 to 1.2) and 1.2-times (95% CI, 1.1 to 1.2) higher failure rate than class I restorations ( ≤ 0.029). Patients aged <20 y and >60 y showed up to a 1.4-times higher failure rate than patients aged 20 to 60 y ( 0.015). Restorations that underwent check-up twice a year or more showed a significantly higher failure rate than those that did so less than twice a year ( < 0.001). Furthermore, the dentists significantly influenced time until failure ( < 0.001). Regarding the restorative material, composites showed up to a 2.1-times longer time until failure than GIC ( ≤ 0.020). Moderate failure rates were observed for direct restorations in the private practice setting after up to 18.5 y. Within the limitations of the present study, several factors on the levels of practice (i.e., dentist), patient (i.e., age), and tooth (i.e., restorative material, restored surfaces according to the classification of Black) were significant predictors for the failure rate. Therefore, treatment decision should take into account most relevant factors (German Clinical Trials Register DRKS00015228).
本回顾性、非干预性、多中心实践研究旨在分析影响直接修复体存活率的因素。检索了定期到 5 家私人诊所就诊的患者的记录，以寻找直接修复体的存在。从 7858 名患者中记录了至少在最后一次就诊前 6 个月内发现的 27407 个直接修复体的数据。使用多级 Cox 比例风险模型来评估临床因素与失败时间之间的关联。在 228 个月内，观察到 5493 次失败。中位生存时间为 207 个月。每年的失败率分别为 I 类、II 类、III 类、IV 类和 V 类修复体的 3.8%、4.0%、4.6%、4.9%和 3.9%。II 类和 IV 类修复体的失败率比 I 类修复体高 1.1 倍（95%CI，1.0 至 1.2）和 1.2 倍（95%CI，1.1 至 1.2）（≤0.029）。年龄<20 岁和>60 岁的患者的失败率比 20 至 60 岁的患者高 1.4 倍（0.015）。每年接受两次或更多次检查的修复体的失败率明显高于每年接受检查少于两次的修复体（<0.001）。此外，牙医对失败时间有显著影响（<0.001）。关于修复材料，复合材料的失败时间比玻璃离子水门汀（GIC）长 2.1 倍（≤0.020）。在私人诊所环境中，直接修复体的中等失败率在长达 18.5 年的时间内得到了观察。在本研究的限制范围内，实践层面的几个因素（即牙医）、患者层面的因素（即年龄）和牙齿层面的因素（即修复材料、根据 Black 分类修复的表面）是失败率的显著预测因素。因此，治疗决策应考虑到最相关的因素（德国临床试验注册 DRKS00015228）。
