Department of Operative Dentistry and Dental Materials, School of Dentistry, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil.
Department of Postgraduate Program in Dentistry, CEUMA University, São Luis, Maranhão, Brazil.
PLoS One. 2020 Dec 22;15(12):e0243288. doi: 10.1371/journal.pone.0243288. eCollection 2020.
The aim of this retrospective study was to evaluate the survival and associated factors for the longevity of direct posterior restorations and to verify whether the geographic location of public health units could influence the long-term survival of such restorations. Data were extracted from electronic patient files of the Brazilian public oral health services. The sample comprised 2,405 class I and II restorations performed 4 to 24 years ago (mean, 8.9 years) in 351 patients (6.8 teeth/patient) across 12 public health units located in different city regions (42 professionals-55 restorations). The restoration was considered successful if it had not been repaired or replaced at the time of evaluation; failure was defined as replacement of the restoration, the need for endodontic treatment, tooth/restoration fracture or tooth extraction. Data were analyzed using the Kaplan-Meier test for restoration survival and Cox regression to evaluate the factors associated with failure. The majority of the restorations involved the use of amalgam (85%), involved a single face (70%), and were without pulp/dentin capping (85%). The overall survival rate was 95%, and the mean observation time was 8.9 years. The restoration survival was 79% (95% CI: 60.6-89.5) over 24 years, and the mean survival time was 22.2 years (95% CI: 21.9-22.6 years). The annual failure rate up to 24 years was 0.9%. After the adjustment, only the number of restored faces and the geographic location where the restoration was performed remained associated with failure of the restoration. The direct posterior restorations performed at the evaluated public health service units presented high survival rates. The restorations of people with lower access to POHS had lower survival rates. Class I restorations presented higher survival rates than class II restorations with two or more faces, regardless of the restorative material used.
本回顾性研究旨在评估直接后牙修复的生存率及影响其长期生存的相关因素，并验证公共卫生单位的地理位置是否会影响此类修复体的长期生存率。研究数据从巴西公共口腔卫生服务的电子患者档案中提取。样本包括 351 名患者的 2405 个 I 类和 II 类修复体，这些修复体于 4 至 24 年前（平均 8.9 年）进行，分布在位于不同城市区域的 12 个公共卫生单位（42 名医生-55 个修复体）。如果在评估时修复体未进行修复或更换，则认为修复体成功；如果修复体更换、需要根管治疗、牙/修复体折裂或拔牙，则定义为失败。采用 Kaplan-Meier 检验评估修复体生存率，采用 Cox 回归分析评估与失败相关的因素。大多数修复体采用银汞合金（85%）、涉及单个面（70%），且未进行牙髓/牙本质覆盖（85%）。总体生存率为 95%，平均观察时间为 8.9 年。24 年内修复体的生存率为 79%（95%CI：60.6-89.5），平均生存时间为 22.2 年（95%CI：21.9-22.6 年）。24 年内的年失败率为 0.9%。调整后，只有修复的牙面数量和修复部位与修复失败相关。评估的公共卫生服务单位所进行的直接后牙修复体具有较高的生存率。修复体数量较少的人群和修复体数量较少的公共卫生单位的修复体生存率较低。与使用两种或更多牙面的 II 类修复体相比，无论使用何种修复材料，I 类修复体的生存率均较高。
