R A Bresser1, D Gerdolle2, I A van den Heijkant1, L M A Sluiter-Pouwels1, M S Cune3, M M M Gresnigt4. 1. University Medical Center Groningen, University of Groningen, Center for Dentistry and Oral Hygiene, Department of Restorative Dentistry and Biomaterials, Groningen, The Netherlands. 2. Private Practice, Montreux, Switzerland. 3. University Medical Center Groningen, University of Groningen, Center for Dentistry and Oral Hygiene, Department of Restorative Dentistry and Biomaterials, Groningen, The Netherlands; St. Antonius Hospital, Department of Oral Maxillofacial Surgery, Prosthodontics and Special Dental Care, Nieuwegein, The Netherlands; University of Utrecht, University Medical Center Utrecht, Department of Oral Maxillofacial Surgery, Prosthodontics and Special Dental Care, Utrecht, The Netherlands. 4. University Medical Center Groningen, University of Groningen, Center for Dentistry and Oral Hygiene, Department of Restorative Dentistry and Biomaterials, Groningen, The Netherlands; Martini Hospital, Department of Special Dental Care, Groningen, The Netherlands. Electronic address: marcogresnigt@yahoo.com.
Abstract
OBJECTIVES: Deep margin elevation (DME) relocates the cervical outline of large-sized cavity dimensions in the posterior area supragingivally, using a resin composite in a direct technique. The aim of this study is to evaluate the clinical performance of partial indirect restorations with DME and compare the effects of selected baseline variables on the (quality of) survival of the restorations. METHODS: All teeth that were restored in combination with indirect restorations and DME between 2007 and 2016 were eligible for inclusion. Overall cumulative survival rates were calculated (Kaplan-Meier estimates) and compared among subsets of variables. Qualitative evaluation of all surviving restorations was performed using the modified United States Public Health Service (USPHS) criteria using Chi-square tests. RESULTS: A total of 197 indirect restorations in 120 patients could be included. Restorations or teeth presenting with secondary caries, fracture of the restoration/tooth, debonding of the indirect restoration, root caries, severe periodontal breakdown or pulpal necrosis were considered as absolute failures (n = 8) leading to an overall cumulative survival rate of 95.9% (SE 2.9%) up to 12 years, with an average evaluation time of 57.7 months. Some indication of degradation of the restorations was seen over time. Indirect composite restorations showed more degradation compared to ceramic restorations (p = 0.000). More wear of the antagonist was observed when teeth were opposed to ceramic restorations (p = 0.04). Endodontic treatment negatively impacted the occurrence of fracture of restorations and teeth (p = 0.000). CONCLUSIONS: Indirect restorations with DME have a good survival rate in this study, however longer follow-up is needed as degradation of the restorations is seen over time. CLINICAL SIGNIFICANCE: This long-term study shows the possible clinical applicability of deep margin elevation.
OBJECTIVES: Deep margin elevation (DME) relocates the cervical outline of large-sized cavity dimensions in the posterior area supragingivally, using a resin composite in a direct technique. The aim of this study is to evaluate the clinical performance of partial indirect restorations with DME and compare the effects of selected baseline variables on the (quality of) survival of the restorations. METHODS: All teeth that were restored in combination with indirect restorations and DME between 2007 and 2016 were eligible for inclusion. Overall cumulative survival rates were calculated (Kaplan-Meier estimates) and compared among subsets of variables. Qualitative evaluation of all surviving restorations was performed using the modified United States Public Health Service (USPHS) criteria using Chi-square tests. RESULTS: A total of 197 indirect restorations in 120 patients could be included. Restorations or teeth presenting with secondary caries, fracture of the restoration/tooth, debonding of the indirect restoration, root caries, severe periodontal breakdown or pulpal necrosis were considered as absolute failures (n = 8) leading to an overall cumulative survival rate of 95.9% (SE 2.9%) up to 12 years, with an average evaluation time of 57.7 months. Some indication of degradation of the restorations was seen over time. Indirect composite restorations showed more degradation compared to ceramic restorations (p = 0.000). More wear of the antagonist was observed when teeth were opposed to ceramic restorations (p = 0.04). Endodontic treatment negatively impacted the occurrence of fracture of restorations and teeth (p = 0.000). CONCLUSIONS: Indirect restorations with DME have a good survival rate in this study, however longer follow-up is needed as degradation of the restorations is seen over time. CLINICAL SIGNIFICANCE: This long-term study shows the possible clinical applicability of deep margin elevation.
Authors: Mario Dioguardi; Mario Alovisi; Giuseppe Troiano; Carlo Vito Alberto Caponio; Andrea Baldi; Giovanni Tommaso Rocca; Allegra Comba; Lorenzo Lo Muzio; Nicola Scotti Journal: Clin Oral Investig Date: 2021-10-10 Impact factor: 3.573