Long-term survival and reasons for failure in direct anterior composite restorations: A systematic review.

This study investigated the clinical longevity of direct anterior composite restorations. Clinical studies exploring survival of anterior light-cured composite restorations with minimum of 2 years of follow-up were screened and reasons related to failure of direct anterior composite restorations were noted. PubMed, LILIACS, ProQuest, CENTRAL, and MEDLINE databases were searched with no restriction on date. Articles obtainable in the English language solely were enclosed during this study. Furthermore, articles to which reviewers had access were solely enclosed in ProQuest. Reference lists of eligible studies were hand searched. Initially, four reviewers screened the titles/abstracts of 947 studies. Out of those studies, a total of 47 articles were selected for full text reading, from which 25 studies were selected for qualitative synthesis. The studies that were enclosed evaluated the clinical performance of composite class III and class IV restorations (11 studies), which were placed due to caries, fracture, or replaced old restorations, veneers and full coverage restorations placed for esthetic reasons (9 studies), restorations in worn teeth (4 studies) with one study including combination of three type of studies listed above. A total of 75,637 restorations were evaluated and annual failure rates were in the range of 0% to 27.11% with survival rates ranging from 28.6% to 100%. Class III restorations had lower failure rates than alternative restorations. Fracture was the main cause of failure of restorations. The factors related to failure of restoration were adhesive technique, type of composite resin used, replacement of restoration first placed, and time required to make up the restorations. Copyright:

INTRODUCTION

Dental caries remains a malady that affects an oversized part of the world's population.[1] There is an oversized demand for the restorative procedures in odontology that consumes most of the operating time of the dentists within the world.[2] Composite resins have gained quality as a restorative choice thanks to their esthetic properties and minimal invasiveness.[3] Thus, composite resin is the premier material for restoration of the anterior and posterior teeth these days.[456] Literature shows that restorations with this material will gift of failure rates and very long time survival in posterior teeth.[78] Secondary decay and fracture are the most reasons for failure within the posterior teeth.[89] There is the lack of proof in the literature concerning the clinical performance of anterior composite restorations within the long run.[5] The increasing demand for esthetics within the anterior region suggests that restoration failure apart from fracture and decay will occur at an oversized extent within the anterior region. A variety of composites are obtainable as a preferred option for restoration in anterior teeth; in vitro tests sometimes indicate differences among the materials while the in vivo tests do not indicate the same.[101112] The aim of this study was to assemble the data by conducting a systematic review of the literature on the long-term survival of the composite resin restorations placed within the anterior region. Clinical prospective and retrospective studies investigating the survival of anterior composite restorations with follow-up amount of minimum 2 years were searched to list the most reasons of failure and whether or not the factors associated with patient, operator and materials would impact the longevity of direct anterior composite restorations.

MATERIALS AND METHODS

Eligibility criteria

This systematic review is reportable as per the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement tips.[13] Before beginning the systematic review, it had been registered on PROSPERO with identification number CRD42020211176. Eligible studies were longitudinal prospective or retrospective clinical trials that evaluated the clinical survival of direct restorations in anterior permanent teeth placed with the visible light cured composite resins. The restorations evaluated enclosed Class III and Class IV cavities, direct veneers and full-coverage build ups. The studies enclosed had a minimum of 2 years of follow-up.

Search strategy

Search for studies from totally different databases (PubMed, LILIACS, ProQuest, CENTRAL, and MEDLINE) was executed with no restriction on date when the study was published. Studies which were a part of qualitative synthesis were published from the year 1997 to 2018. Restriction was put on language and that's why studies in English only were selected. Search strategy was developed by taking reference from the study revealed by Demarco in 2015.[14] The subsequent keywords were utilized in many combinations in numerous databases:

Direct composite resins

Anterior teeth

Restorations

Longitudinal study

Retrospective study

Dental laminates

Dental veneers

Clinical trial.

Study selection

Four reviewers screened the titles and abstracts of all the known studies for eligibility (70,690 studies). All the studies that met the eligibility criteria were selected for full-text reading (47 studies). Full-text articles that satisfied the eligibility criteria were enclosed in the study (25 studies) and processed for knowledge extraction and the reasons for exclusion were recorded. Judgment on inclusion or exclusion was made following discussion with a proficient researcher.

Data extraction

Data from the complete text articles were extracted by the two reviewers. Knowledge assortment was done on the overall study information, intervention characteristics, and longevity outcomes for anterior direct composite restorations (annual failure rate, survival or success rate, and factors related to the restoration failure. For studies that presented results in survival or success rate, the AFR were calculated according to the formula: (1 − y) z = (1 − x), in which 'y' expresses the mean AFR and 'x' the total failure rate at 'z' years given by Demarco et al. in 2015.[14] Mean of the survival rates was calculated for the studies revealing two survival rates for two different types of composites in the same study. Data were divided into three groups according to the type of restoration assessed.[15]

Data analysis

High heterogeneousness was seen among the enclosed studies concerning the study style, methods, and outcomes. Therefore, a meta-analysis was not conducted, and qualitative synthesis was performed for the information collected.

RESULTS

The sequence of finding out the articles is given within the flow chart of this systematic review (PRISMA Flow Chart 1). From the initial 396 articles known once removing the duplicates, 47 full-text articles were assessed for eligibility and 25 studies were subjected to analysis. Table 1 shows all the studies enclosed during this systematic review and details collected from every study. Most of the studies were prospective longitudinal studies with follow-up periods starting from 2 years to 17 years. Four studies reported follow-up amount of quite 10 years from the chosen 25 studies in this systematic review. The number of restorations assessed varied greatly among the studies enclosed for qualitative analysis. Most of the studies used the modified United States Public Health Service (USPHS) criteria for evaluating the success or failure of the composite restoration. Four studies used their own criteria to judge the restorations and remaining studies used modified ryge criteria or dental federation (FDI) criteria for the same purpose. Solely two studies reported no failure of the restoration in the follow-up period of up to 5 years, whereas one study reported that the chance of the survival of the restoration was only 50%.[161718] The AFR ranged from 0% to 27.11% and the survival rates varied from zero to hundred percent. In some of the studies mean survival rate and mean AFR's were calculated; in case the study reported two survival rates and AFR for different material tested or the different type of the tooth tested.[4192021] Only ten studies reported the associated reason for failure or the risk factor responsible for the failure. Table 2 reveals the associated reasons for the failure of the restoration provided by the chosen studies in which fracture was the foremost common reason for the failure of the restoration.

Flow Chart 1

PRISMA

Table 1

Studies with at least two years of follow-up evaluating anterior composite restorations

Author/year	Country	Study design	Follow-up (years)	Pts/number of restorations	Restoration type	Composite type	Success rate/AFR	Failure criteria
Khayatt et al., 2013[16]	England (UK)	PL	7	15/85	Build ups	Herculite XRV	85/2.3	Modified USPHS
Smales and Berekally, 2007[17]	Australia	RL	10	-/164	Class IV Build ups	-	62/	Own Criteria
Loomans et al., 2018[18]	Netherlands	PL	3.5	34/687	Build ups	Clearfill AP-X IPS empress	96.3/1.1	Own Criteria
Gulamali et al., 2011[19]	London (U.K)	PL	10	26/283	Build ups	-	28.6/27.1	USPHS Criteria
Alonso and Caserio, 2012[20]	Spain	RL	11	13/21	Veneers	TPH spectrum Herculite XRV Filtek A110	75.2/2.5	Modified USPHS
Ergin et al., 2018[21]	Turkey	PL	4	19/58	Diastema/veneers	Filtek Z550 Charisma Diamond	94.9/1.25	FDI Criteria
Peumans et al., 1997[15]	Belgium	PL	5	23/87	Veneers/diastema	Herculite XRV	82.8/3.7	Own Criteria
Demirci et al., 2015[22]	Turkey	PL	4	30/147	Diastema	Filtek Supreme XT Ceram X Duo	93/1.6	Modified Ryge Criteria
Lempel et al., 2017[23]	Hungary	RL	7	65/163	Fracture/diastema	78 Filtek Supreme XT 85 enamel Plus HFO	88.3/1.4	USPHS Criteria
Meijering et al., 1998[24]	Netherlands	PL	2.5	-/69	Veneers	Silux Plus 3M	74/2.4	Own Criteria
Gresnigt et al., 2012[12]	Netherlands	PL	4	23/96	Veneers	Enamel plus HFO Miris 2	87.5/3.2	Modified USPHS
Frese et al., 2013[25]	Germany	RL	5	58/176	Veneers/diastemas	Enamel Plus HFO Herculite XRV sthetX	84.6/3.2	Modified USPHS Criteria
Van Dijken et al., 1999[26]	Sweden	PL	5	52/149	Class III Class IV	Pekafill PLT	96/0.8	Modified USPHS Criteria
Coelho de Souza et al., 2015[27]	Brazil	RL	3.5	86/196	Veneers	Microfilled X Universal	80.1/7.4	FDI Criteria
Collares et al., 2017[28]	Netherlands	RL	10	29,855/72,196	-	-	95.4/4.6	-
Demirci et al., 2008[29]	Turkey	PL	2	32/96	Class III	Filtek A110	96.4/3.6	Modified Ryge Criteria
Demirci et al., 2018[30]	Turkey	PL	5	34/84	Class IV	Filtek Supreme XT Ceram X	87.69/1.46	USPHS Criteria
van Dijken and Pallesen, 2010[31]	Sweden	PL	14	-/43	Class IV	Pekafill PLT	74.4/2.1	Modified USPHS Criteria
Van de Sande et al., 2018[32]	Brazil	RL	15	144/226	Class III Class IV	Micro-hybrid, micro-filled	66.5/2.6	-
Moura et al., 2011[4]	Brazil	RL	3	-/170	Class III Class IV	TPH Spectrum	84.8/5	Modifed USPHS Criteria
Millar et al., 1997[33]	England	PL	8	-/28	Class III Class IV	Opalux	85.7/1.9	Modified USPHS Criteria
Kubo et al., 2011[34]	Japan	RL	10	58/147	Class III	Clearfill AP-X	81.5/2	Modified USPHS Criteria
Ermis et al., 2010[35]	Turkey	PL	3	30/80	Class III	Clearfill AP-X	No Failures	Modified USPHS Criteria
Deliperi et al., 2008[36]	Italy	PL	5	20/25	Class III/Class IV	Vitalesence	No Failures	Modified USPHS Criteria
Baldissera et al., 2013[5]	Brazil	RL	17	55/219	Class III Class IV	Charisma Herculite XRV	89.9/0.6	FDI Criteria

PL: Prospective longitudinal, RL: Retrospective longitudinal, AFR: Annual failure rate, -: Not mentioned, USPHS: United States Public Health Service

Table 2

List of reasons for failure

Author/year	Main reasons for failure of restoration
Al Khayatt (2013)	Time to build up the restoration
BAC Loomans (2018)	Chip fractures and caries
AB Gulamali (2011)	Tooth wear
Lempel (2017)	Color mismatch and fracture of the restoration
Meijering (1998)	Fracture chipping and color mismatch
Coelho de Souza (2015)	Fracture and nonvital teeth
Collares (2017)	Young age and large restoration
Demirci (2018)	Fracture of the restoration
Kubo (2011)	Retreatment risk and adhesive technique
Baldiseera (2013)	Composite used

DISCUSSION

The need for the anterior composite restorations is continuously increasing because the patients are more cautious about their aesthetic look. Hence, there was a desire to systematically review the long-term survival of anterior composite restorations. One review with meta-analysis has been reported on the same topic. The review enclosed solely prospective studies with observation time of quite 2 years. Furthermore, within the meta-analysis, chemically cured composites and resin modified glass ionomer cements were enclosed however retrospective studies were excluded. This resulted in the set of studies which were overlapping to only certain extent. The 10-year survival rates for the class III and class IV restorations were reported to be 95% and 90% with AFR's moving around 0.5%−1%.[37] The AFR's of this study were not in line with the review discussed above.

Another review reported in 2015 enclosed studies with follow-up period of more than 3 years reported the survival rates between 53.4% to 100% and AFR's between 0% to 4.1%.[14] Several of the studies overlapped with this review during this study thanks to the very fact that studies with follow-up period of more than 2 years were enclosed in this systematic review. Most of the studies used modified USPHS criteria for evaluating the failure or success of the restoration. Eleven studies used the modified USPHS criteria, three studies used the USPHS criteria, four studies used their own criteria, four studies used the FDI criteria and four studies did not report the method of evaluation. The studies that used their own criteria compromise the comparisons among studies. The overall results of our study showed that anterior composite restorations have good clinical performance history except one study published in 2011 which provided restorations to manage the localized anterior tooth wear.

A study by Coelho de Souza in 2015 reported that there are higher probabilities of failure of the restoration in nonvital teeth. The AFR's for the vital teeth were 4.9%, whereas the AFR's for the nonvital teeth were 9.8% within a follow-up time of around 4 and a ½ years.[27] A study reported by Van de Sande in 2018 reported that there was a differentiation in the survival rates when composite repair was not considered as a failure and when it was considered as a failure. The class III and class IV restorations showed 69% survival and 2.4% AFR when repair was not considered as a failure, and 64% survival and 2.9% AFR, respectively, when repair was considered as a failure.[32]

A number of studies reported the reason or the risk factor associated with the failure of the restoration. Fracture, tooth wear, color mismatch, nonvital teeth, massive restoration, retreatment risk, and adhesive technique used were some of the explanations for the failure of the restorations. Out of these, fracture was the foremost common reason for the failure of the restoration. The class IV restorations which involve the incisal edge are subjected to high masticatory loads with the fracture as the most common clinical outcome over time.[45] A study by Heintze showed that class IV restorations had double the failure rate than class III restorations.[37]

A number of studies self-addressed patient and operator connected factors associated with the restoration failure. In one study that evaluated the build ups placed in worn teeth showed that long time required to place the restoration is associated with higher chances of the failure of the restoration.[35] The study with the longest follow-up period of 17 years showed that composite with lower mechanical properties exhibited higher chances of failure than a composite with higher filler content and elastic modulus.[5]

The studies included in this systematic review evaluated solely the restorations and not the patient factors. This is often critical when more than one restoration is evaluated in a single individual. The clinical performance and longevity of the anterior composite restorations look good however there will be a lot of improvement within the style of the clinical trials to judge the longevity of the anterior composite reasons and investigate the explanations for the failure of the restoration.

CONCLUSION

This review presents good clinical performance of the anterior composite restorations and the main reason for failure is the fracture of the restoration and esthetic appearance. More studies can be carried out in the well-designed manner to check the longevity of the anterior composite restorations in future.

Financial support and sponsorship

Self.

Conflicts of interest

There are no conflicts of interest.