Longevity and associated risk factors in adhesive restorations of young permanent teeth after complete and selective caries removal: a retrospective study

Abstract

Objective: 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). Materials and methods: 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). Results: 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). Conclusion: 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. Clinical relevance: 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.