Decision criteria for replacement of fillings: a retrospective study

Abstract

The exchange of restorations goes along with the loss of healthy tooth structure. Therefore, it is important to investigate helpful decision criteria for the replacement of fillings. Five hundred forty-four filling replacements were evaluated retrospectively. Thereby, different clinical parameters were correlated with the clinical finding of caries directly after removal of the existing filling. The parameters checked for correlations were amalgam and composite, age, and size of the filling, morphology, condition of the filling, type of caries, oral hygiene, anamnesis of the respective tooth, and the decisive factor to replace the restoration. Statistical evaluation was performed by chi-squared-test (P < 0,05) and by regression analysis (Power: 80%). A percentage of 69.8% of all cavities showed softened dentin if exploring with the probe after the removal of the restoration, 7.6% were stainable with caries detector, and 22.6% of the cavities were caries free. Significant indicators for a carious lesion were high age of restoration, imperfections at the margin of the filling, a positive pain sensation in correlation with composite fillings, and multi-surface amalgam fillings. On suspicion of caries, the following decision criteria should encourage the dentist to remove a filling: High age of the filling, imperfections at the margin of the filling, especially fillings with marginal cracks, visible secondary caries, a positive pain sensation in composite filled teeth, and multi-surface amalgam fillings. Filling removals only performed due to the patient's desire for removal should be critically regarded, as most of these fillings are caries free.