Clinical Evaluation of Reasons for Immediate Composite Restoration Failure Placed by Dental Students: A Cross-sectional Study in Jordan

Abstract

Objective: The present study aims to investigate the reasons for the immediate failure of direct anterior and posterior resin composite restorations placed by dental students. Methods: A cross-sectional study on resin composite restorations placed by fourth-and fifth-year dental students (n=436). Variables included in the study were; the operative field isolation method, the time needed to complete the restoration after cavity preparation to polishing and finishing, and the plaque index of the patient. Restoration class distribution according to the type of tooth and cavity classification was examined and recorded. Restorations were clinically evaluated immediately after placement. It involved the assessment of the restoration’s mobility, marginal discoloration, and lack of anatomy. Results: A total of 233 direct anterior and posterior resin composite restorations which were placed by 127 students were diagnosed as failed restorations. The mode of failure was distributed as mobility/debonding (61.80%), marginal discoloration (29.18%), and lack of anatomy (9.02%). Cl III restorations demonstrated the highest failure on tooth type and cavity classification (30%), followed by Cl II restorations in molars (18.45%). Failure-associated factors were proper restoration manipulation, field isolation, and patients’ plaque index. Conclusion: In the current study, the most frequent reason for the immediate failure of resin composite restorations was the quick application of the restoration either as the only associated factor or coupled with other failure-associated factors. Failure to maintain proper field isolation and the poor oral hygiene of the patient were the other two failure-associated factors. materials in the undergraduate curriculum at the School of Dentistry, Jordan University. BDS is a 5-year program followed by a one-year internship wherein students learn about the restoration of teeth from their 3rd academic year, where they start practicing manual skills on simulation units. In the 4th and 5th academic years, they move to the clinical courses where they treat patients under supervision. Even though our dental curriculum emphasizes teaching both amalgam and composite in pre-clinical and clinics which means that our students’ clinical training and knowledge about both restorative materials are the same, students and patients prefer to utilize tooth-colored restorative materials for restoring teeth. However, as aforementioned, resin composites are technique-sensitive materials and adequate operating field isolation is critical for the success and longevity of the restorations [8]. Moreover, the patient’s oral hygiene is an important determining factor associated with the success and longevity of such restorations anteriorly and posteriorly [9]. Students feel more comfortable when handling composites in terms of cavity preparation and material manipulation. Albeit their enthusiasm, immediate failure of those direct composite restorations is not uncommon among undergraduate dental students. The current study aimed to evaluate clinically the reasons for immediate direct composite restoration failure placed by undergraduate dental students among the patients presenting at students’ dental clinics of the School of Dentistry at Jordan University Hospital for dental caries treatment. rolls, with suction), the time needed to complete the restoration after cavity preparation to polishing and finishing (˂ half an hour, half an hour to one hour, ˃ one hour), and the plaque index of the patient (good, fair, poor). Oral hygiene was evaluated by examining the dental plaque present on the inner and outer aspects of the six index teeth (upper right first molar, upper right lateral incisor, upper left first premolar, the lower right first premolar, the lower left lateral incisor and first molar), using the criteria of the plaque index of Silness and Löe [ 10 ]. Evaluating the state of the patient’s oral hygiene during the examination was as follows: good (plaque index 0.0 absence of plaque), fair (plaque index 0.1–1.9 presence of plaque), poor (plaque index 2.0–3.0 plaque seen by the naked eye). All restorations were placed by dental students under the supervision of a staff member according to a fixed yet flexible protocol. The protocol theoretically included the following steps in sequence: local anesthesia (when needed) and rubber dam isolation (if applicable); cavity preparation following a conservative design; sectional matrix (posteriorly) or cellulose strip (anteriorly) and a wooden wedge application; acid etching with 37% phosphoric acid for fifteen seconds, rinsing and drying while leaving the dentin moist; application of dentin bonding agent and light curing for twenty seconds; incrementally restoring the cavity with resin composite and light curing each increment for forty seconds; finishing and polishing of the restoration; finally, checking the occlusion and proximal contacts (Ventura Nanolux kit, Madespa, Spain). © 2023 Al-Asmar et al.