Restorative Dentistry

17.Post deliveries 

The aim of this study was to compare the 5-year outcomes of glass fibre composite with cast posts and cores for the restoration of endodontically treated teeth. A total of 143 patients in need of 203 full ceramic restorations on endodontically treated teeth were included. After primary stratification based on the need for post or no post, teeth were randomly allotted to test group 1 (prefabricated glass fibre posts), 2 (custom-made glass fibre posts), or 3 (composite cores without posts). The control group was treated with gold alloy-based wrought posts and cast cores. The mean follow-up time was 5.8 years (range 0.5-7.2); at 5 years, the success (original present) and survival (present after intervention) probabilities were 85.2% and 91.5% respectively. No significant differences for success or survival could be found among the four groups (the three test groups and the control group). After 5 years of follow-up, cast gold and composite post-and-core systems on teeth with ceramic full restorations provided with a ferrule performed equally well.

Cloet E, Debels E, Naert I. Controlled clinical trial on the outcome of glass fiber composite cores versus wrought posts and cast cores for the restoration of endodontically treated teeth: a 5-year follow-up study. Int J Prosthodont 2017 30: 71-79.

Q For at least five-year longevity, which type of post seems most effective on an endodontically treated tooth in need of restoration?
A Custom-made glass fibre composite
B Prefabricated glass fibre composite
C Gold alloy-based wrought 
D All are equally effective

18.Sensitivity slurry tested

The aim of this study was to investigate the effect of an aqueous slurry of calcium phosphates on the pre- and postcementation sensitivity of contralateral premolars prepared for full-coverage restorations. Using a split-mouth design, 20 patients were allocated and two contralateral vital premolars per patient were randomly assigned to treatment with the test or placebo. One day after preparation and temporisation, sensitivity (pre-) upon air blast (AB) and probe scratch (PS) was determined using a visual analogue scale (VAS). Sensitivity was assessed immediately after treatment, before seating the final crowns after 1 week, and 1 month after cementation. VAS scores upon stimulation with AB and PS were significantly lower postoperatively and 1 week, and with AB after 1 month in the test group. The treated teeth showed significantly less sensitivity than the placebo treated teeth. At the postcementation recall neither group were significantly different and the average pain scores were almost zero. Treatment of teeth prepared for full crown restorations in this way can significantly reduce pre- and postcementation sensitivity.

Shetty R et al. effect of a calcium phosphate desensitizer on pre- and postcementation sensitivity of teeth prepared for full-coverage restorations: a randomized, placebo-controlled clinical study. Int J Prosthodont 2107 30: 38-42.

Q Using an aqueous slurry of calcium phosphates:
A Reduced pre- and post- cementation sensitivity in patients with full coverage restorations
B Eliminated sensitivity to air but not to probe scratching
C Eliminated sensitivity to probe scratching but not to air
D Had no different effect on sensitivity than a placebo

19.Composite figures on composites

Clinical studies published on the performance of posterior composite restorations were included in this review except those of less than a 24-month assessment period. Records about composite type, number of final recall restorations, failure/survival rate, assessment period and failure reasons were analysed for each decade. Overall survival/failure rates for studies in 1995-2005 were 89.41%:10.59% and for 2006-2016 were 86.87%:13.13% respectively. In 1995-2005 the reasons for failure were secondary caries (29.47%) and composite-fracture (28.84%) with low tooth-fracture (3.45%) compared to reasons of failure in 2006-2016, which were secondary caries (25.68%), composite-fracture (39.07%), and tooth-fracture (23.76%). An increase in incidence of composite-fracture, tooth-fracture and need for endodontic treatment as failure reasons was noted in the later decade in addition to a decrease in secondary caries, post-operative sensitivity, unsatisfactory marginal adaptation and wear. The overall rates of failure showed little difference, but the causes showed a notable change. This is believed to be a reflection of increased use of composites for larger restorations and possibly changes of material characteristics.

Alvanforoush N et al. A comparison between published clinical success of direct resin composite restorations in vital posterior teeth in 1995-2005 and 2006-2016 periods. Australian Dent J 2016 Nov 16. doi: 10.1111/adj.12487. [Epub ahead of print].

Q What were the reasons put forward for the change in causes of failure of composite in the two time periods studied? 
A Clumsiness of clinicians and use in larger restorations
B Increased use of composites for larger restorations and possibly changes of material characteristics
C Cost of materials and increase in patient complaints 
D Increased use of composites for smaller restorations and changes of material strength

20.The cost of ART

This study assessed cost-effectiveness from the service provider perspective of the atraumatic restorative treatment-based (ART-based) approach against the standard care (SC) approach to managing early childhood caries in a primary care setting based on a 1-year pragmatic randomised controlled trial. Outcomes included number of referrals to specialists and dental treatments. Six children in the ART-based group and 62 children in the SC group (n=127/group) were referred for paediatric dental specialist care. Children in the ART-based group received more dental services than those allocated to the SC group. Total costs of the ART-based approach and the SC group were Australian$137,860 and $178,217, respectively. Based on analysis, $654 was saved per avoidance of referral to a specialist and $36 was saved per additional dental treatment. Specialist dental treatment fees had a big impact on the cost-effectiveness estimates. The ART-based approach appeared to be a worthwhile intervention because it resulted in fewer referred cases and enabled more treatments to be provided with cost-savings.

Tonmukayakul U, Arrow P. Cost-effectiveness analysis of the atraumatic restorative treatment-based approach to managing early childhood caries. Community Dent Oral Epidemiol 2016 Nov 14. doi: 10.1111/cdoe.12265. [Epub ahead of print].

Q The ART-based approach to manging childhood caries:
A Would appear to cost more as the restorations need more regular replacement 
B Is inappropriate where standard care is available 
C Resulted in fewer referred cases 
D Caused more cases to be referred