Long-term evaluation of extensive restorations in permanent teeth

The present prospective, longitudinal study assessed the outcome of posterior extensive restorations and identified risk factors for failure of the restorations.

The sample consisted of 722 amalgam restorations, 115 composite resin restorations and 89 crowns placed in 428 adults by one dentist from 1982 to 1999 in Belgium. Well-defined criteria were used for cavity preparation design, type of retention and selection of restorative material.

At the closure of the study 48% of the restorations were well functioning, 24% were lost to lack of follow-up, and 28% had failed. The most frequent reasons for failure were fracture of restoration (8%), secondary caries (6%) and fracture of cusp (5%). Failures were more often found in premolar teeth (34%) than in molars (27%) (P=0.05) and occurred in 28% of the amalgam restorations, 30% of the resin restorations and 24% of the crowns (P=0.55). Molar restorations were more frequently repaired than replaced in contrast to premolar restorations. The highest percentage of extractions was related to complete amalgam restorations in premolars. The Kaplan-Meier median survival times were 12.8 years for amalgam restorations, 7.8 years for resin restorations, and more than 14.6 years for crowns, considering all retreatment as failures (P=0.002). The survival was influenced by extension of restoration, age of patient, pulpal vitality, 3-year period of treatment, use of base material and dentinal retentive pins.

Within the limits of the study the data support the view that extensive amalgam restorations but not composite resin restorations can be used as an appropriate alternative to crowns, with due consideration to the longevity of the restorations.