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Diagnostic Strategies for Restorations Management: A 70-Month RCT.

V H Digmayer Romero1,2, C Signori3, J L S Uehara1

  • 1Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil.

Journal of Dental Research
|May 16, 2024
PubMed
Summary

A caries-focused diagnostic strategy for dental restorations leads to fewer initial interventions compared to one including marginal defects. Both strategies demonstrated similar long-term restoration survival rates, suggesting conservative approaches are effective.

Keywords:
cariescaries detection/diagnosis/preventiondecision makingrestorative dentistrysecondary caries

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Area of Science:

  • Dental materials science and restorative dentistry.
  • Clinical trial methodology and diagnostic accuracy studies.

Background:

  • Assessing secondary caries and restoration longevity is crucial for effective dental treatment.
  • Existing diagnostic criteria vary in their focus, potentially impacting clinical decision-making and outcomes.

Purpose of the Study:

  • To compare the long-term survival of permanent posterior restorations managed by two distinct visual diagnostic strategies.
  • To evaluate the impact of caries-focused versus a broader criteria-based approach on restoration interventions and longevity.

Main Methods:

  • A diagnostic cluster-randomized clinical trial with two parallel groups: Caries (C) using ICDAS criteria and Caries plus Additional Staining (C+AS) using FDI criteria.
  • Restoration management decisions were based on the allocated diagnostic strategy.
  • Restoration failure was the primary outcome, assessed up to 71 months using Cox regression analysis.

Main Results:

  • The C strategy resulted in significantly fewer initial interventions (8.4% repaired/replaced) compared to C+AS (31.7%).
  • No statistically significant difference in long-term restoration failure rates was observed between the C group (9.2%) and the C+AS group (8.4%).
  • Hazard ratio for failure was 0.83 (95% CI: 0.51 to 1.38; P = 0.435) with C+AS as reference.

Conclusions:

  • A diagnostic strategy focusing on marginal defects (C+AS) leads to more initial interventions but does not improve restoration longevity compared to a caries-focused strategy (C).
  • Findings suggest that more conservative diagnostic and management approaches for secondary caries and restoration assessment may be equally effective in ensuring long-term survival.
  • The study highlights the importance of evidence-based diagnostic criteria in optimizing dental restorative treatment decisions.