Experts' Willingness to Restore With Direct Composite: Complexity, Cuspal Coverage, and Techniques

Minimal evidence exists on how class II cavity complexity influences direct restoration provision or if complexifying factors influence the use of techniques and materials. This study aimed to explore: (1) experts' willingness to restore a variety of specific presentations of class II cavities with direct composite restorations; (2) the influence of cavity characteristics on this and the provision of cuspal coverage; and (3) how varying cavity presentations affected technique and material use.

An e-questionnaire developed by international experts was distributed to 67 experts on direct composite restoration. The questionnaire section reported here presented vignettes of varying class II cavities, coded by potential complexifying factors. Respondents were asked if they would restore them with a direct composite. If so, it then asked what specific materials and techniques would be used. Regression analyses were performed.

Vignette response rate was 78%. There was a large variation in willingness to restore varying class II cavity presentations with direct composite. This was significantly influenced by the presence of large inter-proximal 'bridging' gaps, root fillings, broad boxes, ≥ 3 cavity surfaces involved and deep sub-gingival margins. When present, these complexifying characteristics affected material and technique use. Those willing to restore more complex cavities were more likely to use more curved circumferential bands and less likely to use a rubber dam, among other factors.

Cavity complexity affects experts' willingness to place direct composite restorations. The willingness to use a variety of techniques was associated with a greater readiness to restore more complex class II cavities with direct composite.