Treatment history of teeth in relation to the longevity of the teeth and their restorations: Outcomes of teeth treated and maintained for 15 years

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Statement of problem

Limited clinical data exist on the survival of teeth relative to their treatment history.

Purpose

This study evaluated failure of teeth relative to their treatment history.

Material and methods

Longitudinal data were collected for 3071 teeth from 148 fully compliant patients from 1 private practice in Yamagata, Japan. Follow-up times ranged from 15 to 23 years, with a mean of 19.2 years (SD 2.4). In this study, every tooth and its restoration were evaluated by one of the authors at the time of each maintenance visit. Treatment history of the teeth was categorized at baseline as follows: (1) sound, unrestored tooth (SUT); (2) 1-surface restoration (RT1); (3) 2-surface restoration (RT2); (4) 3-surface restoration (RT3); (5) 4+-surface restoration (RT4); (6) complete crown (CCT); (7) abutment for fixed partial dental prosthesis (AFT); (8) abutment for removable partial dental prosthesis (APDT); and (9) root canal treatment (RCT). Three types of failure modes were evaluated in this study: (1) restorative failure (secondary caries and/or fracture), (2) extraction, and (3) any failure (restorative failure or extraction). Multivariate survival analysis was used to determine the impact of the treatment history on failure (α=.05).

Results

Teeth with multi-surface restorations experienced the highest incidence of any failure (P<.001). For secondary caries, similar risks were noted for the different treatment histories. For failures resulting in extraction, the only teeth with an increased risk were abutments for removable partial dental prostheses (relative risk=5.5) (P=.008).

Conclusions

The data demonstrated that restored teeth experienced a higher incidence of failure compared with unrestored teeth. Complete crowns and abutments for fixed partial dental prostheses had fewer restorative failures when compared with teeth with complex multisurface restorations. Removable partial denture abutments experienced the highest failure rate.

Section snippets

Material and methods

A total of 548 healthy patients who initiated dental treatment from 1980 to 1988, between the ages of 18 and 73 years, were selected from the patient records of a private office in Yamagata, Japan. Follow-up times ranged from 15 to 23 years, with a mean of 19.2 years (SD 2.4). Patients provided informed consent to the treating dentist before treatment was initiated. Clinical staff collected data and stripped the data of personal identifiers before providing the data to the collaborators on this

Results

Descriptive statistics based on patient-level data were calculated for the baseline age and clinical variables, such as bleeding on probing, plaque index, percentage of sites with probing depths less than 3 mm, percentage of sites with probing depths ranging from 4 to 6 mm, and percentage of sites with probing depths greater than 7 mm (Table I). Descriptive statistics based on tooth-level data for treatment history, such as RT1, AFT, APDT, and RCT, were calculated and are presented in Table II.

Discussion

Most of the results from this study appear intuitive. However, in this age of evidence-based health care, dentists, patients, and third-party payers are seeking substantive data from clinical studies to support treatment decisions. This study provides such data. The longevity of unrestored teeth was superior to that of teeth with any restoration. Therefore, preventing the need for restorations, such as the application of pit and fissure sealants, dietary counseling, daily use of fluoridated

Conclusions

Based on the results of this retrospective study and within the limitations of the study design, the following conclusions were drawn:

  • 1.

    Unrestored teeth had the best overall survival when compared with restored teeth (including single-surface and multisurface restorations), endodontically treated teeth, and abutments for FPD and RPD prostheses.

  • 2.

    Teeth with 3 to 5 surface restorations were 4 times more likely to fail when compared with unrestored teeth.

  • 3.

    Complete crowns and abutments for FPD

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    This study was supported by NIH/NIDCR Grant No. R03DE016924.

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