Restoration outcomes after restoring vital teeth with advanced caries lesions: a practice-based retrospective study

Abstract

Objectives: Maintaining pulpal vitality and achieving long-term restoration success are challenging when treating advanced caries lesions. We aimed at assessing success, survival, and influencing factors of treating advanced lesions in general dental practice.

Methods: Patient record databases from six practices in Germany were assessed. Permanent posterior teeth with lesions radiographically extending into inner dentin with sensible (vital) pulps were retrospectively evaluated. Outcome parameters were success (absence of re-treatment) and survival (absence of extraction). Mean success/survival times were estimated, and effect of treatment modifiers assessed using Lee, Wei, and Amato (LWA) regression.

Results: Two hundred thirty-two patients (308 teeth) were assessed. Lesions (93 %) included proximal surfaces. Eight teeth showed preoperative intermitting or provocation pain. Thirty four % of teeth experienced pulpal exposure during excavation. Mean follow-up time was 74 months. Mean success time was 130 months. Teeth (142/308) required re-interventions, mostly due to secondary caries and restorative or endodontic complications. Only 13 teeth required extraction (mean survival time 307 months). Hazard of failure was significantly reduced in younger patients (<40 years) (hazard ratio (HR) [95 % confidence interval (CI)] 0.57 [0.35/0.91]) and teeth without preoperative pain (0.39 [0.17/0.90]). Compared with teeth receiving amalgams, those restored using cements (2.44 [1.05/3.98]) or composites (1.64 [1.15/2.38]) had higher risk of failure. Hazard of extraction was higher in teeth with pulpal exposure (4.90 [1.36/17.7] or cement restorations (23.6 [5.56/100]).

Conclusion: Teeth with advanced lesions had high risk of failure, while risk of extraction was low.

Clinical relevance: Teeth treated for advanced lesions required re-treatment frequently but were retained long term. Age, pulpal exposure, and restoration type were associated with risk of failure or extraction.

Keywords: Dental caries; Direct capping; Practice-based research; Pulpal vitality; Success; Survival.