Direct technique premolar coronal restorations: From metallic material to "complete adhesive restoration"

Abstract

Introduction: The choice of restorative materials has for a long time been determined by the tooth position. Thus, premolar restoration depended on the practitioner's clinical assessment and practical experience in regard to the material to be handled.

Aim: The objective of this study was to assess, in the students' practice, the change in the choice of materials used for premolars restoration.

Materials and methods: This was a retrospective study based on the available care records in the department of conservative dentistry and endodontics of a dental school. Variables analyzed included the year of restoration, the type of material, the premolar position in the arch, and the coronal restoration site (occlusal, proximal, and cervical). Data collected were processed with the SPSS software version 22 (SPSS Inc., Chicago, IL, USA; 2013). The statistical significance threshold was set at 5% for Pearson's Chi-square test.

Results: Between 1994 and 2017, 1738 restored premolars were identified. Over the years, amalgam restorations declined from 99.2% in 1994 to 1.3% in 2017, contrary to composite whose frequency increased from 0.6% to 88.6%. Maxillary premolars were exclusively restored with composite in 2017 when amalgam was still, somewhat, used for mandibular premolars.

Conclusion: The reversal in the choice of materials in favor of composites reflects the global trend. This seems to be related to the current awareness of the prohibition, among others, of medical devices containing mercury.

Keywords: Amalgam; composite; glass ionomer cement; premolar restoration.

Figure 1

Distribution of premolar restorations from 1994 to 2017. The largest number of restorations was recorded in 1994 and 2014. The differences were due to the variation in the number of students per academic year. Number of restorations

Figure 2

Distribution of restorations from 1994 to 2017 according to premolars and dental sites: Most direct technique coronal restorations were maxillary premolars and proximal (P = 0.000, significant differences observed). Occlusal Proximal Cervical

Figure 3

Number of materials on all premolar restorations between 1994 and 2017: There were more amalgam coronal restorations than any other coronal restorations. Amalgam Composite Glass Ionomer

Figure 4

Patterns in the material choice by year: The 2014 academic year was the cutoff point for a radical change in the choice of restorative materials in favor of composite and GIC. (P = 0.000, significant observed differences). Amalgam Composite Glass Ionomer

Figure 5

As of 2014, vital pulp teeth and non-vital teeth are essentially restored with adhesive materials (P = 0.5. Observed differences are not significant). Amalgam Composite Glass Ionomer

Figure 6

Distribution of materials according to the restored site: Before 2014, amalgam was used in cervical area restorations; after 2014, this site is exclusively restored with composite and glass ionomer cement; the latter is also found in occlusal and proximal surface restorations. (P = 0.000, significant observed differences). Amalgam Composite Glass Ionomer

Figure 7

Patterns of material used for occlusal surface restoration: No amalgam restoration was performed in 2017. (P = 0.000, significant observed differences). Amalgam Composite Glass Ionomer

Figure 8

Patterns of materials used for proximal face restoration during the last 4-year period (2014–2017): Glass ionomer cement proximal face restorations were found in 2015 and 2016. (P = 0.000, significant observed differences). Amalgam Composite Glass Ionomer

Figure 9

Patterns of materials used for cervical area restoration: Since 2014, no cervical area restoration has been done with amalgam. (P = 0.000, significant observed differences). Amalgam Composite Glass ionomer