Restor Dent Endod.  2013 Feb;38(1):11-20. 10.5395/rde.2013.38.1.11.

The effect of clinical performance on the survival estimates of direct restorations

• Kim KL
• Namgung C
• Cho BH

• KMID: 1995471
• DOI: http://doi.org/10.5395/rde.2013.38.1.11

Abstract

OBJECTIVES
In most retrospective studies, the clinical performance of restorations had not been considered in survival analysis. This study investigated the effect of including the clinically unacceptable cases according to modified United States Public Health Service (USPHS) criteria into the failed data on the survival analysis of direct restorations as to the longevity and prognostic variables.
MATERIALS AND METHODS
Nine hundred and sixty-seven direct restorations were evaluated. The data of 204 retreated restorations were collected from the records, and clinical performance of 763 restorations in function was evaluated according to modified USPHS criteria by two observers. The longevity and prognostic variables of the restorations were compared with a factor of involving clinically unacceptable cases into the failures using Kaplan-Meier survival analysis and Cox proportional hazard model.
RESULTS
The median survival times of amalgam, composite resin and glass ionomer were 11.8, 11.0 and 6.8 years, respectively. Glass ionomer showed significantly lower longevity than composite resin and amalgam. When clinically unacceptable restorations were included into the failure, the median survival times of them decreased to 8.9, 9.7 and 6.4 years, respectively.
CONCLUSIONS
After considering the clinical performance, composite resin was the only material that showed a difference in the longevity (p < 0.05) and the significantly higher relative risk of student group than professor group disappeared in operator groups. Even in the design of retrospective study, clinical evaluation needs to be included.

Keyword

Clinical trial; Direct restoration; Longevity; Retrospective study; USPHS criteria

MeSH Terms

Acrylic Resins
Glass
Humans
Longevity
Retrospective Studies
Silicon Dioxide
United States Public Health Service
Acrylic Resins
Silicon Dioxide

Figure

• 

  Figure 1 Comparison of survival estimates according to restorative materials using Kaplan-Meier survival analysis. (a) When clinically unacceptable Charlie cases were not included into the failure, GI showed significantly lower survival estimate compared to CR and AM (Breslow test, p < 0.05); (b) When clinically unacceptable Charlie cases were included into the failure, only the survival estimates of CR and GI showed a significant difference (Breslow test, p < 0.05). AM, amalgam; CR, composite resin; GI, glass ionomer.

• 

  Figure 2 Comparison of survival estimates according to cavity classifications using Kaplan-Meier survival analysis. According to the cavity classifications, the statistical difference in the survival estimates between groups showed a little change. (a) When clinically unacceptable Charlie cases were not included into the failure, there were significant differences between Class I and Class II, Class I and Class IV, Class II and Class III (Log rank test, p < 0.05), and Class II and Class V (Breslow test, p < 0.05); (b) When clinically unacceptable Charlie cases were included into the failure, only the difference in the survival estimates between Classes I and II and Classes II and V were statistically significant (Breslow test, p < 0.05). AM, amalgam; CR, composite resin; GI, glass ionomer.

• 

  Figure 3 Comparison of survival estimates using Kaplan-Meier survival analysis between with and without including the clinically unacceptable Charlie cases into the failure cases. (a) Amalgam restorations showed marginally different survival estimates (Log rank test, p = 0.056); (b) Composite resin restorations showed significantly different survival estimates (Log rank test, p < 0.05); (c) The survival estimates of glass ionomer restorations were not different statistically (Log rank test). USPHS, United States Public Health Service.

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