GERO amalgam-composite
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Resin composite restorations for the elderly patient Cees M. Kreulen, Anneloes E. Gerritsen and Nico H. J. Creugers Department Oral Function, Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands
doi: 10.1111/ger.12174 Resin composite restorations for the elderly patient Keywords: resin composite, elderly, treatment approach, restorative repair cycle Accepted 7 October 2014
In older patients, we often observe cumulative damage of teeth resulting in the need of repair or renewal of restorations. Restorative treatment might be required in case of fracture of tooth or restorative material, caries along restoration margins or simply ageing of restorations. Although the variation among dentists regarding clinical decisions on restoring these teeth will be large, some form of operative restriction has become common in many dental offices1,2. The current approach to restoring defective teeth or restorations is to wait and optimise prevention of further disease by repairing the defects in enamel or dentine, and by repairing rather than completely renewing an old restoration3, especially for older patients who might have a decreasing propensity for restorative treatments. It is good sometimes to put the restorative repair cycle on hold. Many dentists remember the days that amalgam – having a track record of more than 150 years – was the standard direct restorative material4,5. In the absence of adhesive materials, restorative dentistry was very mechanical. If a tooth had to be repaired, usually sound tooth tissue was removed to help retain the amalgam restoration. Ultimately, we have all encountered situations where there was no tooth tissue remaining. How welcome was the idea of the adhesive restoration: just remove carious or weak tooth tissue, use the adhesive material to bond and preserve the remaining sound tissue. It took nearly 30 years after the invention of the Bowen resin and the acid-etch technique before composite was introduced as a material for posterior teeth!6 Adhesive restorations then demanded many clinical precautions to achieve adequate results. Although working with
composites has become simpler, many colleagues still perceive working with composite as a complicated process that limits its indications7. Fortunately, recent graduates have grown very skilful with adhesive composites and some do even not know how to work with amalgam8. Clinical research has demonstrated the acceptable clinical performance of standard Class II composite restorations9–11. The use of composite for different types of restorations has expanded over the years, and composite seems to have surpassed amalgam in the posterior area when appropriately used. Although the survival of large composite restorations is not yet superior to amalgam restorations, the large composite restoration serves to replace the single artificial crown in daily practice quite frequently12,13. For instance, a tooth with a fractured cusp – often seen in older teeth – that traditionally was in need of a crown can be easily restored with composite to immediately re-establish function and serve the patient in one treatment session14. Application of composite that opens up possibilities for creative instant solutions is an alternative to traditional prosthodontics without exposing older patients in particular to the burden of multiple invasive and long treatment sessions. In contrast to teeth restored with amalgam, teeth restored with composite can be splinted easily or used as abutment teeth for fibre-reinforced composite or autologous adhesive bridges15. The use of composite has a few restrictions. Some believe that composite resin when compared to amalgam has more limitations in suboptimal conditions. For example, deep cervical lesions at crown margins are difficult to restore with
© 2014 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd, Gerodontology 2014; 31: 241–244
244
J. Wilson
adhesive composite resin if saliva cannot be controlled. However, those cervical lesions are hard to restore anyway, because moisture reduces the prognosis of all restorative materials, including amalgam16. To conclude, today we may regard resin composite as a material that has a vast potential for restoring older teeth. Amalgam, in contrast, is only suitable for restoring individual teeth.
References 1. Kidd E. The implications of the new paradigm of dental caries. J Dent 2011; 39(Suppl. 2): S3–8. 2. Fejerskov O, Baelum V. Changes in oral health profiles and demography necessitate a revision of the structure and organisation of the oral healthcare system. Gerodontology 2014; 31: 1–3. 3. Hickel R, Br€ ushaver K, Ilie N. Repair of restorations–criteria for decision making and clinical recommendations. Dent Mater 2013; 29: 28–50. 4. Kreulen CM, Tobi H, Gruythuysen RJ, van Amerongen WE, Borgmeijer PJ. Replacement risk of amalgam treatment modalities: 15year results. J Dent 1998; 26: 627–32. 5. Manhart J, Chen H, Hamm G, Hickel R. Buonocore Memorial Lecture. Review of the clinical survival of direct and indirect restorations in posterior teeth of the permanent dentition. Oper Dent 2004; 29: 481– 508. 6. Walsh LJ, Brostek AM. Minimum intervention dentistry principles and objectives. Aust Dent J 2013; 58(Suppl. 1): 3–16.
The material is difficult to repair and does not support prosthodontic treatments beyond filling a cavity. The main advantage of resin composite restorations in older patients is that it is possible with some creativity to repair almost every failed, broken or endangered restoration or tooth with minimal burden on the patient.
7. Shenoy A. Is it the end of the road for dental amalgam? A critical review. J Conserv Dent 2008; 11: 99– 107. 8. Roeters FJM, Opdam NJM, Loomans BAC. The amalgam-free dental school. J Dent 2004; 32: 371–7. 9. Da Rosa Rodolpho PA, Donassollo TA, Cenci MS, Logu ercio AD, Moraes RR, Bronkhorst EM et al. 22-Year clinical evaluation of the performance of two posterior composites with different filler characteristics. Dent Mater 2011; 27: 955–63. 10. Heintze SD, Rousson V. Clinical effectiveness of direct class II restorations – a meta-analysis. J Adhes Dent 2012; 14: 407–31. 11. Van Dijken JWV, Pallesen U. A six-year prospective randomized study of a nano-hybrid and a conventional hybrid resin composite in Class II restorations. Dent Mater 2013; 29: 191–8. 12. Opdam NJM, Bronkhorst EM, Loomans BAC, Huysmans MCDNJM. 12-year survival of composite vs. amalgam restorations. J Dent Res 2011; 89: 1063–7. 13. Laegreid T, Gjerdet NR, Johansson AK. Extensive composite molar restorations: 3 years clinical evalua-
tion. Acta Odontol Scan 2012; 70: 344–52. 14. Fennis WM, Kuijs RH, Roeters FJ, Creugers NH, Kreulen CM. Randomized control trial of composite cuspal restorations: five-year results. J Dent Res 2014; 93: 36–41. 15. Vallittu PK. Survival rates of resinbonded, glass fiber-reinforced composite fixed partial dentures with a mean follow-up of 42 months: a pilot study. J Prosthet Dent 2004; 91: 241–6. 16. Ausiello P, Davidson CL, Cascone P, DeGee AJ, Rengo S. Debonding of adhesively restored deep class II MOD restorations after functional loading. Am J Dent 1999; 12: 84–8.
Correspondence to: Cees M. Kreulen, Department Oral Function, Dentistry, Radboud University Medical Center, Philips van Leydenlaan 25, 6525 EX Nijmegen, The Netherlands. Tel.: +31 24 3616470 Fax: +31 24 3541971 E-mail: [email protected]
© 2014 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd, Gerodontology 2014; 31: 241–244
243
Resin composite restorations for the elderly patient Cees M. Kreulen, Anneloes E. Gerritsen and Nico H. J. Creugers Department Oral Function, Dentistry, Radboud University Medical Center, Nijmegen, The Netherlands
doi: 10.1111/ger.12174 Resin composite restorations for the elderly patient Keywords: resin composite, elderly, treatment approach, restorative repair cycle Accepted 7 October 2014
In older patients, we often observe cumulative damage of teeth resulting in the need of repair or renewal of restorations. Restorative treatment might be required in case of fracture of tooth or restorative material, caries along restoration margins or simply ageing of restorations. Although the variation among dentists regarding clinical decisions on restoring these teeth will be large, some form of operative restriction has become common in many dental offices1,2. The current approach to restoring defective teeth or restorations is to wait and optimise prevention of further disease by repairing the defects in enamel or dentine, and by repairing rather than completely renewing an old restoration3, especially for older patients who might have a decreasing propensity for restorative treatments. It is good sometimes to put the restorative repair cycle on hold. Many dentists remember the days that amalgam – having a track record of more than 150 years – was the standard direct restorative material4,5. In the absence of adhesive materials, restorative dentistry was very mechanical. If a tooth had to be repaired, usually sound tooth tissue was removed to help retain the amalgam restoration. Ultimately, we have all encountered situations where there was no tooth tissue remaining. How welcome was the idea of the adhesive restoration: just remove carious or weak tooth tissue, use the adhesive material to bond and preserve the remaining sound tissue. It took nearly 30 years after the invention of the Bowen resin and the acid-etch technique before composite was introduced as a material for posterior teeth!6 Adhesive restorations then demanded many clinical precautions to achieve adequate results. Although working with
composites has become simpler, many colleagues still perceive working with composite as a complicated process that limits its indications7. Fortunately, recent graduates have grown very skilful with adhesive composites and some do even not know how to work with amalgam8. Clinical research has demonstrated the acceptable clinical performance of standard Class II composite restorations9–11. The use of composite for different types of restorations has expanded over the years, and composite seems to have surpassed amalgam in the posterior area when appropriately used. Although the survival of large composite restorations is not yet superior to amalgam restorations, the large composite restoration serves to replace the single artificial crown in daily practice quite frequently12,13. For instance, a tooth with a fractured cusp – often seen in older teeth – that traditionally was in need of a crown can be easily restored with composite to immediately re-establish function and serve the patient in one treatment session14. Application of composite that opens up possibilities for creative instant solutions is an alternative to traditional prosthodontics without exposing older patients in particular to the burden of multiple invasive and long treatment sessions. In contrast to teeth restored with amalgam, teeth restored with composite can be splinted easily or used as abutment teeth for fibre-reinforced composite or autologous adhesive bridges15. The use of composite has a few restrictions. Some believe that composite resin when compared to amalgam has more limitations in suboptimal conditions. For example, deep cervical lesions at crown margins are difficult to restore with
© 2014 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd, Gerodontology 2014; 31: 241–244
244
J. Wilson
adhesive composite resin if saliva cannot be controlled. However, those cervical lesions are hard to restore anyway, because moisture reduces the prognosis of all restorative materials, including amalgam16. To conclude, today we may regard resin composite as a material that has a vast potential for restoring older teeth. Amalgam, in contrast, is only suitable for restoring individual teeth.
References 1. Kidd E. The implications of the new paradigm of dental caries. J Dent 2011; 39(Suppl. 2): S3–8. 2. Fejerskov O, Baelum V. Changes in oral health profiles and demography necessitate a revision of the structure and organisation of the oral healthcare system. Gerodontology 2014; 31: 1–3. 3. Hickel R, Br€ ushaver K, Ilie N. Repair of restorations–criteria for decision making and clinical recommendations. Dent Mater 2013; 29: 28–50. 4. Kreulen CM, Tobi H, Gruythuysen RJ, van Amerongen WE, Borgmeijer PJ. Replacement risk of amalgam treatment modalities: 15year results. J Dent 1998; 26: 627–32. 5. Manhart J, Chen H, Hamm G, Hickel R. Buonocore Memorial Lecture. Review of the clinical survival of direct and indirect restorations in posterior teeth of the permanent dentition. Oper Dent 2004; 29: 481– 508. 6. Walsh LJ, Brostek AM. Minimum intervention dentistry principles and objectives. Aust Dent J 2013; 58(Suppl. 1): 3–16.
The material is difficult to repair and does not support prosthodontic treatments beyond filling a cavity. The main advantage of resin composite restorations in older patients is that it is possible with some creativity to repair almost every failed, broken or endangered restoration or tooth with minimal burden on the patient.
7. Shenoy A. Is it the end of the road for dental amalgam? A critical review. J Conserv Dent 2008; 11: 99– 107. 8. Roeters FJM, Opdam NJM, Loomans BAC. The amalgam-free dental school. J Dent 2004; 32: 371–7. 9. Da Rosa Rodolpho PA, Donassollo TA, Cenci MS, Logu ercio AD, Moraes RR, Bronkhorst EM et al. 22-Year clinical evaluation of the performance of two posterior composites with different filler characteristics. Dent Mater 2011; 27: 955–63. 10. Heintze SD, Rousson V. Clinical effectiveness of direct class II restorations – a meta-analysis. J Adhes Dent 2012; 14: 407–31. 11. Van Dijken JWV, Pallesen U. A six-year prospective randomized study of a nano-hybrid and a conventional hybrid resin composite in Class II restorations. Dent Mater 2013; 29: 191–8. 12. Opdam NJM, Bronkhorst EM, Loomans BAC, Huysmans MCDNJM. 12-year survival of composite vs. amalgam restorations. J Dent Res 2011; 89: 1063–7. 13. Laegreid T, Gjerdet NR, Johansson AK. Extensive composite molar restorations: 3 years clinical evalua-
tion. Acta Odontol Scan 2012; 70: 344–52. 14. Fennis WM, Kuijs RH, Roeters FJ, Creugers NH, Kreulen CM. Randomized control trial of composite cuspal restorations: five-year results. J Dent Res 2014; 93: 36–41. 15. Vallittu PK. Survival rates of resinbonded, glass fiber-reinforced composite fixed partial dentures with a mean follow-up of 42 months: a pilot study. J Prosthet Dent 2004; 91: 241–6. 16. Ausiello P, Davidson CL, Cascone P, DeGee AJ, Rengo S. Debonding of adhesively restored deep class II MOD restorations after functional loading. Am J Dent 1999; 12: 84–8.
Correspondence to: Cees M. Kreulen, Department Oral Function, Dentistry, Radboud University Medical Center, Philips van Leydenlaan 25, 6525 EX Nijmegen, The Netherlands. Tel.: +31 24 3616470 Fax: +31 24 3541971 E-mail: [email protected]
© 2014 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd, Gerodontology 2014; 31: 241–244
