Placement and replacement of restorations in general dental practice in Iceland.
Level 4 - case-series / case-control
Cross-sectional survey / clinical practice audit
What was done
Ninety-one practicing dentists in Iceland (51% response rate) recorded information on 100 consecutively placed restorations, yielding data on 8,395 restorations and 741 sealants in 5,997 patients. Information collected included patient age and gender, clinician gender and years of experience since graduation, defined criteria for replacement, estimated past material use, and reasons for placement or replacement.
What was found
Materials placed were composite (52.7%), amalgam (29.2%), glass ionomer (9.5%), resin-modified glass ionomer (7.1%), and other materials (1.4%). Material selection was independent of clinician gender, but female patients received more composite and fewer amalgam restorations than male patients. Reasons for placement were replacement of failed restorations (47.2%), primary caries (45.3%), and non-carious defects (7.5%). Secondary caries was the most common reason for replacement across all material types. Clinician experience significantly influenced replacement diagnoses: more experienced clinicians diagnosed secondary caries less frequently than less experienced peers (p<0.0001), while diagnoses of restoration discoloration and fracture increased with experience (p<0.0001).
Why it matters
These findings demonstrate that nearly half of restorative dental activity involves replacing failed restorations and that diagnostic rationales for replacement vary substantially based on clinician experience.
Limits
The response rate was 51%, introducing potential selection bias. Findings rely on clinician self-report without standardized calibration or validation of diagnostic thresholds, and the cross-sectional audit design cannot assess restoration longevity or true failure rates.
Cited by
- supports Roughly 40% of dental work performed in dental practices consists of repairing or replacing previous restorations.