An update on the reasons for placement and replacement of direct restorations.
Level 4 - case-series / case-control
review of observational, practice-based cross-sectional audit studies
PubMed 29522787 · doi:10.1016/j.jdent.2018.03.001
What was done
Authors reviewed literature on patterns of direct dental restoration placement and replacement, updating a pre-1998 review. Included studies followed the standardized Mjör (1981) protocol, in which participating dentists completed a proforma recording clinical data for every initial or replacement restoration placed in practice.
What was found
Across 25 included papers (12 pre-1998 and 13 post-1998), data were collected on 86,720 restorations. Replacements accounted for 57.3% (49,704) of all restorations overall, rising from 56.0% (18,306/32,697) in the pre-1998 review to 58.1% (31,398/54,023) post-1998. Initial placements accounted for 42.7% overall (44.0% pre-1998 vs. 41.9% post-1998). Between the two periods, amalgam placement dropped from 56.7% to 31.2%, while resin composite rose from 36.7% to 48.5%. Highest amalgam utilization was reported in Nigeria (71%), Jordan (59%), and the UK (47%), while composite predominated in Australia (55%), Iceland (53%), and Scandinavia (52%). Secondary caries was the most frequent reason for replacement, accounting for up to 59% of replacement cases.
Why it matters
More than half of all restorative dental work consists of replacing failed restorations rather than treating primary disease, emphasizing the heavy clinical burden of restoration turnover and the ongoing global shift toward composite materials.
Limits
The data rely on self-reported dentist survey proformas with potential selection and reporting biases. Diagnostic thresholds for secondary caries were not standardized across participating clinicians, and newer conservative strategies like restoration repair were not distinguished from total replacement.
Cited by
- supports Roughly 40% of dental work performed in dental practices consists of repairing or replacing previous restorations.