Reasons for Placement of First Restorations by Dental PBRN Clinicians

Dental restorations have limited durability so that placing the first restoration in a tooth is a crucial decision. Clinical validation of the reasons used by dentists to justify surgical intervention is needed to provide a foundation to improve clinical practice. Objective: To quantify factors that Dental Practice-Based Research Network (DPBRN; www.DPBRN.org) dentists use to place restorations in un-restored tooth surfaces. DPBRN comprises practices from five regions: AL/MS: Alabama/Mississippi; FL/GA: Florida/Georgia; HP/MN: dentists employed by HealthPartners and in private practice from the Minneapolis, Minnesota area; PDA: Permanente Dental Associates in cooperation with Kaiser Permanente Center for Health Research; and SK: Denmark, Norway, and Sweden. Methods: To date, 129 practitioner-investigators (out of 212 anticipated) collected data on 5938 consecutive restorations in un-restored permanent tooth surfaces from 3325 patients. Information included the criteria for placing the restoration, tooth number, surfaces restored, and method for caries diagnosis. Results: Restorations were most commonly inserted in occlusal (33%) surfaces, followed by buccal/facial (19%), distal (18%), mesial (15%), lingual/palatal (12%), and incisal (3%) surfaces. Molars were the most commonly restored tooth type. Primary caries was the main reason for placing restorations (84%), followed by non-carious defects (16%), which included abrasion, abfraction or erosion (8%), tooth fracture (4%), cosmetic reasons (2%), restoration of endodontically-treated tooth (1%) and developmental defects or hypoplasia (1%). Probing (55%) was the most commonly-used technique to detect caries, followed by radiographs (40%) and transillumination or optical technique (5%). Conclusion: Practitioner-investigators frequently detect primary caries and decide to intervene operatively based on visual, tactile, and radiographic examinations. Despite the existence of scientific support for delaying surgical intervention in the caries process as a mean to preserve tooth structure, operative intervention mainly in the occlusal surface of molar teeth is still the main reason for placing restoration(s) in un-restored tooth surfaces. Support: U01-DE 16746, U01-DE 16747.