Management of fractured resin composites by dentists in north-east England

Objective One of the many uncertainties of clinical practice is how to manage a fractured composite restoration. This study aimed to investigate current practice within primary care in the North-East of England. Method This was a cross-sectional postal questionnaire-based study utilising an illustrated case-vignette of a fractured composite restoration. A master list of practitioners was generated from the General Dental Council register and a stratified random sample of names was generated based on local post codes. A total of 100 dentists were identified, representing around 10% of all dentists in the region. After 8 weeks a reminder letter was posted to non-respondents. Demographics (location, place of qualification and post-graduate education) and methods of repair were investigated, including mechanical and chemical surface treatments and factors influencing treatment decisions. Results The response rate was 52%, with over 70% deciding to repair the fracture (28% would replace the entire restoration). Whether the restoration was sound underneath was the most common motivating factor for repair vs. replacement (88%). Most (71%) would use a high-speed course diamond bur (in isolation) to mechanically prepare the surface, with only 6% utilising sandblasting. The most frequent method of chemical treatment (32%) was the application of etchant and primer/bonding agent to the surface; the next most common method involved applying primer/bonding agent only. No-one reported using a silane coupling agent. Conclusion Approximately 90% of all respondents used some form of mechanical and chemical preparation prior to composite repair, and the results highlight the disparate practice within primary care. Presence of sound tooth structure was the most motivating factor for immediate repair vs. replacement, and most dentists would prepare with a course diamond bur before etching and applying primer and bond