Reasons of replacement and repair of directly placed dental restorations: A systematic review.

SUMMARY Introduction: Replacement of defective restorations represents the major part of restorative dentistry, and repair is an important alternative to save tooth structure. This project systematically reviewed the available evidence on the replacement and repair of restorations from three different study designs. It compared the rates and reasons of replacement and repair according to the restorative material used and cavity type. It also looked at the change, if any, in the patterns and reasons of replacement and repair over the years. Methods: The NHS Centre for Reviews and Dissemination guidelines were used as a reference for conducting this review. A search of the electronic databases was performed looking for studies reporting on replacement or repair of amalgam or resin-based composite (RBC) restorations in permanent teeth in adults. Reference lists, hand and citation searching were also undertaken. Results: 7,255 articles were identified through the searches, and 151 papers met the initial inclusion criteria. Forty-five clinical trials (CTs) and longitudinal cohort studies (LCSs) and 3 crosssectional studies (CSSs) were included. The results of the studies were analysed separately then compared. Quality assessment of the studies was conducted using the “Newcastle-Ottawa Scale”. Conclusions: Included studies mostly reported on RBC restorations. Results from CTs and LCSs suggest that failure/replacement rate of anterior and posterior RBC restorations is declining. Secondary caries as a reason for failure/replacement is also declining, while tooth fracture in increasing. None of the included amalgam studies were published after 1998, indicating the decline in amalgam use. No accurate conclusions could be drawn on amalgam due to the small number of studies included. Few studies reported on repair of posterior RBC restorations and the rate was lower than replacement (3% compared to 9%). No studies reported on repair of amalgam restorations. Most published CSSs did not meet the inclusion criteria due to the lack of detailed reporting