A systematic review of interventions after restoring the occluding surfaces of anterior and posterior teeth that are affected by tooth wear with filled resin composites

Objectives: The aim of this systematic review was to assess intervention rates of direct composite restorations in the worn dentition based on data published in clinical trials. Methods: Searches of electronic data bases, grey Literature and hand searches were completed, and selection criteria were applied at the title, abstract and full paper stages. Unavailable full papers or papers with unsuitable data were excluded. A reference search was conducted, and a final set of papers were selected for data analysis. Data were extracted and noted as any intervention required or performed, or intervention free. Descriptive statistics were used to summarise the findings and the odds ratios were calculated. Results: 1683 titles were found in the initial searches. On application of selection criteria, 140 abstracts were selected (Kappa 0.885), 17 papers were chosen by 3 reviewers (Kappa 0.914 - 0.942) and 12 selected for statistical analysis (Kappa 0.924). A total of 3540 composites in 386 participants were analysed, with 1919 in the anterior region, and 1044 in the posterior region of these 11.7 % required intervention. Annual Intervention Rates (AIR) ranged from 0.8 to 17.9% reflecting the variation in reporting. Conclusion: There was wide variation between studies on the type of intervention. Overall the intervention rate of 11.6 % shows a favourable outcome but suggests some form intervention may be needed. Clinical significance: Direct composites remain a viable option to treat tooth wear but the outcome varies. Provided patients appreciate that some maintenance may be needed they are an effective intervention.