Retrospective analysis on the repair vs. replacement of composite restorations

Objective. Our retrospective study aimed to assess the impact of repairs on the longevity of anterior and posterior direct composite restorations and to compare longevity of repaired and replacement restorations. Methods. Patient records were retrospectively screened for anterior and/or posterior composite restorations with 2+ surfaces placed in permanent teeth between 2000 and 2015. During follow-up, repaired and replaced restorations were assessed and mean annual failure rates (mAFR) calculated. Outcome was considered in three levels: Success (no further intervention), survival 1 (first repair = survival, second repair = failure) and survival 2 (more than one repair=survival, all surfaces repaired = failure). Statistical analysis was performed using Kaplan-Meier statistics, log-rank tests, and multi-variate Cox-regression analyses with shared frailty (p < 0.05). Results. 8542 initial restorations placed in 3239 patients were included (4.7 +/- 4.4 years followup, 2.5 +/- 0.7 surfaces). Longevity of initial restorations was prolonged by repair(s) (after 10 years: success: 68.3%, mAFR: 3.7%; survival 1: 77.3%, mAFR: 2.5%; survival 2: 80.4%, mAFR: 2.2%; p < 0.001). 616 repaired restorations (4.9 +/- 4.2 years follow-up, 3.5 +/- 1.0 surfaces) and 264 replacement restorations (5.6 +/- 4.1 years follow-up, 3.0 +/- 0.8 surfaces) were analyzed. Success of repaired restorations amounted to 43.4% after 10 years (mAFR: 8.0%), further repair(s) prolonged survival (survival 1: 65.7%, mAFR: 4.1%; survival 2: 74.8%, mAFR: 2.9%; p < 0.001). Success of replacement restorations amounted to 48.6% after 10 years (mAFR: 7.0%), repair(s) prolonged survival (survival 1: 67.4%, mAFR: 3.9%, p = 0.044; survival 2: 74.1%, mAFR: 3.0%, p = 0.003). Significance. Repairs are suitable to increase the survival of restorations; repaired restorations last as long as replacements. (C) 2019 The Academy of Dental Materials. Published by Elsevier Inc. All rights reserved.