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Medical Forum / General / Dentistry / March 2009epidemiology of posterior composites
Nice to see Dental Clinics of North America, Jan 2009. page 74. "There is no doubt that the use of resin composite in posterior restorations has become common in dental practices in the United States and the world today. While there are abundant retrospective and prospective case series showing similar longevity of amalgam and composite in posterior restorations, the higher level of evidence indicates that indeed, amalgam is superior in its clinical performance. Not only is the expected longevity two to three times longer, but failure of posterior composites is much more likely associated with recurrent caries, a fact that may influence the long- term survival of the tooth itself. This real endpoint, tooth loss, has never been studied with respect to placement of amalgam versus resin composite in the posterior dentition, but would ultimately have more clinical relevance than simply looking at replacement rates." Why do dentists do posterior composites? Is it because it costs more or because it is white? ..David DiBenedetto, DMD...author of "Insider's guide to gum disease, orthodontics and dentistry. What is not taught in dental school." > Nice to see Dental Clinics of North America, Jan 2009. page 74. > [quoted text clipped - 17 lines] > ..David DiBenedetto, DMD...author of "Insider's guide to gum disease, > orthodontics and dentistry. What is not taught in dental school." Why would you ask such a question? On Mar 15, 3:53 pm, oralhea...@comcast.net wrote: > Nice to see Dental Clinics of North America, Jan 2009. page 74. > [quoted text clipped - 17 lines] > ..David DiBenedetto, DMD...author of "Insider's guide to gum disease, > orthodontics and dentistry. What is not taught in dental school." Hence the controversy. On Mar 15, 12:53 pm, oralhea...@comcast.net wrote: > Nice to see Dental Clinics of North America, Jan 2009. page 74. > [quoted text clipped - 17 lines] > ..David DiBenedetto, DMD...author of "Insider's guide to gum disease, > orthodontics and dentistry. What is not taught in dental school." We do it because our patients prefer it. >>"There is no doubt that the use of resin composite in posterior >>restorations has become common in dental practices in the United [quoted text clipped - 3 lines] >>indicates that indeed, amalgam is superior in its clinical >>performance. Poor placement of composites and studies done by dentists who have a distinct bias against composites in the first place. Steve > On Mar 15, 12:53 pm, oralhea...@comcast.net wrote: > [quoted text clipped - 21 lines] > > We do it because our patients prefer it. Do they prefer it because they know it is inferior? Who spends the advertising dollars in dental journals to promote their products? Should patients sign consent forms for posterior composites? Posterior composites have their place, but not in high caries rate patients. I also find posterior composites are more likely to cause occlusal interferences because too much of it is placed on the tooth. On Mar 17, 6:03 pm, oralhea...@comcast.net wrote: > > On Mar 15, 12:53 pm, oralhea...@comcast.net wrote: > [quoted text clipped - 33 lines] > > - Show quoted text - And they are inferior how? A consent formn that says what? My Dr places small amounts at a time a cures them little by little. I've been working for him for 14 years and haven't seen them as inferior, so please state why you think they are. > On Mar 17, 6:03 pm, oralhea...@comcast.net wrote: > [quoted text clipped - 41 lines] > I've been working for him for 14 years and haven't seen them as > inferior, so please state why you think they are. With drugs, studies are done to see how well a medicine works. Depending on what the problem or disease is, do we choose the best drug, the most effective, the cheapest, the most expensive, or the one with the fewest side effects, or the one that is easier to give. Are fillings like drugs, how do we choose? Do dentists really care if a filling last 6 years or 9 years? Can we really see a difference after 6 years? White fillings help the dentist's bottom line. I am guessing that for 50% of the public, it probably maybe makes no difference which is used? But, for some patients, definitely, amalgam fillings will last and hold up longer. Are gold crowns better than PFM? Most definitely. On Mar 18, 1:58 pm, oralhea...@comcast.net wrote: > > On Mar 17, 6:03 pm, oralhea...@comcast.net wrote: > [quoted text clipped - 37 lines] > > > And they are inferior how? A consent formn that says what? Please answer the questions I asked above. > > My Dr places small amounts at a time a cures them little by little. > > I've been working for him for 14 years and haven't seen them as [quoted text clipped - 13 lines] > fillings will last and hold up longer. > Are gold crowns better than PFM? Most definitely In my area, nearly 90% of patients want white. Dear Tina, If one drug is superior, than the other is inferior. Read, "Restoration of Posterior teeth in clinical practice: Evidence base for choosing Amalgam vs Composite." Dental Clinics of North America, Jan. 2009, pages 71-76. "7-year survival rate for amalgam was 94.4% vs 85.5% for composite" and "recurrent decay was 12.7% for composite vs 3.7% for amalgam" Should these findings be conveyed to patients? Only you can decide. Another interesting article is "Do we really know what makes us healthy?" N.Y Times Magazine, Sept. 16, 2007. I put this reference in my book. The dental clinic of N. America indirectly talks about this. ...David DiBenedetto, DMD. > Dear Tina, > [quoted text clipped - 6 lines] > "7-year survival rate for amalgam was 94.4% vs 85.5% for composite" > and "recurrent decay was 12.7% for composite vs 3.7% for amalgam" This is one study. Since I have no access to it, perhaps you could quote the criteria for restoration selection. Specifically, is this for class I or II restorations? Are there criteria for maximum bucco-lingual width? Were the same preparations done? Did all restorations end the proximal box on enamel? Without knowing this information, the criteria for "survival" etc., the raw statistics are pretty meaningless. > Should these findings be conveyed to patients? Only you can decide. Why should Tina decide? Can't I decide? Can't I decide that a small occlusal pit on a lower second molar can be restored with resin, or that a wide MOD lesion on an upper second molar is best treated with an onlay? Listen, I'm a guy who still uses amalgam. But if you're losing me with your argument, what are patients going to think? BTW, since Gordon Christensen states that self-etching bonding systems have lower bond strengths than total etch, but lower incidence of postop sensitivity, that the patient should decide which bonding system to use? Just curious, Steve > Another interesting article is "Do we really know what makes us  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Dear Steve, From the article, as best I can paraphase, (1) dentists have seen improvements in posterior composite restorations, but is there real evidence? (2) almost all studies are retrospective case studies, retrospective epidemiologic studies, or prospective nonrandomized. (3) these studies found no basic difference but these studies are susceptible to bias, and confounding variables that are impossible to account for (4) the patient selection may be too well educated(see the N.Y. Times Magazine article that I quoted) with too high a level of dental i.q. (healthy people don't get sick) (5) need randomized prospective study....only two large studies in children, only evidence (6) the studies: "Neuropsychological and renal effects of dental amalgam: a randomized clinical trial." JAMA 2006, 295(15): 1775-83 and "Neurobehavior effects of dental amalgam in children: a randomized clinical trial." JAMA, 2006 , 295(15) 1784-92. .......Interesting that it is published in a Medical Journal and not a dental journal. Can't dentist journal publish randomized trials !!! (7) "These two randomized, controlled clinical studies demonstrate clearly that amalgam has higher survival than composite for posterior composites, and there is much more secondary decay associated with resin composite than amalgam in posterior restorations. These two findings should be conveyed to patients who are receiving restorations in their posterior teeth, so that patients can make decisions with their provider that are informed decisions." page 74 (8) "Trials are needed ...in a large sample of adult patients." (9) "As an aside, it may be worthwhile to evaluate the safety of composite....concerning the potential health effects of bisphenol A." ...David DiBenedetto, DMD....dentist and author of "Insider's guide to gum disease, orthodontics and dentistry. What is not taught in dental school." What is not taught in dental school is how to science. > Dear Steve, > > From the article, as best I can paraphase, > > (1) dentists have seen improvements in posterior composite > restorations, but is there real evidence? There is copious in vitro evidence of improved wear resistance. There is also plenty of in vitro information about the relative polymerization shrinkage of various resin varieties. At least 20 years ago (probably more) the journals were discussing the tradeoffs between wear resistance and polymerization shrinkage on the one hand, and esthetics and polishability on the other. It was already well-known that class II resin restorations with proximal boxes ending on dentin were likely to fail at the proximo-gingival margin due to weaker bond strengths to dentin relative to enamel. IOW, a blanket condemnation of the material is not warrented IMO. Like any other material, it's case selection. I admit that it would give me a little thrill to see the anti-amalgam folks squirm if more data on bisphenol resins and hormone disruption come out. But it would be laughing at my own expense. We do, after all, need materials that are safe for patient and professional, functional, esthetic, and conscious of the larger environmental picture. Steve > (2) almost all studies are retrospective case studies, > retrospective epidemiologic studies, or prospective nonrandomized. [quoted text clipped - 35 lines] > gum disease, orthodontics and dentistry. What is not taught in dental > school." What is not taught in dental school is how to science. SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Just because someone gets something in print, does not mean that it is accurate. Even if some of the statistics are correct, it doesn't mean that the *material* is to blame. From what I have seen (and done) over the years, it is the operator's technique that is most often the cause of *any* early restorative failures, whether amalgam or composite. Steve Fawks > Read, "Restoration of Posterior teeth in clinical practice: Evidence > base for choosing Amalgam vs Composite." Dental Clinics of North [quoted text clipped - 10 lines] > > ...David DiBenedetto, DMD. > Just because someone gets something in print, does not mean that > it is accurate. [quoted text clipped - 21 lines] > > > ...David DiBenedetto, DMD. The problems with dentists we forget about epidemiology. For drugs to be approved randomized prospective studies must be done. The FDA requires this. Where is this done in dentistry? If we have healthy patients and patients who maintain good hygiene, and don't smoke and who eat healthy, does it really make a difference what kind of restorations we do? But if we want good science, then randomized prospective studies must be done. On Mar 19, 7:12 pm, oralhea...@comcast.net wrote: > > Just because someone gets something in print, does not mean that > > it is accurate. [quoted text clipped - 28 lines] > > If we have healthy patients and patients who maintain good hygiene, AND GOOD OCCLUSION...(NO GROUP FUNCTION) > and don't smoke and who eat healthy, does it really make a difference > what kind of restorations we do? > But if we want good science, then randomized prospective studies must > be done. Wrong again....... Steve Fawks >>If we have healthy patients and patients who maintain good hygiene, > > AND GOOD OCCLUSION...(NO GROUP FUNCTION) On Mar 19, 4:12 pm, oralhea...@comcast.net wrote: > > Just because someone gets something in print, does not mean that > > it is accurate. [quoted text clipped - 35 lines] > > - Show quoted text - Why? They're functional and patients like them, and they're safe, what more do you need? >> On Mar 15, 12:53 pm, oralhea...@comcast.net wrote: >> [quoted text clipped - 27 lines] > cause occlusal interferences because too much of it is placed on the > tooth. Well, you DO check occlusion, n'est ce pas? Steve BS. Steve Fawks > Posterior composites have their place, but not in high caries rate > patients. I also find posterior composites are more likely to > cause occlusal interferences because too much of it is placed on the > tooth. |
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