Amalgaam, jarenlang gebruikt in veel tandheelkundige praktijken, is definitief op zijn retour. Composieten hebben bewezen een goed alternatief te zijn. Bij grote restauraties in de (pre)molaarstreek doen posterior composieten niet onder voor amalgaam. Ook voor de lange termijn zijn de resultaten veelbelovend.

Klinisch onderzoek laat zien dat toepassing van composieten met een verschillend percentage anorganische vulstof (55% vs. 70%) in klasse I en II restauraties gedurende de eerste 10 jaar gelijke resultaten laat zien. In de daarop volgende 12 jaar presteren composieten met een hoger vulpercentage wat betreft levensduur echter beter. Uit een literatuuronderzoek blijkt verder dat patiënt, behandelaar en materiaalkenmerken van composieten in gelijke orde van belang zijn voor een lange levensduur van composietrestauraties.

Abstract 1
Objectives: This retrospective longitudinal study investigated the longevity of posterior restorations placed in a single general practice using 2 different composites in filler characteristics and material properties: P-50 APC (3M ESPE) with 70 vol.% inorganic filler loading (midfilled) and Herculite XR (Kerr) with 55 vol.% filler loading (minifilled). Methods: Patient records were used for collecting data. Patients with at least 2 posterior composite restorations placed between 1986 and 1990, and still in the practice for regular check-up visits, were selected. 61 patients (20 male, 41 female, age 31.2–65.1) presenting 362 restorations (121 Class I, 241 Class II) placed using a closed sandwich technique were evaluated by 2 operators using the FDI criteria. Data were analyzed with Fisher’s exact test, Kaplan-Meier statistics, and Cox regression analysis (p < 0.05). Results: 110 failures were detected. Similar survival rates for both composites were observed considering the full period of observation; better performance for the midfilled was detected considering the last 12 years. There was higher probability of failure in molars and for multisurface restorations. Conclusion: Both evaluated composites showed good clinical performance over 22 years with 1.5% (midfilled) and 2.2% (minifilled) annual failure rate. Superior longevity for the higher filler loaded composite (midfilled) was observed in the second part of the observation period with constant annual failure rate between 10 years and 20 years, whereas the minifilled material showed an increase in annual failure rate between 10 years and 20 years, suggesting that physical properties of the composite may have some impact on restoration longevity.

Abstract 2
Resin composites have become the first choice for direct posterior restorations and are increasingly popular among clinicians and patients. Meanwhile, a number of clinical reports in the literature have discussed the durability of these restorations over long periods. In this review, we have searched the dental literature looking for clinical trials investigating posterior composite restorations over periods of at least 5 years of follow-up published between 1996 and 2011. The search resulted in 34 selected studies. 90% of the clinical studies indicated that annual failure rates between 1% and 3% can be achieved with Class I and II posterior composite restorations depending on several factors such as tooth type and location, operator, and socioeconomic, demographic, and behavioural elements. The material properties showed a minor effect on longevity. The main reasons for failure in the long term are secondary caries, related to the individual caries risk, and fracture, related to the presence of a lining or the strength of the material used as well as patient factors such as bruxism. Repair is a viable alternative to replacement, and it can increase significantly the lifetime of restorations. As observed in the literature reviewed, a long survival rate for posterior composite restorations can be expected provided that patient, operator and materials factors are taken into account when the restorations are performed.

Bron
Da Rosa Rodolpho PA et al. 22-Year clinical evaluation of the performance of two posterior composites with different filler characteristics. Dent Mater 2011; 27: 955-963. doi: 10.1016/j.dental.2011.06.001

Demarcoa FF, Corrêa MB, Cenci MS, Moraes RR, Opdam NJ. Longevity of posterior composite restorations: Not only a matter of materials. Dent Mater 2012; 28: 87-101. doi: 10.1016/j.dental.0211.09.003

Klinische relevantie
Met een jaarlijks faalpercentage van 1-3% blijken composietrestauraties in de (pre)molaarstreek goed te voldoen. Om het succespercentage te verhogen, is doelmatige preventie en behoudend vervangingsbeleid net zo belangrijk als verbetering van de materiaaleigenschappen. Verdere mogelijkheden tot verbetering zijn te vinden in vermindering van de breukgevoeligheid en de mogelijkheid om secundaire cariës te remmen.

Bron: NTVT