Longevity of routine dental restorations in permanent posterior teeth: a systematic review

Key Points

• It is important for dental practitioners to know how long simple dental fillings can, and should, be expected to stay intact. It enables them to assess their own clinical performance and give realistic expectations about the life of newly inserted restorations to their patients.

• There have been surprisingly few attempts to distil all the available information on the longevity of restorations and arrive at a consensus on the question. This systematic review attempts to fill the gap in knowledge.

• It is apparent that few reported studies have used satisfactory designs and methods of analysis. However, from what can be deduced it seems that most restorations can be expected to last from 10 to 20 years, although there are evidently enormous variations and many factors which affect survival.

• There are clearly great difficulties in designing appropriate research programmes in this area, but a need remains for definitive randomised controlled trials of restoration longevity of sound design and adequate power, employing standardised assessments and appropriate methods of analysis.

Abstract

Objective

To conduct a systematic review of the literature on the longevity of routine dental restorations in permanent posterior teeth, and to identify and examine factors influencing its variability.

Method

Accepted guidelines were followed. An advisory group oversaw the project. Simple Class I and Class II amalgam, composite resin, glass ionomer and cast gold restorations were covered. Comprehensive searching of electronic databases, hand-searching, and location of 'grey' literature, generated 124 research reports. Those considered relevant were assessed for validity and quality according to agreed criteria. The analysis was descriptive.

Results

Eight of 58 relevant research reports were categorised, according to agreed criteria, as being of satisfactory validity and quality. They suggested that 50% of all restorations last 10 to 20 years, although both higher and lower median survival times were reported. The findings were supported by the totality of studies reviewed. However, variability was substantial. Restoration type, materials, the patient, the operator, the practice environment and type of care system appeared to influence longevity.

Conclusions

Many studies were imperfect in design. Those considered to be the most appropriate for analysis were too limited to undertake a formal statistical exploration. Therefore there remains a need for definitive randomised controlled trials of restoration longevity, of sound design and adequate power, employing standardised assessments and appropriate methods of analysis.

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