Received 2024-09-30

Revised 2024-10-24

Accepted 2024-11-20

Introduction

Dental composite resins are increasingly used for tooth-colored restorations due to their optimal esthetics, conservativeness, and ability to bond to tooth structure. They have largely replaced amalgam restorations worldwide [1, 2]. However, composite resins have high technical sensitivity [3] and cannot ideally prevent marginal leakage [1].

The longevity of dental restorations depends on the type of restorative material, size of cavity [4], degree of polymerization of composite resin [5], expertise and experience of dental clinician [6], patient’s age [7], level of cooperation and oral hygiene of patient [2, 5], number of restored tooth surfaces [8], tobacco use and cigarette smoking [9], age of restoration, and quality of isolation. Evidence shows that the main reasons for composite restoration replacement include secondary caries, marginal fracture of restoration, discoloration, tooth hypersensitivity, periapical abscess, or loss of anatomical contour of restoration [10]. Polymerization shrinkage results in gap formation at the tooth-composite interface and subsequent leakage of saliva and bacteria, leading to composite restoration failure [11].

Correct detection of the tooth-restoration interface is the main problem encountered in composite restoration replacement, which results in excessive removal and weakening of the remaining tooth structure [12]. A previous study reported that dental clinicians were responsible for restoration failure in 30% of the cases; patients and quality of dental restorative materials were responsible for 47% and 23% of the failures, respectively [13]. Poor knowledge of dental clinicians about the biological, chemical, and physical properties of the tooth structure results in early failure of restorations, compromises the integrity of the tooth structure, and results in recurrent caries and subsequent pulp necrosis, necessitating root canal therapy and prosthetic crown placement [14].

Restoration replacement is often associated with enlargement of the cavity size, weakening of the residual tooth structure and restoration, and further damage to both the tooth and restoration [15].

Information about the frequency of different reasons for restoration replacement can help in strategy planning to prevent or minimize future restoration failures. Considering the scarcity of studies in this respect in Iran, this study aimed to assess the reasons for composite restoration replacement in Ahwaz, Iran.

Materials and Methods

This cross-sectional study was conducted on 231 patients presenting to the dental clinic of the School of Dentistry, Ahwaz Jundishapour University in 2017-2018 who required composite restoration replacement. The study protocol was approved by the ethics committee of the university and written informed consent was obtained from all patients prior to their enrollment. All participants were required to be at least 10 years old and to have at least one composite restoration that needed replacement. Patients were also required to provide written informed consent and to be willing to undergo a comprehensive clinical dental examination, including the use of a dental explorer, dental mirror, and dental floss, as well as radiographic imaging. Additionally, patients with a full set of permanent teeth (excluding third molars) and those who had no systemic conditions or medications that could affect dental health were included in the study.

Sample Size

The sample size was calculated to be 231 patients assuming a 95% confidence interval, P=0.308, and d=0.06 using the sample size calculation formula.

Data Collection

A senior dental student performed clinical dental examination for all patients using a dental explorer, a dental mirror, and dental floss under adequate lighting, and the decayed, missed, and filled (DMF) index of patients was recorded. Radiography was also performed.

The assessment of the DMF index involved a systematic clinical examination of an individual’s teeth to quantify the presence of dental caries, missing teeth due to caries, and teeth that had been restored. Each tooth was visually inspected and probed using standardized dental instruments to identify and record the specific condition of each tooth surface. The DMF index was calculated by summing the number of decayed (D), missing (M), and filled (F) teeth or surfaces, providing a comprehensive measure of the individual’s dental health status. For the DMFT index, which assesses the number of decayed, missing, and filled teeth, the score can range from 0 to 28 for an adult with a full set of permanent teeth (excluding third molars). 

Age, gender, class of occlusion, type of tooth with failed/defective composite restoration, and restoration type were all recorded. Occlusion is classified into three main classes: Class I, where the molars are in a normal relationship with the upper first molar’s mesiobuccal cusp occluding in the buccal groove of the lower first molar; Class II, characterized by the upper first molar’s mesiobuccal cusp occluding anterior to the buccal groove of the lower first molar, often indicating an overbite; and Class III, where the upper first molar’s mesiobuccal cusp occludes posterior to the buccal groove of the lower first molar, often indicating an underbite.

The restorations were classified according to the G.V. Black classification system, which includes Class I through Class V restorations, as well as specific subcategories for Class II restorations (mesio-occlusal/disto-occlusal and mesio-occluso-distal). 

The reason for restoration replacement was recorded based on the following definitions: Primary caries, defined as the presence of caries not related to the main restoration; secondary caries, characterized by caries beneath the restoration or at the restoration margins in direct contact with the restoration, detectable clinically with a dental explorer or on radiographs; defective restoration margins (without caries), indicating the presence of defective margins without the anatomical form and no occlusal contact with the opposing tooth; isthmus fracture, referring to the fracture of the restoration isthmus; broken or cracked restoration, involving a true fracture in the composite mass; lost restoration, a restoration lost due to poor retention without underlying caries; tooth fracture, a fracture of a part of the tooth structure in contact with the restoration due to weakening or undermining; open contact, the presence of symptoms such as food impaction and easy passage of dental floss suggesting an open contact; overhang, confirmed by the sharp tip of an explorer and radiographic evidence; pain or hypersensitivity, pain or discomfort in response to thermal stimuli; and other reasons, encompassing any other issues not falling into the above categories.

Statistical Analysis

Data were analyzed by SPSS version 24 (SPSS Inc., IL, USA) using independent t-test, Chi-square test, one-way ANOVA, and LSD test at 0.05 level of significance.

Results

A total of 231 patients were evaluated including 104 males (45%) and 127 females (55%).

Table-1 presents the main reasons for composite restoration replacement in the present study. As shown, secondary caries was the most common cause of restoration replacement (23.4%) followed by a combination of secondary caries and pain or dentin hypersensitivity (15.1%) in general, and also separately in males and females. The Chi-square test showed no significant difference between males and females in reasons for restoration replacement (P=0.640).

Of all patients, 63 (27.3%) were between 41-50 years, 60 (26%) were between 31-40 years, 57 (24.7%) were between 21-30 years, 33 (14.3%) were between 51-60 years, 10 (4.3%) were between 61-70 years, and 8 (3.5%) were between 10-20 years. Of all teeth that required restoration replacement, 71.4% (n=165) were maxillary anterior teeth (highest frequency), 13.4% (n=31) were maxillary premolars, 6.9% (n=16) were mandibular premolars, 4.8% (n=11) were mandibular anterior teeth, 3% (n=7) were maxillary molars, and 0.4% (n=1) were mandibular molars.

Class III restorations had the highest frequency (40.7%, n=94) followed by Class IV (29.9%, n=69), Class II-mesio-occlusal/disto-occlusal (13.4%, n=31), Class V (10%, n=23), Class I (3.9%, n=9), and Class II mesio-occluso-distal restorations (2.2%, n=5).

Secondary caries was most common in the proximal surfaces (66.7%, n=92) followed by the occlusal surface (22.5%, n=31) and cervical region (10.9%, n=15).

Table-2 presents the reasons for restoration replacement based on the age group of patients. The Chi-square test showed a significant difference among different age groups in reasons for restoration replacement (P=0.007). Secondary caries were the main reason for restoration replacement in 10-20-, 31-40-, 41-50-, and 51–60-year-old age groups. Open contact of restoration was the main reason for restoration replacement in 21-30-, and 61–70-year-olds. The highest frequency of restoration replacement was recorded in 21–to 50-year-olds, which was due to secondary caries.

Of all, 62% (n=143) were Class II, 19% (n=44) were Class I, and 19% (n=44) were Class III. Table-3 presents the reasons for restoration replacement based on the class of occlusion. The main reason for restoration replacement was secondary caries plus pain or dentin hypersensitivity in Class I (22.7%), secondary caries alone in Class II (25.9%), and other reasons in Class III (27.3%) cases. The Chi-square test showed no significant difference in reasons for restoration replacement among different classes of occlusion (P=0.144). The mean DMF of patients was 3.48±1.36 (range 0.67 to 8.67). Table-4 shows the reasons for restoration replacement based on the DMF of patients. One-way ANOVA revealed a significant difference in reasons for restoration replacement according to the mean DMF (F=1.90, P=0.031). Pairwise comparisons by the LSD test showed that in patients requiring restoration replacement due to primary caries, the mean DMF was significantly higher than that in patients requiring restoration replacement due to defective margins (without caries), isthmus fracture, lost restoration, open contact, and other reasons (P<0.05). In patients requiring restoration replacement due to secondary caries, the mean DMF was significantly higher than that in patients requiring restoration replacement due to defective margins (without caries) and isthmus fracture (P<0.05). In patients requiring restoration replacement due to defective margins (without caries), the mean DMF was significantly lower than that in patients requiring restoration replacement due to secondary caries plus pain or dentin hypersensitivity, and secondary caries plus other reasons (P<0.05). In patients requiring restoration replacement due to isthmus fracture, the mean DMF was significantly lower than that in patients requiring restoration replacement due to secondary caries plus pain or dentin hypersensitivity, secondary caries plus other reasons, secondary caries plus broken or cracked restoration, and other reasons (P<0.05). Also, patients who required restoration replacement due to primary and secondary caries, and broken or cracked restoration had a higher mean DMF than others.

Discussion

This study assessed the frequency of reasons for composite restoration replacement in Ahwaz, Iran. The results showed that secondary caries was the most common reason for restoration replacement (23.4%), followed by a combination of secondary caries and pain or dentin hypersensitivity (15.1%). Chrysanthakopoulos [16] reported that primary caries (60%) was the main cause of composite restoration of teeth while secondary caries (48%) was the most common reason for composite restoration replacement, which was in agreement with the present results. Discoloration was the second most common reason for restoration replacement in their study. Abolghasemzade et al. [17] demonstrated that secondary caries were the most common reason for composite restoration replacement in Babol, Iran in 2013 and 2014. The same results were reported by Braga et al, [18] Frost [19], and many others [20-24]. Soares and Cavalheiro [15] reported that secondary caries were the reason for the replacement of 41% of amalgam and 36% of composite restorations in Portugal. Composite fracture, caries, marginal defects, and lack of proximal contact (open contact) were reported as the main reasons for composite restoration replacement by Opdam et al [25]. In a review study, Deligergi et al. [26] concluded that clinically evident secondary caries was the main reason for the replacement of dental restorations. Similar results were reported by many other studies [7, 27-29]. The high incidence of secondary caries under composite restorations can be explained by microbiological findings [30]. The high technical sensitivity of composite restorations also contributes to the occurrence of secondary caries. Moreover, the final clinical outcome of composite restorations highly depends on the oral hygiene status of patients. Composite restorations can enhance the proliferation of Streptococcus mutans as the main microorganism responsible for dental caries. This parameter combined with poor oral hygiene can lead to the occurrence of secondary caries [31]. A high load of Streptococcus mutans has been reported at the composite restoration margins compared with amalgam and glass ionomer restoration margins [32]. Some other studies reported higher dental plaque accumulation at the tooth-composite interface compared with the tooth-amalgam interface [33] and confirmed that resin materials result in greater accumulation of dental plaque with a more cariogenic composition compared with amalgam, silicate cement, and glass ionomer [16]. Composite resin shrinkage is another factor contributing to the occurrence of secondary caries. Polymerization shrinkage of resin materials results in gap formation at the tooth-restoration interface, particularly at the gingival margin of the tooth [6].

Therefore, measures must be taken to minimize polymerization shrinkage of composite resins [16]. Microleakage is another parameter related to the development of secondary caries [34]. A previous study reported that a tooth-restoration interface gap>35-50 µm can predispose the tooth to secondary caries [35]; while some other studies found no significant correlation between gap size and secondary caries development except in case of macro-leakage (gaps>250-400 µm) [34]. It appears that secondary caries do not develop due to microleakage at the tooth-restoration interface; it is smooth-surface caries that develop due to reasons similar to those of primary caries [6].

A 10-year study carried out by Gaengler et al. [36] reported that restoration fracture was the most common cause of restoration replacement in the first 5 years while secondary caries was the main cause of replacement in the second 5 years. However, Raskin et al, [37] and Mair [38] reported very few or no cases of secondary caries as the reason for restoration replacement, which may be attributed to the routine use of rubber dam isolation for restorative procedures in European countries, which results in optimal isolation and minimizes the risk of caries recurrence.

Aside from secondary caries, composite restoration replacement may be required due to other reasons such as restoration fracture, marginal defects, tooth fracture, marginal discoloration, poor anatomical contour, and over-contouring of restorations [23, 26, 39, 40]. As mentioned earlier, the success of restorations depends on a number of factors such as quality of restorative material, size and type of restoration, tooth type, experience and expertise of dental clinician, tooth location in the dental arch, number of restored tooth surfaces, and patient’s age [17].

In the present study, the Class of occlusion had no significant association with the reason for restoration replacement. However, Class III and IV composite restorations had a higher frequency of failure. Similar results were reported by Nikaido et al [41]. A previous study reported that the 5-year survival rate of Class III, IV, and V restorations was 54.6%, 47.7%, and 59.2%, respectively [42]. A higher frequency of failure in Class III and IV composite restorations can be due to poor color match, discoloration, or caries, the significance of the optimal appearance of restorations in the esthetic zone, and higher demand of patients for their replacement. It should be noted that the gingival regions in Class II, III, IV, and V restorations are susceptible to secondary caries. The reason may be more difficult clinical control and oral hygiene maintenance at the gingival margins and cervical regions [17, 40]. This statement explains the higher rate of restoration replacement in Class II, III, IV, and V cavities compared with Class I and VI restorations [40]. Abolghasemzade et al. [17] reported that Class II restorations were the most common restoration type requiring replacement, accounting for over 50% of the cases. They explained the reason for be difficult restoration of posterior teeth. This result was different from the present findings, which may be due to the small number of Class II posterior composite restorations in the present study. In the current study, maxillary anterior teeth comprised the majority of the teeth that required restoration replacement, which was in line with previous findings [17] and may be due to the higher frequency of use of composite resin for anterior teeth, compared with posterior teeth, as a result of esthetic considerations and higher cost. Also, problems such as coronal and marginal discoloration and caries are more easily detected by patients with anterior teeth. Therefore, replacement of anterior composite restorations is a major complaint of many patients [17].

Assessment of the correlation of reasons for restoration replacement and demographic factors revealed no significant difference in this regard between males and females, which was in line with some [6, 40], and in contrast to some other studies [23]. Differences in the results in this respect may be due to differences in sample size and study populations. Nonetheless, reasons for restoration replacement had a significant correlation with the age group of patients. Patients between 20-50 years had the highest frequency of restoration replacement, which was mainly due to secondary caries. Higher occupational involvement in this age group probably leads to less attention to oral hygiene and the occurrence of secondary caries. The frequency of restoration replacement and secondary caries was lower in patients between 50-70 years probably due to tooth extraction, less popularity of composite restorations in the past, and lower frequency of dental visits in this age group.

The present results revealed a significant correlation between reasons for restoration replacement and DMF of patients, and patients who required restoration replacement due to primary or secondary caries, and broken or cracked restoration had a higher DMF, which is justifiable by the fact that higher DMF is associated with a higher frequency of carious, extracted, and filled teeth and poorer oral hygiene.

The relatively small sample size was a limitation of this study. Future studies with a larger sample size are required to compare the reasons for composite and amalgam restoration replacements. Also, the success rate of composite restorations performed by general dentists and restorative dentists should be compared.

Conclusion

In conclusion, our study on composite restoration replacement in an Iranian population shows the significant role of secondary caries as the primary reason for restoration failure, followed by a combination of secondary caries and pain or dentin hypersensitivity. The findings indicate that patients in the 40-50 age group are particularly at risk for primary caries. The lack of significant association between restoration replacement and factors such as gender and occlusion class implies that these variables may not be major contributors to restoration failure in this population. Furthermore, the higher mean DMF values observed in patients requiring restoration replacement due to primary and secondary caries, as well as broken or cracked restorations, show the need for early intervention and maintenance to prevent the progression of dental diseases. These results emphasize the importance of regular dental check-ups, effective caries management, and the use of durable restorative materials to reduce the incidence of restoration replacement and improve long-term oral health outcomes.

Conflict of Interest

The authors declare no competing interests.

GMJ Copyright© 2024, Galen Medical Journal. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/) Email:gmj@salviapub.com

 Correspondence to: Kowsar Nouroozi loraki, Department of Restorative Dentistry, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Telephone Number: 0098 61 3320 5170 Email Address: vakili.f63@gmail.com

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Table 1. Main Reasons for Composite Restoration Replacement in the Present Study

Reason	Males		Females		Total		P-value
	n	%	n	%	n	%
Primary caries	14	13.5	8	6.3	22	9.5	0.64
Secondary caries	25	24	29	22.8	54	23.4
Defective margins	0	0	3	2.4	3	1.3
Isthmus fracture	1	1	1	0.8	2	0.9
Failed or cracked restoration	1	1	0	0	1	0.4
Lost restoration	5	4.8	9	7.1	14	6.1
Tooth fracture	3	2.9	1	0.8	4	1.7
Open contact	10	9.6	9	7.1	19	8.2
Overhang	3	2.9	6	4.7	9	3.9
Dentin hypersensitivity	3	2.9	5	3.9	8	3.5
Other reasons	12	11.5	16	12.6	28	12.1
Secondary caries + pain or hypersensitivity	16	15.4	19	15	35	15.1
Secondary caries + other	2	1.9	3	2.4	5	2.2
Secondary caries + broken or cracked restoration	2	1.9	4	3.1	6	2.6
Other	7	6.7	14	11	21	9.9
Total	104	100	127	100	231	100

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Table 2. Reasons for Restoration Replacement based on the Age Group (yrs.) of Patients

Reason	10 to 20		21-30		31- 40		41-50		51-60		61-70		Total		P-value
	n	%	n	%	n	%	n	%	n	%	n	%	n	%
Primary caries	0	0	1	1.8	4	6.7	12	19	5	15.2	0	0	22	9.5	**0.007
Secondary caries	2	25	7	12.3	14	23.3	17	27	13	39.4	1	10	54	23.4
Defective margins	0	0	3	5.3	0	0	0	0	0	0	0	0	3	1.3
Isthmus fracture	0	0	2	3.5	0	0	0	0	0	0	0	0	2	0.9
Failed or cracked restoration	0	0	0	0	0	0	0	0	1	3	0	0	1	0.4
Lost restoration	1	12.5	5	8.8	6	10	0	0	1	3	1	10	14	6.1
Tooth fracture	0	0	3	5.3	0	0	1	1.6	0	0	0	0	4	1.7
Open contact	0	0	9	15.8	5	8.3	3	4.8	0	0	2	20	19	8.2
Overhang	0	0	4	7	1	1.7	2	3.2	1	3	1	10	9	3.9
Dentin hypersensitivity	0	0	3	5.3	2	3.3	2	3.2	1	3	0	0	8	3.5
Other reasons	1	0	7	12.3	10	16.7	8	12.7	1	3	1	10	28	12.1
Secondary caries + pain or hypersensitivity	1	12.5	7	12.3	12	20	8	12.7	7	21.2	0	0	35	15.1
Secondary caries + other	1	12.5	0	0	2	3.3	1	1.6	1	3	0	0	5	2.2
Secondary caries + broken or cracked restoration	0	0	2	3.5	0	0	2	3.2	0	0	2	20	6	2.6
Other	2	25	4	7	4	6.7	7	11.1	2	6.1	2	20	21	9.9
Total	8	100	57	100	60	100	63	100	33	100	10	100	231	100

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Table 3. Reasons for Restoration Replacement based on the Class of Occlusion

Reason	Class I		Class II			Class III		Total		P-value
	n	%	n	%	n		%	n	%
Primary caries	2	4.5	17	11.9	3		6.8	22	9.5	0.144
Secondary caries	8	18.2	37	25.9	9		20.5	54	23.4
Defective margins	0	0	3	2.1	0		0	3	1.3
Isthmus fracture	0	0	2	1.2	0		0	2	0.9
Failed or cracked restoration	0	0	1	0.7	0		0	1	0.4
Lost restoration	5	11.4	7	4.9	2		4.5	14	6.1
Tooth fracture	0	0	3	2.1	1		2.3	4	1.7
Open contact	3	6.8	12	8.4	4		9.1	19	8.2
Overhang	0	0	8	5.6	1		2.3	9	3.9
Dentin hypersensitivity	2	4.5	6	4.2	0		0	8	3.5
Other reasons	4	9.1	12	8.4	12		27.3	28	12.1
Secondary caries + pain or hypersensitivity	10	22.7	17	11.9	8		18.2	35	15.1
Secondary caries + other	3	3.8	2	1.4	0		0	5	2.2
Secondary caries + broken or cracked restoration	2	4.5	3	2.1	1		2.3	6	2.6
Other	5	11.4	3	9.1	3		6.8	21	9.9
Total	44	100	143	100	44		100	231	100

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Table 4. Reasons for Restoration Replacement based on DMF of Patients

Reason	n	DMF (M ± SD)
Primary caries	22	4.09 ± 1.27
Secondary caries	54	3.76 ± 1.44
Defective margins	3	2.00 ± 0.33
Isthmus fracture	2	1.33 ± 0.0
Failed or cracked restoration	1	4.33 ± 0.0
Lost restoration	14	2.88 ± 1.03
Tooth fracture	4	2.92 ± 1.2
Open contact	19	3.07 ± 1.21
Overhang	9	3.15 ± 1.25
Dentin hypersensitivity	8	3.29 ± 1.22
Other reasons	28	3.19 ± 1.4
Secondary caries + pain or hypersensitivity	35	3.65 ± 1.29
Secondary caries + other	5	4.07 ± 1.46
Secondary caries + broken or cracked restoration	6	3.67 ± 1.17
Other	21	3.54 ± 1.41
Total	231	3.48 ± 1.36

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References

1. Ernst CP, Martin M, Stuff S, Willershausen B. Clinical performance of a packable resin composite for posterior teeth after 3 years. Clinical oral investigations. 2001 Sep;5(3):148-55.
2. Demarco FF, Corrêa MB, Cenci MS, Moraes RR, Opdam NJ. Longevity of posterior composite restorations: not only a matter of materials. Dental materials: official publication of the Academy of Dental Materials. 2012 Jan;28(1):87-101.
3. Miyazaki M, Onose H, Moore BK. Effect of operator variability on dentin bond strength of two-step bonding systems. American journal of dentistry. 2000 Apr;13(2):101-4.
4. McCracken MS, Gordan VV, Litaker MS, Funkhouser E, Fellows JL, Shamp DG, Qvist V, Meral JS, Gilbert GH, National Dental Practice-Based Research Network Collaborative Group. A 24-month evaluation of amalgam and resin-based composite restorations: Findings from The National Dental Practice-Based Research Network. Journal of the American Dental Association (1939). 2013 Jun;144(6):583-93.
5. Yang JN, Raj JD, Sherlin H. Effects of Preheated Composite on Micro leakage-An in-vitro Study. Journal of clinical and diagnostic research: JCDR. 2016 Jun;10(6):ZC36-8.
6. Mjör IA, Dahl JE, Moorhead JE. Age of restorations at replacement in permanent teeth in general dental practice. Acta odontologica Scandinavica. 2000 Jun;58(3):97-101.
7. Wahl MJ, Schmitt MM, Overton DA, Gordon MK. Prevalence of cusp fractures in teeth restored with amalgam and with resin-based composite. Journal of the American Dental Association (1939). 2004 Aug;135(8):1127-65.
8. Lucarotti PS, Holder RL, Burke FJ. Outcome of direct restorations placed within the general dental services in England and Wales (Part 1): variation by type of restoration and re-intervention. Journal of dentistry. 2005 Nov;33(10):805-15.
9. Vieira AR, Silva MB, Souza KK, Arnôldo Filho VA, Rosenblatt A, Modesto A. A Pragmatic Study Shows Failure of Dental Composite Fillings Is Genetically Determined: A Contribution to the Discussion on Dental Amalgams. Frontiers in medicine. 2017 Nov 6;4:186.
10. Brunthaler A, König F, Lucas T, Sperr W, Schedle A. Longevity of direct resin composite restorations in posterior teeth. Clinical Oral Investigations. 2003 May 27;7(2):63-70.
11. Kermanshah H, Khorsandian H. Comparison of microleakage of Scotchbond™ Universal Adhesive with methacrylate resin in Class V restorations by two methods: Swept source optical coherence tomography and dye penetration. Dental Research Journal. 2017 Jul 1;14(4):272-81.
12. Sadeghi M, Lynch C. The viewpoints of restorative dentistry specialists towards the teaching of repair versus replacement of defective direct composite restorations in Iranian . Dental Schools. 2011;10:79-90.
13. Maryniuk GA, Kaplan SH. Longevity of restorations: survey results of dentists' estimates and attitudes. Journal of the American Dental Association (1939). 1986 Jan;112(1):39-45.
14. Qvist J, Qvist V, Mjör IA. Placement and longevity of amalgam restorations in Denmark. Acta odontologica Scandinavica. 1990 Oct;48(5):297-303.
15. Soares AC, Cavalheiro A. A review of amalgam and composite longevity of posterior restorations. Revista Portuguesa de Estomatologia, Medicina Dentaria e Cirurgia Maxilofacial. 2010 Jul 1;51(3):155-64.
16. Chrysanthakopoulos NA. Reasons for Placement and Replacement of Resin-based Composite Restorations in Greece. Journal of dental research, dental clinics, dental prospects. 2011;5(3):87-93.
17. Abolghasemzade F, Alaghehmand H, Judi R. The Reasons for Composite Restoration Replacement in Patients of the Restorative Department of Babol Dental School. Jentashapir Journal of Health Research. 2015 Dec 1;31:11-8.
18. Braga SR, Vasconcelos BT, de Paula Macedo MR, Martins VR, Sobral MA. Reasons for placement and replacement of direct restorative materials in Brazil. Quintessence international (Berlin, Germany: 1985). 2007 Apr;38(4):e189-94.
19. Frost PM. An audit on the placement and replacement of restorations in a general dental practice. Primary dental care: journal of the Faculty of General Dental Practitioners (UK). 2002 Jan;9(1):31-6.
20. Mahmood S, Chohan AN, Al-Jannakh M, Al-Baker H, Smales RJ. Placement and replacement of dental restorations. Journal of the College of Physicians and Surgeons--Pakistan: JCPSP. 2004 Oct;14(10):589-92.
21. Manhart J, Chen H, Hamm G, Hickel R. Buonocore Memorial Lecture Review of the clinical survival of direct and indirect restorations in posterior teeth of the permanent dentition. Operative dentistry. 2004;29(5):481-508.
22. Tyas MJ. Placement and replacement of restorations by selected practitioners. Australian dental journal. 2005 Jun;50(2):81-127.
23. Asghar S, Ali A, Rashid S, Hussain T. Replacement of resin-based composite restorations in permanent teeth. Journal of the College of Physicians and Surgeons--Pakistan: JCPSP. 2010 Oct;20(10):639-43.
24. Sunnegårdh-Grönberg K, van Dijken JW, Funegård U, Lindberg A, Nilsson M. Selection of dental materials and longevity of replaced restorations in Public Dental Health clinics in northern Sweden. Journal of dentistry. 2009 Sep;37(9):673-8.
25. Opdam NJ, Loomans BA, Roeters FJ, Bronkhorst EM. Five-year clinical performance of posterior resin composite restorations placed by dental students. Journal of Dentistry. 2004 Jul 1;32(5):379-83.
26. Deligeorgi V, Mjör IA, Wilson NH. An overview of reasons for the placement and replacement of restorations. Primary dental care: journal of the Faculty of General Dental Practitioners (UK). 2001 Jan;8(1):5-11.
27. Opdam NJ, Bronkhorst EM, Roeters JM, Loomans BA. A retrospective clinical study on longevity of posterior composite and amalgam restorations. Dental Materials: Official Publication of the Academy of Dental Materials. 2006 Jan 18;23(1):2-8.
28. Bernardo M, Luis H, Martin MD, Leroux BG, Rue T, Leitão J, DeRouen TA. Survival and reasons for failure of amalgam versus composite posterior restorations placed in a randomized clinical trial. Journal of the American Dental Association (1939). 2007 Jun 1;138(6):775-83.
29. Burke FJ, Wilson NH, Cheung SW, Mjör IA. Influence of patient factors on age of restorations at failure and reasons for their placement and replacement. Journal of dentistry. 2001 Jul;29(5):317-24.
30. Svanberg M, Mjör IA, Orstavik D. Mutans streptococci in plaque from margins of amalgam, composite, and glass-ionomer restorations. Journal of dental research. 1990 Mar;69(3):861-4.
31. Page J, Welbury RR. Operative treatment of dental caries. In: Welbury RR, ed Paediatric Dentistry, 3rd ed. Oxford: Oxford University Press. 1999:121-3.
32. Mjör IA, Jokstad A. Five-year study of Class II restorations in permanent teeth using amalgam, glass polyalkenoate (ionomer) cerment and resin-based composite materials. Journal of dentistry. 1993 Dec;21(6):338-43.
33. Friedl KH, Hiller KA, Schmalz G. Placement and replacement of composite restorations in Germany. Operative dentistry. 1995;20(1):34-8.
34. Kidd EA, Joyston-Bechal S, Beighton D. Marginal ditching and staining as a predictor of secondary caries around amalgam restorations: a clinical and microbiological study. Journal of dental research. 1995 May;74(5):1206-11.
35. Pimenta LA, Navarro MF, Consolaro A. Secondary caries around amalgam restorations. The Journal of prosthetic dentistry. 1995 Sep;74(3):219-22.
36. Gaengler P, Hoyer I, Montag R. Clinical evaluation of posterior composite restorations: the 10-year report. The journal of adhesive dentistry. 2001;3(2):185-94.
37. Raskin A, Michotte-Theall B, Vreven J, Wilson NH. Clinical evaluation of a posterior composite 10-year report. Journal of dentistry. 1999 Jan;27(1):13-9.
38. Mair LH. Ten-year clinical assessment of three posterior resin composites and two amalgams. Quintessence international (Berlin, Germany: 1985). 1998 Aug;29(8):483-90.
39. Forss H, Widstrom E. Reasons for restorative therapy and the longevity of restorations in adults. Acta Odontol Scand. 2004;62:82-6.
40. Mjör IA, Gordan VV. Failure, repair, refurbishing and longevity of restorations. Operative dentistry. 2002;27(5):528-34.
41. Nikaido T, Takada T, Kitasako Y, Ogata M, Shimada Y, Yoshikawa T, Nakajima M, Otsuki M, Tagami J, Burrow MF. Retrospective study of five-year clinical performance of direct composite restorations using a self-etching primer adhesive system. Dental materials journal. 2006 Sep;25(3):611-5.
42. Brukiene V, Aleksejuniene J, Balciuniene I. Dental restorations quality in Lithuanian adolescents. Stomatologija. 2005 Jan 1;7(4):103-9.

Composite Restoration Replacement in Patients

Nouroozi Loraki K, et al.

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Nouroozi Loraki K, et al.

Composite Restoration Replacement in Patients

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