How do dentists make decisions when restoring extensive defects in posterior molar teeth?

This summary is based on the article published in Operative Dentistry: Clinical Decision Making on Extensive Molar Restorations (November/December 2014)

T Laegreid; NR Gjerdet; A Johansson; A-K Johansson

Courtesy of Operative Dentistry, you can access the full-text article here for the next 3 months. 

Context

• Clinical decision making is an important component of everyday dentistry, and its outcome depends on a large number of different crucial factors.
• Improved biological and mechanical properties of composite restorative materials have broadened their indications during the past few decades.¹
• Extensive loss of posterior tooth substance, which traditionally was restored with amalgam or indirect restorations, is more commonly being restored with resin-based composite restorations. 
• These changes have challenged the clinical decision making of dentists and, specifically, the choice between prescribing direct or indirect techniques when restoring extensive posterior defects has been rendered difficult.
• Suggested treatment options must primarily be based on an individual clinical assessment, but other factors such as patient requests and economy may also contribute to the decision making. ^{2, 3}
• While there is little scientific information available concerning the choice of restorative treatment for extensive loss of tooth substance in posterior teeth, more research has been carried out on treatment options for intra-coronal Class I and II cavities in posterior teeth. ^{4, 5}
• The available literature is sparse concerning the choice between direct and indirect restorative treatment of extensive defects in posterior teeth.

Purpose of the Study

• Survey Norwegian dentists’ clinical decision making when restoring extensive defects in posterior molar teeth.
• Evaluate the importance of influencing factors when it comes to the choice of treatment.
• Study the associations between treatment choice, operator, and patient-related factors.

Clinical Relevance

• Extensive loss of posterior tooth substance, which traditionally was restored with amalgam or indirect restorations, is more commonly being restored with resin-based composite restorations.
• The choice between prescribing direct or indirect techniques when restoring extensive posterior defects has challenged clinical decision making.

Key Findings

• The most important factor reported was the amount of remaining tooth substance.
• Other important factors were patient request, presence of para-functional oral habits, caries activity, and lectures.
• Factors that were less important for the respondents were advertisements, use of fluoride, and dietary habits.
• Female dentists consider factors such as patient requests and economy to be more important than do their male colleagues in clinical decision making.
• The amount of remaining tooth substance was clearly considered the most important factor influencing the treatment choice.

References

1. Hickel R, Manhart J, & Garcia-Godoy F (2000). Clinical results and new developments of direct posterior restorations American Journal of Dentistry 13(Spec No) 41D-54D.
2. Forss H, & Widstro¨m E (1996). Factors influencing the selection of restorative materials in dental care in Finland Journal of Dentistry 24(4) 257-262.
3. Brennan DS, & Spencer AJ (2006). Longitudinal comparison of factors influencing choice of dental treatment by private general practitioners Australian Dental Journal 51(2) 117-123.
4. Burke FJ, McHugh S, Hall AC, Randall RC, Widstro¨m E, & Forss H (2003) Amalgam and composite use in UK general dental practice in 2001 British Dental Journal 194(11) 613-618.
5. Mjo¨r IA, Shen C, Eliasson ST, & Richter S (2002) Placement and replacement of restorations in general dental practice in Iceland Operative Dentistry 27(2) 117-123.