Authors' objectives:

To summarise the results of a systematic review of the relative longevity and cost-effectiveness of routine intra-coronal dental restorations.

Authors' recommendations: Tooth decay is one of the most common diseases and accounts for almost half of all tooth extractions. The treatment of tooth decay by the placement of simple, direct restorations (fillings) alone costs the NHS in England and Wales 173 million GBP per year. Dental restorations do not last forever; over 60% of all restorative dentistry is for the replacement of restorations. New restorative materials are often marketed and introduced into practice with limited evidence on their long-term clinical performance. Overall, amalgam is the direct restorative material of choice unless aesthetics are important. It lasts longest and is the cheapest. The newer generation dentine bonding agents for composite restorations use some form of acidic primer and have better retention rates than earlier generations. The use of cermet cements, and the composite and glass ionomer sandwich technique in class II cavities, had high failure rates and cannot be recommended. There is significant variation in decision making between dentists. Appropriate criteria for replacement of restorations are needed and dental schools should train dentists in their use in order to reduce unnecessary procedures and improve quality. The longevity of restorations carried out in the better quality research studies suggests that routine clinical practice may be producing sub-optimal results. Work is needed to establish means of improving the quality of routine practice, putting in place incentives to promote cost-effective care and identifying the resource implications.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.york.ac.uk/inst/crd/ehcb.htm

Year Published: 1999

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England

Organisation Name: University of York

Contact Address: University of York, York, Y01 5DD, United Kingdom. Tel: +44 1904 321040, Fax: +44 1904 321041,

Contact Name: crd@york.ac.uk

Contact Email: crd@york.ac.uk

Copyright: Centre for Reviews and Dissemination