Re-treatment decisions for failed posterior fillings by Finnish general practitioners.
OBJECTIVE
To evaluate treatment decisions of general dental practitioners (GDPs) in the private and public sector in cases of re-treatment of failed posterior fillings.


METHODS
A questionnaire on six cases from 400 GDPs, selected by stratified randomisation by gender, and main occupation (public vs. private sector). Others were all full-time dental teachers (DTs; n=47) representing clinical disciplines other than surgery and orthodontics. Restorative cases were described in detail, including figures drawn on four subcases involving the first permanent upper molar where the filling to be replaced increased in size from occlusal filling to the entire clinical crown. For each case, respondents chose the optimal treatment from eight alternatives, later re-classified as amalgam restoration, direct composite restoration, prosthetic restoration (indirect composite, cast gold inlay/onlay, ceramic inlay/onlay, ceramic crown, or bridge construction following tooth extraction).


RESULTS
For re-treatment of the occlusal filling, composite restoration was preferred both by GDPs (92%) and DTs (83%). For three-surface fillings, prosthetic restorations were dominant in the private sector (OR=2.3; 95% CI: 1.4, 3.8; P<0.001). In total loss of the clinical crown, prosthetic restoration was chosen by all the DTs, public-sector dentists, and 95% of private-sector dentists. No more than 10% of GDPs chose amalgam and 2% gold; the rest chose composites.


CONCLUSIONS
Treatment decisions were similar in public and private sectors for cases with the smallest and largest fillings. Wide variation in cases of medium-sized restorations indicated a lack of generally accepted guidelines of good clinical practice and of evidence-based treatment practice.
Heinikainen
Mia
M
Department of Oral Public Health, Institute of Dentistry, University of Helsinki, Finland.
Vehkalahti
Miira
M
Murtomaa
Heikki
H
D000328:Adult; D001291:Attitude of Health Personnel; D002516:Ceramics; D016009:Chi-Square Distribution; D003188:Composite Resins; D016001:Confidence Intervals; D003442:Crowns; D003657:Decision Making; D003723:Dental Amalgam; D003793:Dental Restoration, Permanent / Q000145:classification; D003815:Dentists; D003829:Denture, Partial; D005179:Faculty, Dental; D005260:Female; D005387:Finland; D005792:General Practice, Dental; D006047:Gold Alloys; D006801:Humans; D007284:Inlays; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010347:Patient Care Planning; D017149:Private Sector; D017150:Public Sector; D019233:Retreatment; D011795:Surveys and Questionnaires
D003188:Composite Resins; D006047:Gold Alloys; D003723:Dental Amalgam