title: Longevity of posterior resin composite restorations in adults – A systematic review.
abstract: OBJECTIVE
  To conduct a systematic review of the literature on the longevity of posterior resin composite restorations in adults.
  
  
  METHODS
  A systematic literature search was conducted according to pre-determined criteria for inclusion and exclusion. The studies selected were prospective clinical trials with a minimum follow-up time of 4 years, 40 restorations per experimental group and an annual attrition rate of less than 5%. Initially, abstracts and full-text articles were assessed independently and the assessment was subsequently agreed on by five reviewers. The methodological quality of the studies was assessed according to the Swedish Council on Health Technology Assessment (SBU) standard checklist for determining the extent to which studies meet basic quality criteria.
  
  
  RESULTS
  In all, the literature search identified 4275 abstracts and 93 articles were read in full-text. There were eighteen studies which met the criteria for inclusion, eight of which were included in the analysis. There were 80 failures of restorations with a total follow-up time at risk for failure of 62,030 months. The overall incidence rate for all causes of failure was 1.55 lost restorations per 100 restoration years. The most common biological reason for failure (a total of 31 restorations) was secondary caries, with or without fracture of the restoration. The quality of the evidence was low.
  
  
  CONCLUSIONS
  In an efficacy setting, the overall survival proportion of posterior resin composite restorations is high. The major reasons for failure are secondary caries and restoration fracture which supports the importance of adequate follow-up time.
  
  
  CONCLUSIONS
  The overall survival proportion of posterior composite restorations was high, but the results cannot be extrapolated to an effectiveness setting. The importance of adequate follow-up time is supported by the finding that secondary caries often occurred after 3 years or later.
authors.affiliation: Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden. Electronic address: Alfheidur.Astvaldsdottir@ki.se.
authors.forename: Álfheiður
authors.initials: Á
authors.lastname: Ástvaldsdóttir
authors.affiliation: Swedish Council on Health Technology Assessment, Stockholm, Sweden.
authors.forename: Jessica
authors.initials: J
authors.lastname: Dagerhamn
authors.affiliation: Department of Odontology, Dental School Umeå, Umeå University, Umeå, Sweden.
authors.forename: Jan W V
authors.initials: JW
authors.lastname: van Dijken
authors.affiliation: Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
authors.forename: Aron
authors.initials: A
authors.lastname: Naimi-Akbar
authors.affiliation: Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.
authors.forename: Gunilla
authors.initials: G
authors.lastname: Sandborgh-Englund
authors.affiliation: Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden; Swedish Council on Health Technology Assessment, Stockholm, Sweden; Faculty of Odontology, Malmö University, Malmö, Sweden.
authors.forename: Sofia
authors.initials: S
authors.lastname: Tranæus
authors.affiliation: Swedish Council on Health Technology Assessment, Stockholm, Sweden; Faculty of Odontology, Malmö University, Malmö, Sweden.
authors.forename: Mikael
authors.initials: M
authors.lastname: Nilsson
mesh_terms: D000328:Adult; D002986:Clinical Trials as Topic; D003188:Composite Resins; D019232:Dental Restoration Failure; D003793:Dental Restoration, Permanent / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D003188:Composite Resins
keywords: Clinical; Composite; Effectiveness; Longevity; Resin; Systematic review