title: The survival of direct composite restorations in the management of severe tooth wear including attrition and erosion: A prospective 8-year study.
abstract: OBJECTIVE
  Survival of directly placed composite to restore worn teeth has been reported in studies with small sample sizes, short observation periods and different materials. This study aimed to estimate survival for a hybrid composite placed by one clinician up to 8-years follow-up.
  
  
  METHODS
  All patients were referred and recruited for a prospective observational cohort study. One composite was used: Spectrum(®) (DentsplyDeTrey). Most restorations were placed on the maxillary anterior teeth using a Dahl approach.
  
  
  RESULTS
  A total of 1010 direct composites were placed in 164 patients. Mean follow-up time was 33.8 months (s.d. 27.7). 71 of 1010 restorations failed during follow-up. The estimated failure rate in the first year was 5.4% (95% CI 3.7-7.0%). Time to failure was significantly greater in older subjects (p=0.005) and when a lack of posterior support was present (p=0.003). Bruxism and an increase in the occlusal vertical dimension were not associated with failure. The proportion of failures was greater in patients with a Class 3 or edge-to-edge incisal relationship than in Class 1 and Class 2 cases but this was not statistically significant. More failures occurred in the lower arch (9.6%) compared to the upper arch (6%) with the largest number of composites having been placed on the maxillary incisors (n=519).
  
  
  CONCLUSIONS
  The worn dentition presents a restorative challenge but composite is an appropriate restorative material.
  
  
  CONCLUSIONS
  This study shows that posterior occlusal support is necessary to optimise survival.
authors.affiliation: Department of Restorative Dentistry, Liverpool University Dental Hospital, Pembroke Place, Liverpool, Merseyside L3 5PS, UK. Electronic address: alexander.milosevic@rlbuht.nhs.uk.
authors.forename: A
authors.initials: A
authors.lastname: Milosevic
authors.affiliation: The University of Liverpool, Dental Research Wing, Daulby Street, Liverpool, L69 3GN, UK.
authors.forename: G
authors.initials: G
authors.lastname: Burnside
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003188:Composite Resins / Q000737:chemistry / Q000627:therapeutic use*; D003764:Dental Materials / Q000737:chemistry; D019232:Dental Restoration Failure; D019554:Dental Restoration Wear; D003793:Dental Restoration, Permanent; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019217:Tooth Attrition / Q000628:therapy*; D014077:Tooth Erosion / Q000628:therapy*; D057085:Tooth Wear / Q000628:therapy*
chemical_list: D003188:Composite Resins; D003764:Dental Materials
keywords: Attrition; Composite survival; Erosion; Tooth wear