title: Restoration outcomes after restoring vital teeth with advanced caries lesions: a practice-based retrospective study.
abstract: OBJECTIVE
  Maintaining pulpal vitality and achieving long-term restoration success are challenging when treating advanced caries lesions. We aimed at assessing success, survival, and influencing factors of treating advanced lesions in general dental practice.
  
  
  METHODS
  Patient record databases from six practices in Germany were assessed. Permanent posterior teeth with lesions radiographically extending into inner dentin with sensible (vital) pulps were retrospectively evaluated. Outcome parameters were success (absence of re-treatment) and survival (absence of extraction). Mean success/survival times were estimated, and effect of treatment modifiers assessed using Lee, Wei, and Amato (LWA) regression.
  
  
  RESULTS
  Two hundred thirty-two patients (308 teeth) were assessed. Lesions (93 %) included proximal surfaces. Eight teeth showed preoperative intermitting or provocation pain. Thirty four % of teeth experienced pulpal exposure during excavation. Mean follow-up time was 74 months. Mean success time was 130 months. Teeth (142/308) required re-interventions, mostly due to secondary caries and restorative or endodontic complications. Only 13 teeth required extraction (mean survival time 307 months). Hazard of failure was significantly reduced in younger patients (<40 years) (hazard ratio (HR) [95 % confidence interval (CI)] 0.57 [0.35/0.91]) and teeth without preoperative pain (0.39 [0.17/0.90]). Compared with teeth receiving amalgams, those restored using cements (2.44 [1.05/3.98]) or composites (1.64 [1.15/2.38]) had higher risk of failure. Hazard of extraction was higher in teeth with pulpal exposure (4.90 [1.36/17.7] or cement restorations (23.6 [5.56/100]).
  
  
  CONCLUSIONS
  Teeth with advanced lesions had high risk of failure, while risk of extraction was low.
  
  
  CONCLUSIONS
  Teeth treated for advanced lesions required re-treatment frequently but were retained long term. Age, pulpal exposure, and restoration type were associated with risk of failure or extraction.
authors.affiliation: Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14199, Berlin, Germany. falk.schwendicke@charite.de.|Department for Operative and Preventive Dentistry, Charité Centre for Dental Medicine, Aßmannshauser Str. 4-6, 14197, Berlin, Germany. falk.schwendicke@charite.de.
authors.forename: Falk
authors.initials: F
authors.lastname: Schwendicke
authors.affiliation: Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14199, Berlin, Germany.|Clinic for Conservative Dentistry and Periodontology, Christian-Albrechts-Universität Kiel, Arnold-Heller-Str. 3,, 24105, Kiel, Germany.
authors.forename: Hannes
authors.initials: H
authors.lastname: Krüger
authors.affiliation: Department of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Schlattmann
authors.affiliation: Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14199, Berlin, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Paris
mesh_terms: D000328:Adult; D003731:Dental Caries / Q000628:therapy*; D003793:Dental Restoration, Permanent / Q000379:methods*; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Dental caries; Direct capping; Practice-based research; Pulpal vitality; Success; Survival