title: Re-interventions after restoring teeth-Mining an insurance database.
abstract: OBJECTIVE
  The aim of this study was to examine re-interventions after restorative treatment.
  
  
  METHODS
  The data was collected from the digital database of a major German national health insurance company. Only permanent teeth were observed. Placing a permanent restoration other than a crown regardless of involved surfaces and material was the study intervention. The data did not allow for a differentiation between fillings and inlays that were estimated only a very small portion of the restorations. Success was defined as not undergoing any restorative re-intervention with fillings or inlays on the same tooth (primary outcome) and assessed with Kaplan-Meier survival analyses over four years. An additional analysis was conducted rating "crowning" and "extraction" of respective teeth as target events. Differences were tested with the Log-Rank-test. A multivariate Cox regression analyses was carried out.
  
  
  RESULTS
  A total of 17,024,344 restorations placed in 4,825,408 anterior teeth and 9,973,177 posterior teeth could be traced. Focussing on the primary outcome re-intervention, the cumulative four-year success rate was 69.9% for one surface restorations, 74.8% for two surface restorations, 66.6% for three surface restorations and 61.0% for four surface and more extended restorations. These differences were significant (p<0.0001). Focussing on all three target events re-intervention, crowning and extraction, the cumulative four-year success rate was 66.1% for one surface restorations, 67.5% for two surface restorations, 63.0% for three surface restorations and 55.8% for four surface and more extended restorations. The number of restoration surfaces as well as the tooth position remained significant in the multivariate Cox regression.
  
  
  CONCLUSIONS
  The sustainability of restorative dental treatment under the terms and conditions of the German national health insurance system shows room for improvement. From a public health perspective, special focus should be laid on primary and secondary prevention to minimize the restorative treatment need.
  
  
  CONCLUSIONS
  This study shows that re-interventions are observed regularly after restorative treatment. Therefore, preventive and restorative strategies should be revisited and optimised.
authors.affiliation: Department of Prosthetic Dentistry, Technische Universität Dresden, Faculty of Medicine Carl Gustav Carus, Fetscherstraße 74, 01307 Dresden, Germany. Electronic address: Michael.Raedel@uniklinikum-dresden.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Raedel
authors.affiliation: AGENON, Gesellschaft für Forschung und Entwicklung im Gesundheitswesen, Kaunstraße 21, 14163 Berlin, Germany. Electronic address: ah@agenon.de.
authors.forename: Andrea
authors.initials: A
authors.lastname: Hartmann
authors.affiliation: AGENON, Gesellschaft für Forschung und Entwicklung im Gesundheitswesen, Kaunstraße 21, 14163 Berlin, Germany. Electronic address: priess@agenon.de.
authors.forename: Heinz-Werner
authors.initials: HW
authors.lastname: Priess
authors.affiliation: AGENON, Gesellschaft für Forschung und Entwicklung im Gesundheitswesen, Kaunstraße 21, 14163 Berlin, Germany. Electronic address: bohm@agenon.de.
authors.forename: Steffen
authors.initials: S
authors.lastname: Bohm
authors.affiliation: Policlinic of Prosthetic Dentistry, Gerodontology and Biomaterials, Center of Oral Health, University Medicine Greifswald, Rotgerberstr. 8, 17475 Greifswald, Germany. Electronic address: samietzs@uni-greifswald.de.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Samietz
authors.affiliation: Department of Prosthetic Dentistry, Technische Universität Dresden, Faculty of Medicine Carl Gustav Carus, Fetscherstraße 74, 01307 Dresden, Germany. Electronic address: ioannis.konstantinidis@uniklinikum-dresden.de.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Konstantinidis
authors.affiliation: Department of Prosthetic Dentistry, Technische Universität Dresden, Faculty of Medicine Carl Gustav Carus, Fetscherstraße 74, 01307 Dresden, Germany. Electronic address: Michael.Walter@uniklinikum-dresden.de.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Walter
mesh_terms: D003442:Crowns; D019232:Dental Restoration Failure / Q000706:statistics & numerical data*; D003793:Dental Restoration, Permanent / Q000145:classification / Q000706:statistics & numerical data*; D003814:Dentistry, Operative; D019229:Dentition, Permanent; D005792:General Practice, Dental; D005858:Germany; D006302:Health Services Research; D006801:Humans; D007284:Inlays; D007347:Insurance, Dental; D015999:Multivariate Analysis; D011634:Public Health; D012044:Regression Analysis; D014070:Tooth; D014081:Tooth Extraction; D016896:Treatment Outcome
keywords: Dental restoration (permanent); General practice (dental); Health services research; Operative dentistry; Public health; Treatment outcome