Thursday, July 26, 2012

A Six-Month Study

I know; it is Thursday and I am blogging. Wednesday came and went, and I totally forgot to do a blog. I am so out of it. See, along with my assistant still being out, my son left to go on his first mission trip yesterday.

I was totally fine. I wasn’t nervous or concerned about anything until I dropped him off. I made sure he had his passport, and the hard realization that he was going out of the country to a drug cartel-infested country hit me like a ton of lead.

I have not been myself today. I know, I know. Trust God. And I do. But this is hard to do when it is your son. I am okay. I just have to keep telling myself he is going to be fine. It is going to be such a good thing for him. He is such a great, tender-hearted kid, but he is as spoiled as the day is long. This trip will give him a little perspective (and a little case of the "runs," too).

Today’s topic is composites. I hope you are not tired of this topic. This is the stuff that I am reading about, so this is the stuff that I am learning, and I have to tell you about it. I have been to a couple of lectures recently and they both said different things about the longevity of composites. The first said that five years is still the average on a composite filling, but the second guy said that they are confident that they will last 12 years.

I was sent a journal article from the Journal of Dental Materials about the longevity of composite fillings – it is a 22-year study!!! They looked at 362 restorations and they only had 110 failures. I did the math for you: that is 70% success rate. And the kicker is that only 41% of the failures (49 out of 362) had to be replaced (60 of the failures just were repaired). How about that? That means 49 out of 362 restorations had to be replaced at the 22 year mark.

I think this is a study of restorations from one dentist. This guy was pretty good. There are pictures of his work, and you can tell the guy was good. He put anatomy in all his restorations and looked to be very conscientious (and that was 22 years ago). Does that mean all restorations will last 22 years? No. Does this mean they all still look awesome in 22 years? No. But they don't need to be replaced.

It is the same thing we were talking about with the root canal failure rate in last week’s blog. Endodontists claim about a 2-4% failure and that article was saying about a 19% failure rate. But this article was saying is that if you do it well, if you try hard and use the right materials and you are conscientious, composite restorations are dynamite.

We knew that. We know because we see it in our own practices. We are looking at our restorations and doing our own studies. How do my fillings look? How are my margins holding up? At every recall appointment, you get to have your own research study. And not just for fillings. I look at the margins of my crowns and get angry when the tissue recedes or there is an overhang. I look at the color of the teeth and how stable the color is in all my all porcelain crowns. I look at everything I do and see how it is going.

You guys are doing this, right? I mean, along with looking for things that are going wrong in my patients’ mouths, I look at the things that are going right. I am my own worst critic, so it really does make me a better dentist. The problem is that by the time I think I have this profession licked, I will be right at retirement age.

Hope you are having a good Thursday. I will talk to you tomorrow.


1 comment:

B Draht said...

Thanks for the information on composites. I have been attempting to find out the durability of them, what you note is similar to what I have concluded. The big deal for me is that they seem to strengthen the tooth, which is important (I have had numerous cusps repaired over the last ten years). Are there differences in brands of composites? What about adhesives?


PLEASE NOTE: When commenting on this blog, you are affirming that any and all statements, and parts thereof, that you post on “The Daily Grind” (the blog) are your own.

The statements expressed on this blog to include the bloggers postings do not necessarily reflect the opinions of the Academy of General Dentistry (AGD), nor do they imply endorsement by the AGD.