Evaluation of the marginal adaptation of fillings under various conditions of dental caries treatment

The dissertation is devoted to improving the quality of dental caries treatment through early diagnosis of marginal adaptation disturbances in composite fillings under different filling conditions. The research focuses on studying the factors that affect the durability of restorations, including the level of enamel resistance to caries, the localization of carious cavities, the method of working field isolation, the condition of the pulp, and the follow-up period. The author proposes the use of an electrometric method for the objective assessment of marginal adaptation of fillings and develops a differentiated approach to the timing of follow-up examinations aimed at the prevention of secondary caries and the economic substantiation of early correction of restorations.

Relevance of the Problem

To date, the prevalence and intensity of dental caries among the population of Russia reaches 99% (Borovsky E.V., 2006; Kuzmina E.M., Maksimovsky Yu.M., 2008). Untreated caries transforms from an aesthetic deficiency into a pathology that causes a severe complex of morphofunctional disorders: deterioration of nutritional quality, changes in facial aesthetics, and others [57, 59, 201].

High demands are placed on the quality of dental treatment. The emergence of new technologies, materials, and methods makes it possible to improve the effectiveness of caries treatment and to extend the service life of fillings [59]. At present, the therapy of carious dental lesions is reduced to the excision of pathologically altered tissues and the replacement of the defect with a filling material.

It is known that the durability of composite fillings is influenced by such conditions as the level of tooth resistance to caries, the state of oral hygiene, the presence and severity of periodontal tissue inflammation, the volume and class of the carious cavity, pulp vitality, the type of filling material, and the time elapsed since the restoration [16, 34, 41, 42, 211]. Despite the increasingly widespread introduction of the rubber dam into dental practice and the obvious advantage of the absolute isolation method, its influence on the quality of filling adhesion to tooth tissues has not yet been studied, and the literature mainly highlights the practical aspects of its clinical application [7, 186].

The combined influence of external and internal factors on the development of secondary caries and on the service life of restorations has likewise not been investigated.

Under contemporary conditions, improving the quality of dental care becomes not only a medical but also a social and economic problem, since 40% of repeat interventions are accounted for by the restoration of filling defects or their replacement, which consumes one-third of the working time of a dental practitioner [14, 72, 193]. In this regard, during the warranty period and the service life of the restoration, it is extremely important to regularly diagnose its condition and to make timely corrections without allowing complete replacement of the composite filling.

At present, simple and reliable methods for the objective assessment of filling adaptation quality are practically not used in outpatient practice, and the timing of follow-up examinations aimed at eliminating defects and preventing recurrent caries has not been defined [103, 222].

Aim of the Research

To improve the quality of dental caries treatment under different filling conditions on the basis of early diagnosis of marginal adaptation disturbances in composite fillings.

Research Objectives

1. To study the dynamics of clinical and electrometric indicators of marginal adaptation of composite fillings in patients with medium and low levels of enamel resistance to caries in different localizations of carious cavities.

2. To assess the dependence of filling marginal adaptation quality on the conditions of working field isolation over time.

3. To identify, at different follow-up periods, changes in the marginal adaptation of the composite material depending on the viability of the dental pulp.

4. To analyze the influence of carious cavity filling conditions over time in order to determine the timing of follow-up examinations and to evaluate the clinical and economic effectiveness of early diagnosis of marginal adaptation disturbances in fillings for the prevention of secondary caries.

Scientific Novelty of the Research

• For the first time, the advantage of the absolute method of tooth isolation using a rubber dam for achieving high-quality marginal adaptation of fillings has been objectively proved.

• For the first time, the combined influence of the level of enamel caries resistance, pulp viability, and working field isolation on the marginal adaptation of fillings has been studied over time.

• For the first time, a differentiated approach to the timing of follow-up examinations for identifying the need for early correction of fillings has been developed and substantiated, and its economic effectiveness has been proved.

Practical Significance

In the present work, which is preventive in orientation, combinations of active factors have been determined that make it possible in clinical practice to achieve the maximum quality and long-term marginal adaptation of fillings to the hard dental tissues during caries treatment, provided that a rubber dam is applied and remineralizing therapy is carried out in patients with low caries resistance.

On the basis of clinical research and economic analysis, the timing of follow-up examinations has been substantiated for determining filling unsealing with the aim of early correction and prevention of recurrent caries.

The availability and high informational content of the electrometric method for the early diagnosis of marginal adaptation disturbances in composite fillings has been proved, which can be used in the expert assessment of treatment at a dental appointment.

Implementation

The results of the work have been implemented in the Municipal Healthcare Institution "Stomatological Polyclinic No. 1", the Municipal Healthcare Institution "Children's Stomatological Polyclinic No. 1", and the Municipal Healthcare Institution "Children's Stomatological Polyclinic No. 2" of the city of Barnaul.

The acquired knowledge about the influence of the studied factors on the adhesion quality of composite fillings is used in the educational process during lectures and practical classes at the Department of Therapeutic Dentistry of ASMU when studying the topic: "Treatment of dental caries with composite materials".

Main Provisions Defended

1. The electrometric method of diagnostics makes it possible to assess with high accuracy the marginal adaptation of composite fillings, which deteriorates with an increase in their service life. The most significant conditions for the qualitative filling of carious cavities are the method of working field isolation and enamel resistance, while pulp viability is less significant.

2. The developed differentiated approach to the timing of follow-up examinations, taking into account the combined influence of the acting factors for the early detection of filling unsealing, contributes to improving the quality of treatment and is economically effective.

Approval of the Work

The materials of the dissertation were reported and discussed at the VII scientific and practical conference with international participation "Modern Stomatological Technologies" (Barnaul, 2005), the annual scientific and practical conference of ASMU (Barnaul, 2006), the VIII city scientific and practical conference "Youth — to Barnaul" (Barnaul, 2006), the scientific and practical conference "Modern Technologies in the System of Improving the Quality of Stomatological Care for the Population of the Altai Krai" (Barnaul, 2006), and the krai's scientific and practical conference "Stomatology — 2007" (Barnaul, 2007).

The dissertation was approved at the inter-departmental meeting of the staff of the departments of therapeutic dentistry, surgical dentistry, orthopedic dentistry, pediatric dentistry, and otolaryngology with a course in eye diseases of ASMU on February 26, 2009, as well as at the joint meeting of the staff of the departments of therapeutic dentistry, surgical dentistry, orthopedic dentistry, pediatric dentistry, and histology of the Novosibirsk State Medical University of Roszdrav on May 29, 2009.

Publications

Based on the materials of the dissertation, 7 works have been published, of which 2 are in journals reviewed by the Higher Attestation Commission.