Dentists’ Treatment Decisions Concerning Restorations in Adult Patients in North Norway: A Cross-Sectional Tromsø 7 Study.

\n<bold><italic>Introduction:</italic></bold> The aim of this cross-sectional study was to explore the degree whereby dentists differentiate between repair versus replacement for failed restorations. A random selection of adult patients from North Norway was chosen from the larger Tromsø 7 study. <bold><italic>Methods:</italic></bold> A randomized sample of 3,653 persons (11.5% of the total number of individuals invited to the Tromsø 7 study, 51.5% women, aged 40–93 years) were included. Based on FDI’s clinical criteria for the evaluation of restorations – 2010, 17 calibrated dentists evaluated patients by clinical and radiographical pictures in a specially designed software developed for this purpose. The dental practitioners’ opinions gave rise to the reported treatment decisions. Descriptive statistics and multivariable multilevel mixed-effect logistic regression models (STATA 17/SE) were performed. <bold><italic>Results:</italic></bold> The participants’ DMFT values ranged from 0 (0.9%) to 24 (8.8%) (median DMFT 21.3, mean 20.0). A total of 90.062 teeth (24.7 teeth per patient) were assessed. Re-treatment suggestions were made for 3,006 restorations, i.e., an average of 3.3% re-treatments. Of these, 25.3% (<italic>n</italic> = 814) were suggested for repair and 74.7% (<italic>n</italic> = 2,192) for replacement. Dental treatment was suggested for 1,597 patients and varying from 1 to 14 suggestions per patient. Secondary caries (37.6%) and restoration fracture (15.2%) were found to be most frequently used indications for re-treatment, surface properties the least. No significant difference was found between assessing dentists based on sex or age. Clustering by dentist level was checked using intra-class correlation coefficients, demonstrating that 16% of the variance in suggestions for restoration re-treatment was explained at the dentist level. Thus, a wide range of treatment suggestions was noted among the dentists. <bold><italic>Conclusion:</italic></bold> Need for restoration revision seems low in North Norway. There is a tendency towards larger and more indirect restorations, and the diagnosis of secondary caries is still a matter of uncertainty. A randomized population of adults over 40 years, selected among the citizens of Tromsø County in North Norway, were examined by dentists, resulting in a study group of 3,653. Clinical examinations were executed, clinical photos and X-rays taken of each patient in a dental clinic. This is part of the Tromsø 7 study. A specially designed data programme was developed, and 17 trained dentists were able to assess the clinical state of restorations. All the dentists were working as clinical teachers in dental schools. The purpose was to decide what kind of treatment they thought best for unacceptable restorations. Should they be replaced or repaired if revision was needed. Only 3.3% of all examined teeth were proposed for restoration revision, which seemed to be rather low. Among the suggested revisions, approx. 25% were recommended for repair, while 75% was assigned for replacement. Tooth-coloured material, i.e., composite, was recommended in almost 75% of the cases. Different kinds of crowns counted for 25%. A considerable difference in the number of treatment suggestions was noted among the dentists. Statistical analyses demonstrated that 16% of the difference in suggestions for restoration re-treatment depended on different dentist opinions. Secondary caries and restoration fracture were found to be the most used indications for re-treatment. Need for restoration revision seems low in North Norway. However, there is a tendency towards larger and more indirect restorations. The diagnosis of secondary caries is still a matter of uncertainty. [ABSTRACT FROM AUTHOR]