Association Of Age And Gender In Patients Undergoing Class II Composite Restoration In Mesial And Distal Surfaces Of Mandibular Molars

Keywords

Class II Cavity; Composite Restorations; Disto-Occlusal; Mandibular Molars; Mesio-Occlusal.

Introduction

When a tooth is restored for the first time an adhesive restoration can preserve sound tooth structures when compared to conventional amalgam. This is true when a tooth is initially restored. Composite resin comprises of three phases: the matrix, the coupling agents and the fillers. The most commonly used components in the organic resin Matrix are BIS-GMA modified BISGMA, urethane dimethacrylate and a number of diluents [21].

Bi polar molecules such as organosilanes are usually used as coupling agents to connect to organic as well as inorganic fillers, the bond is polymeric in nature if the organic filler particles are prepolymerised. Beveling is also one of the most important steps in class II restorations. The traditional retention form of cavity preparations lost its relevance when the acid-etch technique was found to bind composite materials effectively to enamel. The surface size and pattern of etched enamel surrounding cavity preparations (and recently dentin) became dominant factors influencing retention of restorative composite materials, rather than convergence of cavity walls. As a result, new conservative cavity preparations were designed preserving sound tooth structure and involving a wide area of beveled enamel, intending to reduce marginal. However, the cavosurface finish of the enamel wall at the cervical margins of class 2 cavity preparations gained only little attention. Beveling the enamel and restoring the tooth with a composite material may present excellent results in vitro. cervical margin of the approximal box and restore the tooth in the clinical setting: the interdental papilla may become injured by the high-speed bur and bleed; the etching agent may leak and harm the gingiva; the gingival fluid may contaminate and dilute the acid, thereby reducing its chelating •effect; the cervical sulcular fluids and blood may contaminate the etched enamel, compromising the retention of the composite and increasing marginal leakage; tight adaptation of the matrix band to the etched enamel may damage the tags; and, in addition, the attached matrix band may interfere with application of the bonding agent and composite material [13]. Therefore small carious lesions in the proximal surface of premolars and molars should conserve sound tooth structure [13, 25].

The box type restoration has been difficult to control because of limited access to the cavity And poor clinic performances [5]. Also some studies state that box type restoration satisfies the required condition [5, 2, 6]. Composite resin are subjected to wear under oral conditions and in time undergo other physical and chemical alterations [11]. Class II decays have become very common because patients fail to use interdental cleaning aids to clean the proximal surfaces of posterior teeth.

Thus this study aims to evaluate age and gender association among patients undergoing class two composite restoration in mandibular molars.

Materials and Methods

Study setting

This study was done in a university setting conducted in Saveetha Dental College, Chennai. Approval from the ethical committee was obtained. Two examiners are involved in this study.

Sampling

In this retrospective study, a total of 86000 case sheets were reviewed, out of which 50 case records were collected from June 2019 and March 2020.Cross verification of data for errors were analysed using photographs by another examiner. Simple random sampling was done to minimize sampling bias. Study was generalised to the South Indian population.

Data collection

Data of patients who underwent class II composite restoration in mandibular molars was collected from the record management system of the college. Data was entered in excel in a methodological manner and imported to SPSS. Incomplete data was excluded from study.

Analysis

IBM SPSS 23.0 software was used for data analysis. Independent variables include age, gender, tooth. Dependent variable is surface of class II composite restoration. The surfaces involved are Mesio occlusal (MO), Disto occlusal (DO). Both descriptive and inferential statistics were done. Frequency distribution was done for age and gender in which class II composite restoration in mandibular molars was performed. Chi square test was done to find the association.

Results And Discussion

Total of 50 patients underwent Class 2 composite restoration in mandibular molars, 28 were male patients and 22 were female patients. Amongst male patients 10 had undergone composite restoration in MO and 18 had undergone composite restoration in DO. Amongst female patients 8 had undergone composite restoration in MO and 14 had undergone composite restoration in DO. Chi square test was done to evaluate the association between gender and the surface of class II composite restoration, which was found to be statistically not significant, p value was 0.962 (p>0.05) (Figure 1).

On analysing the age groups: In 18-30 years, 7 had undergone composite restoration in MO and 14 had undergone composite restoration in DO. In 31-40 years, 2 had undergone composite restoration in MO and 10 had undergone composite restoration in DO. In 41-50 years 6 had undergone composite restoration in MO and 3 had undergone composite restoration in DO. In 51 years and above 3 had undergone composite restoration in MO and 5 had undergone composite restoration in DO. Chi square test was done to evaluate the correlation and p value was 0.128 which was not statistically significant (p>0.05) (Figure 2). A restorative material to be used in these heavily loaded restorations should have a sufficiently high strength and wear resistance. Clinical studies performed in a general practice environment have shown that composite resin performs well in normal and large sized restorations in all kinds of patients. Apparently, current dental composites have adequate mechanical properties for use in all areas of the mouth [12].

Greater demand for aesthetic restorations has revolutionised modern dentistry and brought about the widespread use of resin composites. In accordance with respective clinical indications, resin composite materials are suitable to be used for both direct and indirect restorations. The rehabilitation of decayed or fractured posterior teeth using an indirect technique was introduced to overcome some of the problems associated with direct restorative techniques, amongst others, polymerization shrinkage and insufficient wear resistance or mechanical properties of directly placed filling materials. Moreover, the achievement of proper interproximal contact and occlusal morphology and the complete cure of composite resins in the deepest regions of a cavity are other challenges related to direct composite restorations [14].

In this study male population had more prevalence of class II dental caries and this can be attributed to poor usage of interdental brush and other cleaning aids a study by yamamoto et al states that interdental brushes or other interdental cleaning aids can reduce plaque accumulation and thus reduce Caries incidence in the proximal surface of teeth [26]. In this study the age group of 18 to 30 years had more class II caries and Have undergone class II composite restoration. This can be overcome by the usage of proper cleaning technique. Imai et al. states that interdental brush is easy to use and has high patient compliance.

This study can be used as a base and the cons in the study are the small sample size limitation of population group to south Indian population this can be altered and done in large-scale.The in-vitro studies conducted at our university were [20, 23], the in vivo studies include [15, 22], molecular study includes [7]. The reviews and systematic review published are [18, 24]. The surveys conducted were [17, 8]. The clinical trials about root canal were [16, 9]. Currently we are analysing retrospective studies and in this study we have evaluated the frequency of class II composite restorations in mandibular molars amongst different age groups and gender. Aesthetics are as valuable in the posterior region as they are in the anterior. While the former is sometimes overlooked due to the limited visibility of posterior teeth, it is important that the clinician follow guidelines to ensure a high-quality restoration in this region. Restoring posterior teeth with direct resin can be accomplished through conservative and aesthetic treatment; however, it can also be challenging and time consuming to achieve exceptional aesthetics [1, 10, 3, 19, 4]. The increase in demand for aesthetics paves the way for dentists to opt for composite restorations for posterior class II cavities.

This study is of a shorter time frame with a limited population. So to ascertain the findings of our study, we have to do further studies in the future with larger sample size and longer duration.This can be helpful to find more information regarding the frequency of class II composite restoration in mandibular molars done and its efficacy based on age and gender.

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Conclusion

Within the limitations of the study on the basis of age group 18 to 30 years have undergone more class II restorations. When comparison was done based on gender, males have undergone more class II restorations. This may be due to the increasing aesthetic concern among patients and thus patients prefer composite over other restorative materials available..