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ORIGINAL ARTICLE
Year : 2021  |  Volume : 12  |  Issue : 1  |  Page : 1-7

Periodontium and restoration: A comparative study of restored and unrestored molars


1 Department of Periodontics, University of Benin/ University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
2 Department of Restorative Dentistry, University of Benin/University of Benin Teaching Hospital, Benin City, Edo State, Nigeria

Date of Submission25-Aug-2020
Date of Decision23-Dec-2020
Date of Acceptance13-Jan-2021
Date of Web Publication30-Mar-2021

Correspondence Address:
Dr. Joan Emien Enabulele
Department of Restorative Dentistry, University of Benin/University of Benin Teaching Hospital, Benin City, Edo State
Nigeria
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DOI: 10.4103/srmjrds.srmjrds_82_20

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  Abstract 

Background: Restorations have been known to have a detrimental effect on the periodontium with certain teeth or groups of teeth prone to develop more severe periodontal destruction. This study compared the periodontal health of restored molars with that of unrestored molars and determined the correlation between the type, age, and status of the restorations on the molars and the health of the associated periodontium. Materials and Methods: Patients with at least one restored molar and its contralateral counterpart of one unrestored molar were recruited for the study. The type of restoration and material, age of restoration, and type of defects on the restoration were noted in the restored group, while the degree of tooth mobility, furcation involvement, gingival recession, gingival status, and periodontal pockets depth were measured in all teeth studied. Data were analyzed using IBM SPSS version 21.0. Results: A total of 160 molars (80 restored and 80 unrestored molars) were studied. There were more restored mandibular molars (53.7%) than restored maxillary molars (46.3%). More first molars (43) compared to second molars (37) were restored. The most prevalent type of restoration was amalgam restoration (67.5%), followed by glass ionomer cement restoration (10%). There was no statistically significant association between the type of restoration and the periodontal clinical parameters assessed (P > 0.05). Similarly, there was no statistically significant association between the class of the restoration whether Class I or II and the periodontal clinical parameters assessed. The restored molars had 3.2 (95% confidence interval [CI] 0.5–32.8) times the odds of bleeding on probing, 1.5 (95% CI 0.2–8.9) times the odds of having Grade 1 mobility, 2.1 (95% CI 0.5–10.0) times the odds of having Grade 1 gingival recession, and 1.5 (95% CI 0.3–9.2) times the odds of having Grade 1 furcation involvement than the unrestored. Conclusion: It can be concluded that there is no statistically significant difference in the health of the periodontium of restored and unrestored molars or correlation between the type, age, and status of the restorations on the molars and their periodontal health. The odds of having bleeding on probing, tooth mobility, gingival recession, and furcation involvement tends to be higher with the restoration of the molars.

Keywords: Effect, molars, periodontal health, restorations


How to cite this article:
Ehizele AO, Enabulele JE. Periodontium and restoration: A comparative study of restored and unrestored molars. SRM J Res Dent Sci 2021;12:1-7

How to cite this URL:
Ehizele AO, Enabulele JE. Periodontium and restoration: A comparative study of restored and unrestored molars. SRM J Res Dent Sci [serial online] 2021 [cited 2021 Jun 25];12:1-7. Available from: https://www.srmjrds.in/text.asp?2021/12/1/1/312478


  Introduction Top


The pulpal tissue of a tooth and the tooth's supporting structures are regarded as one biologic unit,[1] and so it is possible that the disease of one may compromise the health of the other.[2] A relationship may also exist between the health of the periodontium surrounding a tooth and the status of a dental restoration on the tooth.[3] All types of dental restorations, if not properly done, can have adverse effects on the periodontium ranging from gingivitis to chronic periodontitis resulting in furcation involvement and eventually tooth loss.

It is important to restore correctly the margins of the restorations, the occlusal anatomy as well as the proximal area of any restored tooth. Failure to restore properly the occlusal anatomy may result in improper direction of forces during functional movements causing enlargement of contact points and impaction of food in the proximal areas and subsequently destruction of periodontal tissues.[4],[5],[6]

Another error that can occur during tooth restoration is a lack of smoothening and polishing of the proximal areas which leads to food impaction. Overcontouring and under-contouring of the vestibular and oral surfaces of restorations can also be associated with food stagnation. Restorative materials with surface roughness, such as amalgam, gold, resin, and porcelain, can act as foci for plaque accumulation making adequate polishing a necessity.[1]

Certain teeth or groups of teeth are prone to develop more severe periodontal destruction than other teeth in the same individuals. Molars have been reported to be more disposed to periodontal attachment loss than others.[7]

Restorations have been known to fail because of poor periodontal health and periodontal health has been reported to be adversely affected by some faults in restorations on the teeth. Previous studies have investigated the effect of some specific restorations on the periodontium.[8],[9],[10],[11] The aim of this study, however, is to compare the periodontal health of restored molars with that of unrestored molars and to determine the correlation between the type, age, and status of the restorations on the molars and the health of the associated periodontium. This study is significant because it serves as a review of treatment outcome of restorative procedures done in our environment.


  Materials and Methods Top


This was a cross-sectional analytic study that compared the periodontal health of restored molars with unrestored molars. Ethical approval was obtained from the research and Ethics Committee of the University of Benin Teaching Hospital before commencement of the study. Written informed consent was obtained from all participants.

The study population comprised patients presenting at the periodontology clinic and conservative clinic of the University of Benin Teaching Hospital. The inclusion criteria were patients aged 17 years and above with at least one restored molar and its contralateral counterpart unrestored. The restorations included were intracoronal restorations (Class I, II, and V), extracoronal restoration, root treated teeth with or without extracoronal restoration, and patients who had good oral hygiene as determined using the Simplified Oral Hygiene Index by Green and Vermillion.

Persons with medical history that can affect periodontal health such as uncontrolled diabetes, use of drugs such as antiepileptic drugs, use of alcohol, and tobacco smoking were excluded from the study.

All the first and second molars which were restored were taken as the cases and their contralateral counterparts which were unrestored were taken as the controls. A total of 160 molars consisting of eighty restored molars and eighty unrestored molars were utilized for the study. The following details were noted in relation to each molar;

  • Presence or absence of restoration on the molars
  • Type of restoration and restorative material used (Class I, II, and V amalgam or composite fillings, crown placements ± root canal treatment)
  • Age of restoration
  • Integrity of the proximal contours, contact points, interproximal embrasures, and margins of restorations both visually and radiographically
  • The degree of tooth mobility classified using Miller's classification of tooth mobility[12]
  • The degree of furcation involvement classified using Glickman classification of tooth furcation involvement[13]
  • The degree of gingival recession classified using Miller's classification of gingival recession.[14]


Gingival status determined using Gingival index by Loe and Silness.[15]

Periodontal pockets depth measured using CPITN probe.[16]

The data were analyzed using the IBM SPSS statistics for windows version 21.0 (IBM Corp. Armonk, NY, USA). Statistical analysis was done using frequency distributions and cross tabulations. Chi-square test was done to test statistical significance, and P < 0.05 was considered statistically significant.


  Results Top


A total of 63 participants consisting of 27 (42.8%) males and 36 (57.2) females with 160 molars, made up of 80 restored and 80 unrestored molars, were utilized for the study. The age of the participants ranged from 17 years to 69 years.

A higher proportion of first molars (43) compared to second molars (37) were restored. Furthermore, there were more restored molars [43 (53.7%)] on the mandibular arch (i.e., 19 first molars and 24 second molars) compared to the maxillary arch (37 [46.3%] i.e., 24 first molars and 13 second molars) [Table 1].
Table 1: Distribution of the restored and unrestored molars

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Various restorations were recorded for the molars with the most prevalent restoration being amalgam restoration (67.5%). Root canal treatment was noted in 11.25% of the molars and Glass Ionomer Cement (GIC) restoration in 10% of the molars.

Half (50.0%) of the restorations had been in place for 1–5 years, while 15.0% of the restorations had been in place for over 5 years. Defective restorations were noted on 25.0% of the restored teeth [Table 2].
Table 2: Type of restoration, presence of defect and age of the restorations

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Various defects were observed in the restorations. Fractured filling accounted for 25.0%, marginal leakage 10%, and rough surfaced filling 10% of the defects. Underfilling, overhanging restorations dentinal hypersensitivity, and failure of root canal treatment were noted in 20.0%, 5.0%, 10%, and 20% of the defective restorations, respectively. Most (65.0%) of the defective restorations had been in place for 1–5 years, while 30.0% were in place for less than a year and 5.0% were in place for more than 5 years [Table 3].
Table 3: Types of defects and age of the defective restorations

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There was no statistically significant association between the type of restoration whether amalgam, composite, temporary restoration, GIC, and endodontic treatment with or without crown restoration and the periodontal clinical parameters assessed (P > 0.05) [Table 4]. Similarly, there was no statistically significant association between the class of the restoration whether Class I or II and the periodontal clinical parameters assessed [Table 5].
Table 4: Relationship between the type of restoration and the periodontal clinical parameters

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Table 5: Relationship between the class of restoration and the periodontal clinical parameters

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On assessment of the periodontal parameters of the restored and unrestored molar, it was observed that majority in both groups had no bleeding on probing, no mobility, no gingival recession, and no furcation involvement (P > 0.05). However, the restored molars had 3.2 (95% confidence interval [CI] 0.5–32.8) times the odds of bleeding on probing, 1.5 (95% CI 0.2–8.9) times the odds of having Grade 1 mobility, 2.1 (95% CI 0.5–10.0) times the odds of having Grade 1 gingival recession, and 1.5 (95% CI 0.3–9.2) times the odds of having Grade 1 furcation involvement than the unrestored molars [Table 6].
Table 6: Comparison of periodontal parameters of restored and unrestored molars

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There was no statistically significant association between the pocket probing depth on all six areas of the tooth assessed between restored and unrestored molars (P > 0.05) [Table 7].
Table 7: Comparison of pocket probing depth of restored and unrestored molars

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  Discussion Top


The first permanent molars have been reported to be the tooth most likely to be defective, thereby requiring restoration. They are considered to be most prone to caries, probably because of their morphological characteristics and position in the oral cavity and because they erupt early with the period of their mineralization coinciding with early childhood diseases which can cause structural abnormality of teeth.[17] The first molars have also been reported to present most with biologic width invasion,[18] loss of adhesion of the junctional epithelium as well as loss of the barrier against microbial entry in the periodontium[19] which leads to chronic inflammation of the soft tissues around the restoration, bleeding on probing, gingival hyperplasia, gingival recession, periodontal pocket, with loss of clinical insertion, and progressive alveolar bone loss.[20] This present study also supports that first molar may be more likely to require restoration because the results show that more first molars were restored when compared with second molars.

Dental material on tooth surface may increase the tendency of the filled tooth to have periodontal disease. Plaque adhere more to materials used for restorations than enamel because of the surface roughness and surface-free energy inherent in the material.[21] Although plaque accumulation may increase with restorations, irrespective of the restorative material used,[22] the surface smoothness of the restoration is the key. This study suggests that defective amalgam may be as a result of fractured fillings, rough surfaced filling, underfilling as well as overhanging restorations, and these defects are all potential plaque retentive features which are secondary etiologic factors of periodontal diseases. Proper contouring of restorations and removal of marginal overhangs would permit adequate tooth cleaning and improve gingival health.

A study comparing amalgam, gold alloy, resin composite, and three ceramic materials concluded that bacteria plaque adhered most to amalgam, then to resin composite, then to casting gold restoration, and least to the ceramics, but the level of adhesion decreases when the materials were polished.[21] Studies have also suggested that different dental materials may pose differential risks for loss of periodontal clinical attachment.[23],[24] Many physical and chemical characteristics of restorative materials such as their organic and inorganic composition, topography, surfaces area, the surface free energy, hydrophobicity, and surface-coating techniques used are believed to determine their ability to influence the oral biofilm to start off a disease process.[25] However, this study was unable to categorically elicit the differential risk posed by the individual restorative materials as majority in both the restored and unrestored groups had similar and relatively healthy periodontium. Nevertheless, this study was able to show that the odds of having bleeding on probing, tooth mobility, gingival recession, and furcation involvement are higher with restoration of the molars. The type of restoration and class of restoration had no statistically significant effect on the periodontal health of the restored molars in this study. The similar pattern of relatively healthy periodontal tissues reported in both groups in this study may be a reflection of the high level of oral hygiene knowledge, attitude, and practice expected to be seen among highly educated patients who utilize tertiary oral health facilities. There may be a need to carry out a similar study among a population with suboptimal oral hygiene knowledge, attitude, and practice.

A previous study to show the differential effect of restorations on the periodontium had reported that amalgam restorations, crowns, and bridge abutments had the highest gingival index and that nonprecious alloys and acrylic covered castings demonstrated the highest periodontal indices indicating periodontal breakdown.[26] It was also reported by another study that there is a significant association between the presence of defect on the restoration and the periodontal health of the restored tooth.[27] However, the result of this study suggests that periodontal parameters are similar in the restored group, irrespective of the restorative material used.

This study seems to suggest only mild changes in the health of the periodontium in restored teeth and could not establish a causal relationship between the restoration and periodontal health deterioration. This is different from the result of a previous study where alarming negative clinical and radiographic changes were reported in 80% and 87% of cases, respectively.[28] The pattern reported in this study may be because majority of the restorations were not older than 5 years. It will be good to follow these cases up for a longer period and determine if there will be any deterioration of their periodontal health, especially since a study recently reported correlation between periodontal probing depth and the age of the restoration.[29]


  Conclusion Top


First molars were more restored than second molars and more molars were restored in the mandibular arch than maxillary arch. There was no statistically significant difference in the health of the periodontium of restored and unrestored molars or correlation between the type, age, and status of the restorations on the molars and their periodontal health. However, the odds of having bleeding on probing, tooth mobility, gingival recession, and furcation involvement may be higher with the restoration of the molars.

There is a need to ensure that restorations placed on molar teeth do not cause harm to the periodontium. Similarly, good oral hygiene practices should be adhered to whether a molar tooth has a restoration or not.

Acknowledgment

The authors acknowledge all the patients that agreed to participant in the study and the house officers who assisted with data collection.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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