Clinical Decision-Making of Repair vs. Replacement of Defective Direct Dental Restorations: A Multinational Cross-Sectional Study With Meta-Analysis

Hatipoğlu Ö. Martins J.F.B. Karobari M.I. Taha N. Aldhelai T.A. Ayyad D.M. Madfa A.A. Martin-Biedma B. Fernández-Grisales R. Omarova B.A. Lim W.Y. Alfirjani S. Nijakowski K. Sugumaran S. Petridis X. Krmek S.J. Wahjuningrum D.A. Iqbal A. Abidin I.Z. Intriago M.G. Elhamouly Y. Palma P.J. Hatipoğlu F.P.
April 2025 John Wiley and Sons Inc

Journal of Esthetic and Restorative Dentistry
2025 #37 Issue 4 977 - 991 pp.

Objectives: This web-based survey, conducted across multiple countries, sought to explore the factors that impact the decision-making of clinicians when it comes to managing defective direct restorations. Methods: A survey consisting of 14 questions was sent out to dentists in 21 countries through various online platforms. The survey consisted of two sections. The first contained five questions about demographic information, while the second involved eight clinical scenarios. In the second part, participants were tasked with deciding whether to repair or replace defective composite and amalgam restorations. Results: Three thousand six hundred eighty dental practitioners completed the survey. For composite restorations, repair was preferred in scenarios like partial loss or fracture (RR:0.72; 95% CI: 0.58, 0.89; p = 0.002), whereas replacement was favored for secondary caries (RR:2.43; 95% CI: 1.87, 3.16; p < 0.001) and open/defective margins (RR:3.93; 95% CI: 2.68, 5.76;p < 0.001). Amalgam restorations were mostly replaced across all scenarios. The main factors influencing decision-making were caries risk, restoration size, and patient oral hygiene. Substantial heterogeneity was observed across countries. Conclusion: This study underscores the complexity of the decision-making process and the need for evidence-based guidelines to inform clinicians decisions regarding restoration management. Patient-level factors predominantly influence decision-making, emphasizing the need for individualized approaches. Clinical Significance: The study reveals that the material type in the original restoration is a critical determinant, with composite restorations being repaired in specific scenarios, while amalgam restorations are consistently replaced across different countries. Key patient and tooth-level factors, such as high caries risk, poor oral hygiene, and restoration size, significantly impact clinicians decisions, often favoring replacement over repair. These findings underscore the necessity for evidence-based guidelines to assist clinicians in making informed choices, ultimately enhancing the quality of patient care.

amalgam , composite resin , minimally invasive dentistry , repair , replacement

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Department of Restorative Dentistry, Recep Tayyip Erdogan University, Rize, Turkey
Department of Restorative Dentistry, Nigde Omer Halisdemir University, Niğde, Turkey
ACTA, Amsterdam, Netherlands
Department of Conservative Dentistry and Endodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
Department of Conservative Dentistry, Jordan University of Science and Technology, Irbid, Jordan
Department of Orthodontics and Pediatric Dentistry, College of Dentistry, Qassim University, Buraydah, Saudi Arabia
Head of the Endodontics Department, Faculty of Dentistry, Al-Quds University, Jerusalem, Palestine
Department of Restorative Dental Science, College of Dentistry, University of Hail, Hail, Saudi Arabia
Universidade de Santiago de Compostela (USC) Rua Entrerríos s/n, A Coruña, Spain
Department of Endodontics, School of Dentistry, CES University, Medellín, Colombia
Dentistry School, Department of Therapeutic Dentistry, S. D. Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
Department of Restorative Dentistry, National Dental Centre, Singapore, Singapore
Department of Conservative Dentistry and Endodontics, University of Benghazi, Benghazi, Libya
Department of Conservative Dentistry and Endodontics, Poznan University of Medical Sciences, Poznan, Poland
Department of cariology and comprehensive care Dentistry, NYU college of Dentistry, NY, United States
Department of Endodontics, Section of Dental Pathology and Therapeutics, School of Dentistry, National and Kapodistrian University of Athens, Greece
Department of Endodontics and Restorative Dentistry, University of Zagreb School of Dental Medicine, Zagreb, Croatia
Department of Conservative Dentistry. Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
Department of Restorative Dental Sciences, College of Dentistry, Jouf University, Sakaka, Saudi Arabia
Department of Restorative Dentistry, International Islamic University, Kuantan, Malaysia
Endodontic Department of Dentistry, Universidad Central del Ecuador, Quito, Ecuador
Department of Pediatric and Community Dentistry, Faculty of Dentistry, Pharos University in Alexandria, Alexandria, Egypt
Center for Innovation and Research in Oral Sciences (CIROS), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
Institute of Endodontics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
Department of Endodontics, Recep Tayyip Erdogan University, Rize, Turkey

Department of Restorative Dentistry
Department of Restorative Dentistry
ACTA
Department of Conservative Dentistry and Endodontics
Department of Conservative Dentistry
Department of Orthodontics and Pediatric Dentistry
Head of the Endodontics Department
Department of Restorative Dental Science
Universidade de Santiago de Compostela (USC) Rua Entrerríos s/n
Department of Endodontics
Dentistry School
Department of Restorative Dentistry
Department of Conservative Dentistry and Endodontics
Department of Conservative Dentistry and Endodontics
Department of cariology and comprehensive care Dentistry
Department of Endodontics
Department of Endodontics and Restorative Dentistry
Department of Conservative Dentistry. Faculty of Dental Medicine
Department of Restorative Dental Sciences
Department of Restorative Dentistry
Endodontic Department of Dentistry
Department of Pediatric and Community Dentistry
Center for Innovation and Research in Oral Sciences (CIROS)
Institute of Endodontics
Department of Endodontics

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