Voitovych V. Expert clinical and laboratorial quality evaluation of direct restorations provided by composite materials for hard dental tissue defects

Available approaches aimed at direct composite restorations’ quality assessment and verification of their success of functioning characterized by a lack of consistency and differences among the criteria used for interpretation of specificclinical characteristics. Moreover, it is not yet established whether the criteria used in practical dentistry to assess the quality of direct composite restorations contribute to the identification of absolutely all problematic constructions, and whether they have a sufficient level of validity in terms of verification not only clinically compromised restorations at the time of control, but also those which in the future could be associated with a critical decrease of their functioning level. An objective assessment of the quality of direct restorations of hard dental tissues defects made of composite materials should take into account a combination of factors related not only with present condition of fillings during monitoring, but also such associated with the forecast of its functioning in the future, and the ability to identify causal or regression relationships for the verification of the constituent elements that in the greatest manner determine the level of restorations’ clinical success. The objective of the study was to improve a comprehensive approach for the expert evaluation of direct composite restorations’ quality by individualizing the prognostic model of changes within the parameters related with the success of their functioning while using methods of clinical and laboratorial diagnostics. Realization of the research objective was based on the solution of the following tasks: 1. To evaluate changes of the parameters related with clinical success of direct composite restorations’ functioning at different time intervals of their performance and determine the specifics of the dependences of such on the initial characteristics of the hard dental tissues’ defects. 2. To conduct a comprehensive study of the relationship between different criteria for assessing the performance and quality parameters of direct composite restorations with the identification of their clinical significance and diagnostic sensitivity as potential regressors for the prognostic model of their changes. 3. To substantiate the hierarchical structure of distribution regarding the impact of biomechanical, biological, structural and functional patient-oriented and defect-associated factors, as components of a risk assessment profile for various types of complications related to changes of composite restoration quality and сondition of restored tooth in general. 4. To determine the prognostic efficiency and clinical feasibility of the proposed individualized approach aimed at assessing the quality of direct composite restorations based on patient-oriented criteria using clinical and laboratory diagnostic methods during the process of clinical monitoring. 5. To implement a program for differentiation of the choice and modification of approaches for the restoration of hard dental tissue defects with the use of composite materials for the optimization of changes regarding quality parameters and the clinical success of the restorations in the short and long termed perspective. Realization of the dissertation research’s objective required the usage of the following methods: clinical, expert assessments, digital, radiological, laboratorial, prognostic estimations, mathematical, graphical, statistical. An analysis of 446 restorations of hard dental tissue’ defects registered among 386 patients aged 18–56 years was performed on the basis of the University Dental Clinic of the Faculty of Dentistry of Uzhhorod National University by the doctors of this medical institution.