57 - Survival Rates of Restorations in Primary First Maxillary Molars: A Claims Data Analysis

Background: Dental caries is a multifactorial disease that affects over 500 million children worldwide. Proximal caries in the primary dentition have a rapid rate of progression due to morphological characteristics. These anatomic factors facilitate caries progression and make high quality restorative care challenging.

Objective: The objective of this study was to examine the survival rates of primary maxillary first molars initially restored with a direct restoration versus those restored with a full coverage crown (SSC).

Design: Private insurance data claims from 2004-2023 were obtained through Fluent Dental Strategies in partnership with Indiana University. CDT codes for direct restorations, full coverage crowns and follow-up care were used to track success over time. Time to first re-treatment was compared between the direct restoration and SSC groups using Cox proportional hazards survival analysis. A marginal model was used to account for correlation among multiple teeth within a patient. Provider specialty, patient age, and patient gender were included as covariates in the analysis. A survival, model-based hazard ratio (HR, with 95% CI) was adjusted for patient gender, patient age, and provider specialty. Analyses were performed using SAS version 9.4. 502,863 total observations (426,033 direct restorations, 76,830 SSCs) from 375,671 patients: Risk of failure was significantly higher for direct restorations than SSCs (HR=1.53 (1.48-1.57), p<0.001). Provider specialty had a significant effect (HR=1.27 (1.25-1.30, p<0.001) for general dentist vs. pediatric dentist.

Conclusion: The results suggest that primary maxillary first molars initially restored with a full coverage crown have a lower risk of failure and should be considered as primary when diagnosing and treatment planning. Research supported by the Indiana University School of Dentistry Graduate Student Research Committee.