Placement of posterior composite restorations in United Kingdom dental practices: Techniques, problems, and attitudes

Objective: To investigate the range of techniques used by UK general dental practitioners when placing posterior composites, their attitudes and opinions and problems encountered. Methods: A pre-piloted questionnaire was distributed to 500 UK GDPs selected at random from the UK Dentists Register requesting specific information on attitudes, use and problems encountered in relation to posterior composite placement. Results: 254 useable replies were returned (response rate= 51%). Over 95% of respondents would consider placing posterior composites, but only 33% (n=84) would regularly or often place composite in the occlusal surface of a molar tooth. 62% of respondents (n=157) are influenced by articles in peer-reviewed journals when deciding to place a posterior composite, while 95% (n=241) reported that they are not influenced by advertising. Techniques for managing operatively exposed dentine vary, and are related to the depth of the dentine cavity: 79% (n=201) use a 'dentine-bonding' technique (i.e. no base/liner) approach for shallow cavities, while only 9% (n=23) would consider this approach for a deep dentine cavity. Only 10% of respondents (n=25) use a sectional metal matrix system for restoring occlusoproximal cavities, while 29% (n=74) use transparent matrix systems, and 61% (n=155) use a circumferential metal matrix system. More than one-half (52%, n=132) of practitioners reported they experienced problems with food packing in more than one in four posterior composites placed. Conclusions: Despite having been previously discouraged by financial guidelines and with probable limited exposure to posterior composite instruction at dental school, UK GDPs are placing posterior composites with reasonable reference to current best available evidence. Diverse opinions exist on the management of certain clinical scenarios, such as of operatively exposed dentine.