Does refurbishing composites lead to short-term effects or long-lasting improvement?

Abstract

Purpose: The aim of this study was to evaluate the clinical performance of refurbished composite resin restorations compared to untreated (negative control) restorations over a period of 10 years.
Methods: Twenty-six patients (having a total of 52 composite restorations) were recruited. All restorations in the refurbished group showed clinical features rated bravo according to modified USPHS criteria. Untreated restorations were those that had been deemed acceptable (alfa or bravo rated) ; these were used as controls. Two examiners performed assessments at baseline and during the fifth and tenth years after the intervention. Wilcoxon tests were performed for within-group comparisons, Friedman tests were used for multiple within-group comparisons, and Mann Whitney tests were used for between-groups comparisons. Kaplan-Meier survival curves were calculated, and the Mantel-Cox test was used to compare curves. A p-value of <0.05 was considered statistically significant.
Results: In both groups, tenth-year scores were significantly different from baseline scores in all clinical parameters except secondary caries. There were no statistically significant differences in the survival analysis of groups (log-rank test, p=0.376). Refurbishing treatment improved the anatomy, roughness, luster, and marginal adaptation of restorations with a short term effect, with most properties rated acceptable after 10 years of clinical service. The clinical characteristics were similar across groups in the tenth year.

Clinical Significance: Refurbishing improves the surface properties and anatomy of composite resins and may be considered a minimally invasive treatment with a short term effect.

Full text

¿Refurbishment of composites, short-term effect or influence achieved in time?
*E. Fernández,P. Vildósola,C.Bersezio,I.Mjor, V.Gordan,RR Moraes, OB Oliveira Junior,J.Estay, G.
Moncada,J. Martín
a:Department of Restorative Dentistry - Faculty of Dentistry - University of Chile.
b:Department of Restorative Dentistry - School of Dentistry - University Estadual Paulista-Unesp.
c: Restorative Dental Sciences Department, Division of Operative Dentistry, University of Florida, College of Dentistry
d: Department of Restorative Dentistry, School of Dentistry, UFPel, Brazil
e: School of Dentistry – Universidad Mayor – Chile
Eduardo Fernández Godoy DDS -PhD(c)
Department of Restorative Dentistry - Faculty of Dentistry – University of Chile
Sergio Livingstone Pohlhammer 943, Independencia - Santiago, Chile.
Patricio Vildósola Grez DDS
Department of Restorative Dentistry - Faculty of Dentistry – University of Chile
Sergio Livingstone Pohlhammer 943, Independencia - Santiago, Chile.
Cristian Bersezio Miranda DDS
Department of Restorative Dentistry - Faculty of Dentistry – University of Chile
Sergio Livingstone Pohlhammer 943, Independencia - Santiago, Chile.
Valeria V Gordan, DDS, MS, MS-CI Professor, Restorative Dental Sciences Department, Division of Operative
Dentistry, University of Florida, College of Dentistry
Ivar A Mjor, Professor Emeritus, Restorative Dental Sciences Department, Division of Operative Dentistry,
University of Florida, College of Dentistry
Rafael Ratto de Moraes, DDS, MS, PhD, professor, Department of Restorative Dentistry, School of Dentistry,
UFPel, Brazil
Osmir Batista Oliveira Junior DDS
Univ. Estadual Paulista-Unesp. School of Dentistry
Rua Humaitá, 1680 - Centro - CEP: 14801-903 Araraquara. Brasil.
Juan Estay Larenas DDS
Department of Restorative Dentistry - Faculty of Dentistry – University of Chile
Sergio Livingstone Pohlhammer 943, Independencia - Santiago, Chile.
Gustavo Moncada Cortés DDS
Faculty of Dentistry - Universidad Mayor-Alameda 2001 Santiago, Chile.
Javier Martin Casielles DDS
Department of Restorative Dentistry - Faculty of Dentistry – University of Chile
Sergio Livingstone Pohlhammer 943, Independencia - Santiago, Chile.
* Corresponding Authors:
Eduardo Fernández G. DDS,PhD(c)/Patricio Vildósola DDS,PhD(c)
Department of Restorative Dentistry
Universidad de Chile, Dental school - Sergio Livingstone Pohlhammer 943, Independencia
Phone-Fax:+56229462929 – edofdez@yahoo.com
Santiago, Chile.

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¿Refurbishment of composites, short -term effect or influence achieved in time?
Abstract
Purpose: The aim of this study was to evaluate the clinical performance over 10 years of refurbished composite
resin restorations compared to untreated (negative control) restorations.
Methods: Twenty-six patients (having 56 composite restorations) were recruited. All restorations in the
refurbishing groups showed clinical features rated bravo according to modified USPHS criteria. Untreated were
acceptable restorations rated Bravo were used as controls. Two examiners performed assessments at Baseline ,
during the fifth first years and the tenth years after the intervention . Wilcoxon tests were performed for within-
group comparisons, and Friedman tests were used for multiple within-group comparisons and Mann Whitney
was used for between groups comparisons . Kaplan-Meier survival curves were calculated and the Mantel -Cox
test was used to compare curves. A p -value of <0.05 was considered statistically significant.
Results: In the both groups, tenth year scores were significantly different from baseline scores in all clinical
parameters, except secondary caries. There were not statistically significant differences in the survival analisys
of groups (log-rank test, p = 0.376).Refurbishing treatment improves the anatomy, roughness, luster, and
marginal adaptation of restorations with a short term effect, with most properties being acceptable after 10 years
of clinical service. The clinical characteristics were similar across treatment groups in the tenth year.
Clinical Significance: Refurbishing improves the surfac e properties and anatomy of composite resins and may
be considered a minimally invasive treatment with a short term effect.
Key words: Composite Resins; Restoration; Refurbishing; Clinical Trial
INTRODUCTION
Currently a very good choice for direct posterior restorations are composite resins, largely because of 1) the
evidence-based practice of minimally invasive dentistry, 2) the possibility of reconditioning or repairing
composite resins, and 3) their predictable performance over time1.
For a long time, dentists have replaced composite resin restorations due to problems such as secondary caries,
fractures, and marginal adaptation. The advent of minimally invasive dentistry generated interest in modifying
treatments to increase the lifespan of deteriorating restora tions2.
There are a few reasons to repair or replace restorations that are defective, such as significant change of the
anatomy and presence of high surface roughness3. In the case of composite resins, these reasons have more to
do with the nature of the material, such as their composition, percentage of filler, and type of filler. There are
also factors that depend on patient’s variables and these include caries-risk status of the patient, tooth type,
tooth surface, as well as secondary factors, such as exposure to abrasives or certain types of food with acidic
pH or with high levels of alcohol4.
Refurbishing defective composite restorations may allow improvement in certain clinical aspects of the
restoration such as anatomy, luster, and surface roughness. Promoting improvement in the occlusal anatomy
and surface smoothness may decrease problems related to plaque accumulation5.
Although numerous in vitro studies have attempted to predict the behavior of a given material in the mouth,
there are many clinical factors that can actually affect the clinical performance of composite restorations6. The
aim of this study was to evaluate the clinical performance over a 10 year follow-up of defective composite resin
restorations that were refurbished and compare to the control group: untreated restorations (negative control).

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The null-hypothesis of this study was that there would be no difference in longevity of restorations that were
refurbished compared to the control group.
MATERIALS and METHODS
Study Design
A cohort of 26 patients aged 18–80 years old (mean: 28.35 years; 42% men, 58% women) with 52 composite
restorations (Class I: 26; Class II: 26) were recruited at the Operative Dentistry Clinic at the Dental School of
the University of Chile . All participants in the refurbished group showed clinical features for anatomy, surface
roughness, and/or luster that deviated from ideal conditions (alfa) and were rated bravo according to the
modified United States Public Health Service (USPHS) criteria 7. Acceptable composites (no treatment group,
rated alfa or bravo scores) were used as controls. The protocol was approved by the Institutional Research
Ethics Committee of the Dental School at the University of Chile (Project PRI -ODO-0207). All patients
consented to participation in the study by signing an informed-consent form and by completing the registration
forms. The selection criteria are summari zed in Figure 1.
General Inclusion Criteria:
• Patients with more than 20 teeth.
• Restorations in functional occlusion, with an opposing natural tooth.
• Asymptomatic restored tooth.
• At least one proximal contact area with adjacent tooth.
• Patients older than 18 years.
General Exclusion Criteria:
• Patients with contra-indications for regular dental treatment based on their medical history.
• Patients with xerostomia or individuals taking medication that significantly decreased salivary
flow.(high risk caries)
• Patients with a high caries risk.(high frecuency fermentable carbohydrates , high plaque amount and
Mutans Streptococci level, non-use of fluoride, low saliva secretion rate and/or clinical judgement about caries
will occur , assessed by Cariogram software8)
• Patients with psychiatric diseases or physical condition, which interfered with oral hygiene.
Caries Risk Assessment
A graphical computer program (Cariogram, Malmö högskola, Malmo, Sweden) was used to assess the risk of
caries for individual patients8. The results also indicated where targeted actions would be most effective. This
analysis was performed only for selected patients with low or medium risk of caries, according to the
recommendations of the local ethics committee, which did not allow the inclus ion of patients with high caries
risk.
Treatment Group Criteria
Two hundred and fifty four patients were initially evaluated and assigned in accordance with modified USPHS
criteria. Twenty-six patients were selected based on the inclusion criteria, each having at least one composite
restoration with anatomy, roughness and/or luster scores suitable for refurbishing treatment (bravo rating), and

Page 3of 12
another pre-existing composite that were in an acceptable condition (alfa or bravo scores). Original restorations
were placed using microhybrid composite resin (Filtek Z100; 3M ESPE, St. Paul, MN, USA) with either a 3-
step etch-and-rinse adhesive system (Adper Scotchbond Multipurpose, 3M ESPE). The group of untreated
composites (negative control) worked as independent control group. The patient was considered the statistical
unit in this study (n=26) Figure 1.
Fig.1 : Flow chart of clinical design
Restoration Assessment
The quality of the restorations was scored in accordance with modified USPHS criteria (Tabñe 1 ). The Cohen
Kappa inter-examiner coefficient agreement was 0.74 in the first year and 0.87 after 10 years for two examiners
(J.M. and E.F.) who underwent calibration training exercises each year. In the first, second, third, fourth , fifth,
and tenth years, the examiners independently assessed the restorations for anatomic form, roughness, color,
marginal staining, luster, secondary caries, and marginal adaptation, both directly by tactile and visual
examinations [with mouth mirror number five and explorer number 23 (Hu Friedy Mfg. Co. Inc.)] and indirectly
by radiographic examination using bitewing radiographs. If the two examiners could not agree on the
assessments, the opinion of a third clinician (G.M.) with calibration score 0.8 was decisive.

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Clinical Characteristic
Alfa
Bravo
Charlie
Anatomy
The general contour of the
restoration follows the contour
of the tooth
The general contour of the
restoration does not follow the
contour of the tooth
The restoration has an overhang
Roughness
The surface of the restoration
has no surface defects
The surface of the restoration has
minimal surface defects
The surface of restoration has
severe surface defects
Color
The restoration matches in
color and translucency to the
adjacent tooth structure
The mismatch in color and
translucency is whitin the
acceptable range of tooth color and
translucency
The mismatch is outside the
acceptable range of color and
translucency
Marginal Staining
There is no discoloration
between the restorations and
tooth
There is discoloration on less than
half of the circunferencial margin
There is discoloration on more
than half of the circunferencial
margin
Luster
The restoration surface is shiny
and has and enamel-like,
translucent surface
The restoration surface is dull and
somewhar opaque
The restoration surface is
distincly dull and opaque and is
esthetically displeasing
Secondary Caries
There is no clinical diagnosis of
caries
N/A
There is clinical diagnosis of
caries
Marginal Adaptation
Explorer does not catch or has
one-way catch when drawn
across the restoration/tooth
interface
Explorer falls into crevice when
drawn across the restoration/tooth
interface
Dentin or base is exposed along
the margin
Table 1 .- Ryge USPSH clinical criteria
Treatment Groups
Refurbishing group
The dentists refinished the occlusal, lingual, or facial surfaces of defective resin-based composite (RBC)
restorations with the medium series of aluminum oxide disks (Sof -Lex, 3M ESPE) or carbide burs (12 and 30
blades, Brasseler, Dental Instrumentation, Savannah, GA, USA) and then polished them with a series of fine
aluminum oxide disks (Sof-Lex, 3M ESPE) and diamond-impregnated composite polishers (ComposiPro
Diacomp, Brasseler). Any proximal surface areas in restorations that were affected were smoothed with
interproximal aluminum oxide finishing strips (Sof-Lex Finishing Strips, 3M ESPE).
No treatment group
RBC restorations (Z100, 3M ESPE) that did not receive any treatment, and with baseline alfas score in most
criteria and some bravo scores were used as negative controls.
Statistical Analysis
The sample size was defined by setting a beta error rate of 0.2. A Wilcoxon test was performed for within-group
comparisons with a significance level of 0.05. A Friedman test was used for multiple within-group comparisons
(i.e., between different years). The comparison between groups was analyzed by the Mann-Whitney test
.Kaplan-Meier survival curves were calculated and the Mantel -Cox test was used to conduct a comparison of
the curves. The statistical analysis was performed using SPSS 21.0 (IBM, New York, NY, USA) and GraphPad
Prism version 6.00 for Windows (GraphPad Software, La Jolla, CA, USA; www.graphpad.com) statistical
software. The "intention to treat" CONSORT protocol was used to analyse data on restorations that were

Page 5of 12
evaluated in the tenth year and lacked data from a previous evaluation. Restorations that could not be assessed
in the tenth year were considered absent and not entered into the analysis9.
RESULTS
The study had a dropout rate of 11.5% (3 patients) at the 10 year examination. Four restorations were lost for
orthodontic reasons and two restorations were lost for causes unknown to the research team. The total percent
loss of restorations was 19.2% at the tenth year.
The distribution of patients according to caries risk was 76.9% (n=20) for medium caries risk and 23.1% (n=6)
for low risk at the baseline, at tenth year the distribution was the same. The median age of the restorations and
number of failures, causes of failures, and longevity of the restorations are presented in Table 2.
Table 2 : Age of restorations, number of failures by group, reason for failure, and longevity of composite resins. (SC=
Secondary Caries, Sen=Sensitivity , Anat=Anatomy , MS=Marginal staining)
Results at 10th year for various clinical characteristics
Anatomy: the refurbishing group had high percentage (55.6%) of alfa scores and some (5.6%) charlie scores,
and no treatment group had a low percentage (13%) of alfa scores and no charlie scores.
Roughness: the refurbishing group had a high percentage (72.2%) of alfa scores and no charlie scores and the
no treatment group had a high percentage (69.6%) of alfa and no charlie scores.
Color: the refurbishing group had a moderate percentage (33.3%) of alfa scores and some (11.1%) charlie
scores, and the no treatment group had a high percentage (60.9%) of alfa and a moderate percentage (39.1%)
of bravo scores.
Marginal staining: the refurbishing group had 55.6% of restorations with alfa scores and 16.7% with charlie
scores. The no treatment group had a high percentage (65.2%) of alfa scores and some (4.3%) charlie scores.
Luster: the refurbishing group had a moderate percentage (38.9%) of alfa scores and no charlie scoresand the
no treatment group had a moderate percentage (34.8%) of alfa scores and no charlie scores.
Secondary caries: the refurbishing group had a high percentage (88.9%) of alfa scores and some (4.5%) bravo
scores, and the no treatment group had only alfa scores.
Marginal adaptation: the refurbishing group had a low percentage (27.8%) of alfa scores and some (11.1%)
charlie scores, and the non-treatment group had a moderate percentage (39.1%) of alfa scores and no charlie
scores.
The summary of the alfa values over time are presented in Table 3.
Group
Medium age of
restorations at ten year
assessment
Number
Failures
Reasons for failure and number
of restorations that failed
Longevity of
Composite Resins
Refurbishing
=14,5 SD=2,5 years
4
SC (1-2) , Sen (3-4)
1=(19 y),2=(16
y),3=(19 y),4=(11 y)
No
Treatment
=14,1 SD=2,6 years
1
Ms(1)
1= (13 y)

Page 6of 12
Refurbishing group
No Treatment group
P
value
Effect
size d
Power (1-
β)
B
1
2
3
4
5
10
B
1
2
3
4
5
10
Anatomy
78
94
94,4
88,9
77,8
61,1
55,6
82,6
78
73,9
73,9
52
30
13
0,713
0,07
0,08
Roughness
72
100
94,4
94,4
88,9
77,8
72,2
100
100
100
91,3
87
73,9
69,6
0,905
0,39
0,32
Color
72
83
77,8
77,8
55,6
33,3
33,3
100
96
95,7
91,3
78
60,9
60,9
0,05
0,675
0,66
Marginal Staining
50
83
77,8
72,2
72,2
55,6
55,6
95,7
96
95,7
91,3
91
65,2
65,2
0,395
0,32
0,25
Luster
78
89
88,9
88,9
77,8
44,4
38,9
91
70
69,6
60,5
57
34,8
34,8
0,789
0,08
0,08
Secondary Caries
100
100
100
100
100
100
88,9
100
100
100
100
100
100
100
0,105
0,48
0,42
Marginal Adaptation
22
61
55,6
55,6
55,6
44,4
27,8
82,6
74
60,9
60,9
52
39,1
39,1
0,25
0,39
0,32
Table 3: Distribution of alpha values for parameter Ryge and group in each year of assessment expressed in
percentages, p value for comparison of values of the tenth year by Mann Whittney test, effect size and statistical
power
Within-group comparisons by Wilcoxon tests
Within the refurbished group, the first year (baseline) and the tenth year scores were significantly different
(p≤0.03) in all clinical characteristics, except for secondary caries (p=0.157). Within the no treatment group,
the baseline and tenth year scores were significantly different (p≤0.05) in all clinical characteristics, except for
sensitivity and secondary caries.
Change in parameter scores over the time (Friedman test)
Within the refurbishing group, multiple comparisons between scores at different evaluation years showed score
differences that were statistically significant (p≤0.02) for all clinical characteristics, except for secondary caries.
Within the no treatment group, multiple comparisons between scores at different evaluation years showed score
differences that were statistically significant (p <0.05) for all clinical characteristics, except for secondary
caries.
Between-groups comparisons by Mann Whitney tests
When comparing values of the tenth year in all Ryge parameters there was no statistically signif icant difference
(p>0.05) Table 2.
Survival analysis
In a survival analysis of the two groups , there were four failures in the refurbished group and one failure in the
no treatment group. There were not statistically significant differences (log -rank test, p = 0.37) between the

Page 7of 12
groups in the dropout dates of each restoration in Kaplan-Meier analysis. Only the refurbishing group had
enough data available to calculate a restoration half -life which was determined to be 20.5 years. Kaplan-Meier
survival analysis showed no statistically significant differences between the refurbishing and no treatment
groups, (log-rank test, p = 0.376; and hazard ratio (Mantel-Haenszel) of 0.168 (refurbished/no treatment) Figure
2.
Fig. 2 - Kaplan-Meier survival curves for the Refurbishing and No treatment groups. Log -rank test, p = 0.376.
DISCUSSION
This prospective clinical study attempted to examine the longevity of composite resin restorations that were
refurbished, compared to restorations that received no treatment. USPHS criteria were used to evaluate the
clinical characteristics and the results from the first five years were previously published by Fernandez et al.10,
and similar studies with a different patient cohort were published by Moncada et al.11 and the similar cohort by
Fernández et al.12. No prior study has described the longevity of the refurbished restorations after ten years of
clinical use. As in previous studies13-18, the type of restoration (Class I or Class II) was not considered when
selecting the experimental groups. Therefore, the evaluations in this study considered only the occlusal faces
of the restorations.
The sample size was calculated based on studies reporting restoration longevity19; however, since the
refurbishing treatment had not been studies so far, we learned that in reality we would have needed over 100
restorations in each group to detect statistical differences in all parameters. Despite this limitation, the results
show significant differences for certain clinical characteristics and may improve the clinical decision-making
regarding those characteristics.
The study shows that the two groups exhibited similar longevity results for the observation period for most
clinical characteristics, including normal deterioration over time. Multiple between-year and within and
between-group comparisons also showed similar results for the two groups. Defective composite resin
restorations can be improved by a simple and conservative method which applies polishing and reshaping of
the restoration surface with an immediate improvement to certain clinical characteristics such as anatomy,
roughness, and gloss. Secondly, refurbishing eliminates surface stains during the polishing procedure, which
may also remove small marginal defects and therefore, has the potential to improve the marginal adaptation of
the restoration. These changes may improve the overall aesthetic appearance of the restoration with impact on
color, gloss, and roughness.

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Within the analysis between the study groups in the tenth year, we did not obtain statistically significant
differences in any parameter studied between groups, however it is interes ting to discuss the low occurrence of
new caries lesions in both groups, despite the deteriorating of restorations, which could be explained by a poor
relationship between factors such as increased roughness, loss of marginal adaptation, or marginal staini ng and
the appearance of new caries lesions, or rather that factors such as low salivary flow, high intake in frequency
and amount of fermentable carbohydrates, or low fluoride exposure may be more relevant in this regard 8. Recent
evidence links the greatest cariogenic risk the appearance of new caries lesions on margins defective composite
resin restorations in vitro, confirming this evidence with the cohort of patients studied are low or medium risk
and hence the low occurrence of new caries lesions, so this finding agrees with the statements by Kuper et al.20
Some earlier reports described that refurbishing of old restorations in some cases improved anatomy and
affected dentists’ decision regarding treatment of the existing restoration21. Formerly, the decision to replace
composite resin restorations was widely influenced by certain clinical characteristics such as anatomy,
roughness, and luster. The advent of minimally invasive dentistry treatments questioned whether restorations
should be maintained or replaced and has supported the refurbishing of existing composite restorations with the
purpose to increase the longevity of restorations5.
Composite resin restoration wears by 10-20 µm in average per year6; after a 10-year cumulative wear, it may
result in an alteration of the anatomy22, 23. When anatomy was evaluated in the current study, it showed a
predominant number of restorations that had bravo scores after the tenth year. The percentage of bravo scores
reported for “anatomy” was higher in the no treatment group, likely due to the accumulated increased wear of
the restoration over time (average age: 14.5 years; SD = 2.56) and also due to the lack of any procedure to
improve their anatomy. In contrast, an increased percentage of alfa scores was observed in the refurbishing
group.
It is important to note that the type of composite resin used in the no treatment and refurbishing groups was a
microhybrid material filled with 85wt% of zirconia-silica particles with a size range between 0.01 and 3.5 µm,
The clinical performance of posterior composite restoration in the long-term has been indicated to be determined
by factors that are not only a matter of materials 24, including tooth type and location, operator, and behavioral
elements.
The polishing procedure used in the current study has been recognised as an effective protocol for improving
surface roughness scores compared to other polishing systems that are available for composite resins. Abrasive
granulometry is the main factor determining the ability of a polishing system in rendering the surface a smooth
aspect. As the resin phase and the inorganic particles differ in hardness, their abrasion rate is not uniform,
affecting the composite surface micromorphology and the pattern left on the surface. This is why abrasive discs
with differences in granulometry are generally indicated for sequential used in polishing procedures. A recent
systematic review6indicated that approximately 61% of the included studies that used similar polishing
procedures used here (aluminium oxide discs) showed similar results for surface roughness and gloss between
nanofilled and microhybrid composite resins. The same systematic review also pointed out that irrespective of
the polishing system used, there is little current in vitro evidence that nanofilled composites may show improved
smoothness or gloss over traditional microhybrids. In corroboration, results of the present study showed that
the proportion of bravo scores after 10 years for the roughness characteristic was the same in both groups (was
used microhybrid composite resins).
The traditional 3-step system was used in the refurbishing and no treatment groups, this adhesive system ensured
optimum sealing and adhesive longevity of restorations, corroborated that no loss of adhesive restorations
problems. This observation may be likely due too to the fact that Class I and II restorations have
macromechanical retention, making this type of failure less likely to occur in clinical studies.
The results of this study are consistent with those by Opdam et al.3and Demarco et al.24 in that the survival
rates for posterior composite restorations were satisfactory, even for restorations that included hybrid materials
that are no longer available in the market.The main reason for the failure observed in the current study was
secondary caries and fracture of the tooth, neither of which constituting failures of the materials themselves

Page 9of 12
but rather due to various reasons that are related to operator’s and patient’s characteristics. Refurbishing
improved the anatomy, roughness, luster, and marginal adaptation of defective composite resins restorations
achieve a short term effect. Survival curves of refurbishing and untreated groups were not significantly different,
and the half-life in the refurbishing group was 20.5 years.
ACKNOWLEDGEMENTS
U-Apoya – VID – Universidad de Chile

Page 10 of 12
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Legend of tables and figures:
Table 1: Ryge USPSH clinical criteria
Table 2 : Age of restorations, number of failures by group, reason for failure, and longevity of composite resins.
(SC= Secondary Caries, Sen=Sensitivity , Anat=Anatomy , MS=Marginal staining)
Table 3: Distribution of alpha values for parameter Ryge and group in each year of assessment expressed in
percentages, p value for comparison of values of the tenth year by Mann Whittney test, effect size and statistical
power
Fig.1 : Flow chart of clinical design
Fig. 2 - Kaplan-Meier survival curves for the Refurbishing and No treatment groups. Log-rank test, p = 0.376.