04 June 2023

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Implementation of repairs in dental practice

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Background

Despite increasing evidence, dentists have not widely adopted repairs. The authors aimed to develop and test potential interventions targeting dentists’ behavior.

Methods

Problem-centered interviews were performed. Emerging themes were linked to the Behavior Change Wheel to develop potential interventions. The efficacy of two interventions was then tested in a postally delivered behavioral change simulation trial among German dentists (n = 1,472 per intervention). Dentists’ stated repair behavior regarding 2 case vignettes was assessed. Statistical analysis was performed using McNemar test, Fisher exact test, and a generalized estimating equation model (P < .05).

Results

Two interventions (guideline, treatment fee item) were developed on the basis of identified barriers. A total of 504 dentists participated in the trial (17.1% response rate). Both interventions significantly changed dentists’ behavior toward repairs of composite and amalgam restorations, respectively (guideline: difference [Δ] = +7.8% and Δ = +17.6%, treatment fee item: Δ = +6.4% and Δ = +31.5%; adjusted P < .001). Dentists were more likely to consider repairs if they already performed repairs frequently (odds ratio [OR], 1.23; 95% CI, 1.14 to 1.34) or sometimes (OR, 1.08; 95% CI, 1.01 to 1.16), if they regarded repairs as highly successful (OR, 1.24; 95% CI, 1.04 to 1.48), if their patients preferred repairs over total replacements (OR, 1.12; 95% CI, 1.03 to 1.23), for partially defective composite restorations (OR, 1.46; 95% CI, 1.39 to 1.53), and after receiving one of the two behavioral interventions (OR, 1.15; 95% CI, 1.13 to 1.19).

Conclusions

Systematically developed interventions targeting dentists’ repair behaviors are likely efficacious to promote repairs.

Practical implications

Most partially defective restorations are replaced completely. Effective implementation strategies are required to change dentists’ behavior.

This trial was registered at https://www.clinicaltrials.gov. The registration number is NCT03279874 for the qualitative phase and NCT05335616 for the quantitative phase.

Philipp Kanzow et al. "Implementation of repairs in dental practice: Randomized behavior simulation trial." JADA. 22 May 2023. DOI:https://doi.org/10.1016/j.adaj.2023.04.007