Management Decisions for Direct Resin-Based Restorations Among a Group of Brazilian Dentists Compared with FDI Criteria: A Diagnostic Accuracy Study.

OBJECTIVE

To evaluate the accuracy of a group of Brazilian dentists' management decisions for direct resin-based restorations against FDI World Dental Federation (FDI) criteria-based reference decisions, and to identify associated factors.

METHODS

In this diagnostic accuracy study, 394 dentists recruited online selected the management option (reviewing, refurbishment/reseal, repair, or replacement) for posterior scenarios from the revised FDI criteria supplementary material. One of 28 scenarios with a non-unique reference decision was excluded (10,638 decisions analyzed). Accuracy, sensitivity, specificity, Cohen's kappa (κ), and direction of errors were calculated, and a logistic mixed model with crossed random effects (dentist, scenario) was fitted.

RESULTS

Overall accuracy was 44.8% (95% confidence interval [CI] 43.8-45.7%), with fair agreement (κ = 0.27). Over-treatment (46.9%) was seven times more frequent than under-treatment (6.8%). Replacement was selected in 47.8% of decisions but indicated in 25.9% (sensitivity 0.81; specificity 0.64), whereas sensitivity for refurbishment/reseal was 0.21. Variability was explained mainly by scenario (intraclass correlation coefficient [ICC] 0.44) rather than dentist (ICC 0.05). Education level showed no significant overall association (p = 0.069), although undergraduate-only education was associated with lower accuracy than a doctoral degree (odds ratio 0.70; 95% CI 0.50-0.98; p = 0.036). Time since graduation showed a significant overall association (p = 0.037), without significant individual contrasts.

CONCLUSIONS

Dentists' decisions frequently diverged from the reference, with a systematic tendency toward replacement driven by specific clinical presentations rather than individual dentists.

CLINICAL SIGNIFICANCE: Unnecessary replacement removes sound tooth structure. Education should emphasize refurbishment and repair as valid options.