Prevalence and evolution of dental restorations: results of the 6th German Oral Health Study (DMS • 6).

OBJECTIVES: Epidemiologic evidence on oral health in Germany was updated in 2025 by the 6th German Oral Health Study (DMS • 6). However, epidemiologic data describing changes and progression of dental restorations over time under real-world conditions are lacking at the population level. This analysis of DMS • 6 data therefore aimed to assess the clinical development of caries-related dental restorations and the materials used, and to quantify their rates of change, including the development of secondary caries, after a 9-year follow-up. METHOD AND MATERIALS: First, a cross-sectional analysis of caries-related dental restorations was conducted. A total of 958 younger adolescents (12-year-olds), 927 younger adults (35- to 44-year-olds), and 797 younger seniors (65- to 74-year-olds) underwent standardized clinical examinations. Restorations were classified as direct and indirect restorations, and by restorative material (tooth-colored, casting alloy, and cement). Secondary (dentin) caries at the restoration margins were also assessed. Second, 371 individuals from the adolescent cohort (12-year olds at baseline; 20-year-olds at follow-up), 342 individuals from the adult cohort (35- to 44-year-olds at baseline; 43- to 52-year-olds at follow-up), and 350 individuals from the senior cohort (65- to 74-year-olds at baseline; 73- to 82-year-olds at follow-up) were reexamined after 9.1 (± 0.3) years for longitudinal analyses (incidence and progression). RESULTS: Younger adolescents predominantly presented with tooth-colored restorations, whereas amalgam fillings and indirect restorations were virtually absent. In adulthood, the prevalence of amalgam restorations increased continuously with age, reaching a maximum of 42% in seniors. The prevalence of indirect restorations also increased with age. The proportion of secondary caries increased to 10.5% in senior age. During the 9-year observation period, the prevalence of dental restorations among adolescents increased from 13.2% to 47.7%. The progression rates of dental restorations (per 100 person-years) were 16.4 and 15.8 in adults and seniors, respectively. CONCLUSION: The prevalence of dental restorations increased markedly across the life course, with indirect restorations being more frequent in older age groups. The development of secondary caries also appears to be age-dependent. Under real-world conditions, tooth-colored restorations did not exhibit a higher risk of secondary caries than amalgam restorations. (Quintessence Int 2026;57(Suppl): S24-S33; doi: 10.3290/j.qi.b6955480).