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Pediatric Dentistry Jul 2020The purpose of this systematic review and meta-analysis was to assess success rates for nonvital treatment in primary teeth for caries/trauma. Databases were searched... (Meta-Analysis)
Meta-Analysis
The purpose of this systematic review and meta-analysis was to assess success rates for nonvital treatment in primary teeth for caries/trauma. Databases were searched between 1960 and 2020 for randomized controlled trials, cohorts, case series, and in vitro studies. The primary outcome was overall success (clinical and radiographic) for pulpectomy and lesion sterilization tissue repair (LSTR). Included articles were independently determined, agreed upon, data extraction assessed, risk of bias, meta-analyses, and assignment of quality of evidence (GRADE). Comparing teeth with and without root resorption, pulpectomy success was better (P<0.001) in teeth without preoperative root resorption. Success with pulpectomies performed with zinc oxide eugenol [ZOE] and with Endoflas (ZOE plus iodoform plus calcium hydroxide) did not differ from that observed using Vitapex or Metapex (iodoform plus calcium hydroxide; P0.50) after 18 months; however, Endoflas and ZOE success rates remained near 90 percent versus 71 percent or less for iodoform. Network analysis ratings showed Endoflas and ZOE performed better than iodoform alone. Also, LSTR performed better (P<0.001) than pulpectomies in teeth with preoperative root resorption, but pulpectomy results were superior (P=0.09) if roots were intact. Rotary instrumentation of root canals was significantly faster (P<0.001) than manual instrumentation. Success rates were not impacted by method of obturation or root length determination, type of tooth, number of visits, irrigants, smear layer removal, or timing/type of final restoration. Eighteen-month success rates support Endloflas and zinc oxide eugenol pulpectomies over iodoform pulpectomies. Lesion sterilization tissue repair had limited indication for teeth with resorbed roots.
Topics: Calcium Hydroxide; Dental Caries; Humans; Pulpectomy; Root Canal Filling Materials; Root Resorption; Tooth, Deciduous; Zinc Oxide-Eugenol Cement
PubMed: 32847665
DOI: No ID Found -
The Cochrane Database of Systematic... Dec 2017Fixed prosthodontic treatment (crowns, fixed dental prostheses (FDPs), complete arch prostheses) involves the use of several different materials to replace missing tooth... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Fixed prosthodontic treatment (crowns, fixed dental prostheses (FDPs), complete arch prostheses) involves the use of several different materials to replace missing tooth structure. Traditionally full metal or metal frameworks veneered with ceramic (metal-ceramic (MC)) have been used. In recent years several different metal-free systems have become available to clinicians and patients. In general, metal-free restorations should allow practitioners to better reproduce natural tooth colour, avoiding shortcomings of MC restorations. The comparative in service clinical performance of fixed prosthodontic treatments of different materials is unclear.
OBJECTIVES
To assess the effects of metal-free materials for prosthodontic restorations compared to metal-ceramic or other conventional all-metal materials.
SEARCH METHODS
Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (searched 3 May 2017), Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 4) in the Cochrane Library (searched 3 May 2017), MEDLINE Ovid (1946 to 3 May 2017), and Embase Ovid (1980 to 3 May 2017). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials (searched 3 May 2017). No restrictions were placed on the language or date of publication when searching the electronic databases.
SELECTION CRITERIA
Randomised controlled trials (RCTs) in which the clinical performance of metal-free fixed prosthodontic restorations was compared with metal-ceramic (MC) or other conventional restorations in adult patients requiring prosthodontic treatment. RCTs in which the clinical performance of different kinds of metal-free systems were compared among themselves were also considered.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by Cochrane. Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted independently and in duplicate. Trial authors were contacted for missing information. Available results for the outcomes of interest of the systematic review of the studies included were tabulated as they could not be included in a formal meta-analysis.
MAIN RESULTS
Nine trials involving a total of 448 participants were included. We judged two trials to be at unclear risk of bias and seven to be at high risk of bias. The majority of items of risk of bias were evaluated to be at unclear or high risk level in more than 50% of the included trials. Each trial except two was addressing a different type of intervention. All evidence was rated as being of very low quality due to problems with risk of bias and imprecision of results, the latter being due to very small sample sizes, low event rates, 95% confidence intervals including the possibility of benefit for both the test and control groups, or combinations of these problems. This means that we are very uncertain about all of the results presented in this review.One trial compared metal-free single crowns (full contour zirconia) to cast gold single crowns in 224 participants and found insufficient evidence of a difference in failure rate after one year, but after five years there was some evidence of a benefit for the gold crowns. There was insufficient evidence of a difference for crown complications at either time of assessment.One trial compared three-unit metal-free FDPs (lithium disilicate) to three-unit metal-ceramic FDPs in 37 participants. There was insufficient evidence of a difference in bridge failure at one and six years, but some evidence of a benefit for the lithium disilicate group in terms of bridge complications at six years. One trial compared zirconia-ceramic FDPs to metal-ceramic FDPs in 34 participants but found insufficient evidence of a difference in bridge failures (i.e. no failures in either treatment group), bridge complications or patients' aesthetic evaluation at any time of assessment up to three years.One trial compared metal-free cantilevered FDPs to metal-ceramic cantilevered FDPs in 21 participants. There was insufficient evidence of a difference for any primary outcome: bridge failures (i.e. no failures in either treatment group), bridge complications, or patients' aesthetic evaluation at any time of assessment up to three years.One trial compared metal-free implant-supported screw retained single crowns (zirconia veneered with feldspathic ceramic) to metal-ceramic implant-supported screw-retained single crowns in 20 participants. There was insufficient evidence of a difference for any primary outcome: crown failures (i.e. no failures in either treatment group), crown complications, or satisfaction/aesthetic evaluation at any time of assessment up to two years.Two trials compared metal-free implant abutments (zirconia) to metal implant abutments both supporting single crowns in 50 participants. There was insufficient evidence of a difference in abutment failure at one year.One trial compared metal-free implant-supported FDPs made of two different types of zirconia ceramic in 18 participants. There was insufficient evidence of a difference in failures at any time of assessment up to 10 years (i.e. no failures in either treatment group). There was some evidence of a benefit for the zirconia-toughened alumina group in terms of complications (chipping).One trial compared metal-free tooth-supported FDPs made with two different veneering techniques (pressed versus layered) in 40 participants. There was insufficient evidence of a difference for failures (i.e. no failures in either treatment group) or complications at any time of assessment up to three years.
AUTHORS' CONCLUSIONS
There is insufficient evidence to support or refute the effectiveness of metal-free materials for fixed prosthodontic treatment over metal-ceramic or other type of standard restorations. The overall quality of existing evidence was very low, therefore great caution should be exercised when generalising the results of the included trials. Until more evidence becomes available clinicians should continue to base decisions on which material to use for fixed prosthodontic treatment on their own clinical experience, whilst taking into consideration the individual circumstances and preferences of their patients. There is urgent need of properly designed RCTs.
Topics: Crowns; Dental Alloys; Dental Materials; Dental Restoration, Permanent; Humans; Randomized Controlled Trials as Topic; Zirconium
PubMed: 29261853
DOI: 10.1002/14651858.CD009606.pub2 -
Journal of Prosthodontics : Official... Oct 2020To systematically review in vitro and clinical studies comparing quantitatively the 3D accuracy (global implant deviations) of digital vs conventional implant... (Meta-Analysis)
Meta-Analysis
PURPOSE
To systematically review in vitro and clinical studies comparing quantitatively the 3D accuracy (global implant deviations) of digital vs conventional implant impressions for partially and completely edentulous patients.
MATERIALS AND METHODS
Electronic and manual searches were conducted to identify in vitro and clinical studies, reporting on the 3D accuracy between digital and conventional implant impressions. Secondary outcomes were the effect of implant angulation, type of conventional impression technique, and type of intraoral scanner on the accuracy of implant impressions.
RESULTS
The inclusion criteria were met by 9 in vitro studies and 1 clinical study reporting on completely edentulous impressions, while 6 in vitro and 2 clinical studies reported on partially edentulous impressions. Quantitative meta-analysis was performed for 5 completely edentulous and 6 partially edentulous studies. The studies exhibited high values for heterogeneity. A random effects model was conducted to estimate the effect size. Based on 5 in vitro studies on completely edentulous impressions, the mean 3D implant deviation between conventional and digital impressions was 8.20 µm (95% CI: -53.56, 37.15) and the digital impressions had nominally less deviation (p = 0.72). Based on 1 clinical and 5 in vitro studies on partially edentulous impressions, the mean 3D implant deviation between conventional and digital impressions was 52.31 µm (95% CI: 6.30, 98.33) and the conventional impressions had nominally less deviation (p = 0.03). Five in vitro and 2 clinical studies were not included in the quantitative analysis due to heterogeneity in the methodology. Implant angulation affected the accuracy in favor of the partially edentulous conventional impressions whereas the effect of different scanners was not statistically significant on the completely edentulous impressions (p = 0.82).
CONCLUSIONS
Digital scans appear to have comparable 3D accuracy with conventional implant impressions based mainly on in vitro studies. However, clinical trials are recommended to investigate the clinical accuracy of digital scans and digitally fabricated interim or prototype prostheses, before digital implant scans can be recommended for routine clinical use.
Topics: Computer-Aided Design; Dental Implants; Dental Impression Materials; Dental Impression Technique; Humans; Models, Dental; Mouth, Edentulous
PubMed: 32613641
DOI: 10.1111/jopr.13211 -
Dental Materials : Official Publication... May 2022The present review is an update of a systematic review that has been published in 2012. Meanwhile, many new clinical trials on resin composites had been published. New... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The present review is an update of a systematic review that has been published in 2012. Meanwhile, many new clinical trials on resin composites had been published. New materials such as bulk fill resin composites and new glass-ionomer (GIC) based materials had been introduced. The focus of this review was to evaluate the longevity in relation to the material class and adhesive class, while adjusting for a possible study bias effect.
MATERIAL AND METHODS
The database PUBMED/SCOPUS were searched for clinical trials on posterior resin composites. The inclusion criteria were: (1) studies published between 2000 and 2019, (2) prospective clinical trial with at least 2 years of observation; (2) minimal number of restorations at last recall = 20; (3) report on drop-out rate; (4) report of operative technique and used materials; (5) utilisation of Ryge, modified Ryge or FDI evaluation criteria. The bias of each study was assessed by two independent reviewers using Cochrane Collaboration's tool for assessing risk of bias in randomised trials. For the statistical analysis, linear mixed models fitted on the individual data recorded along time have been used with random effects to account for study, patients and experiment effects. P-values smaller than 0.05 were considered significant.
RESULTS
Of the 423 clinical trials, 62 studies (including 110 experiments) met the inclusion criteria. Material class was divided according to the composite filler in microhybrid (39 experiments/2807 restorations), nanohybrid (24 experiments/1254 restorations), and hybrid (22 experiments/1255 restorations). So-called bulk fill materials were treated as a separate category (9 experiments/506 restorations) as were the GIC (11 experiments/2121 restorations) and the compomer materials (5 experiments/238 restorations). Only one study (1.6%) had low risk of bias, 42 (67.7%) were assessed to have unclear risk of bias and 19 (30.6%) had a high risk of bias. In 52.3% of the studies Class II and Class I restorations had been placed. After 10 years, the survival rate for resin composite restorations dropped to about 85-90% with no significant difference between hybrid, microhybrid and nao-hybrid resin materials. The main reasons for restoration replacement were bulk fractures and wear, which accounted for a about 70% of replacements. Caries at the restorative margins accounted for about 20% of the replacements, and retention loss, inacceptable colour match or marginal integrity, endodontic treatment or cusp fracture for about 10% of the replacements of the resin composite restorations. For compomer and GIC restorations the mean overall survival rate was about 80% after 6 years. For GIC, the main reasons for failure were substantial loss of anatomical contour along with loss of proximal contacts and retention loss. Mainly fractures reduced the longevity of compomers restorations. Also, there was no statistically significant difference between hybrid, micro-hybrid, nano-hybrid and bulk fill resin composites with regard to colour match, surface texture, material fractures, and anatomical form.
CONCLUSIONS
Posterior resin composite restorations that were placed with the enamel etch technique showed the best overall performance; the longevity was not significantly influenced by the filler type or viscosity of resin composite material. With regard to colour match, surface texture and anatomical form, nanohybrid resins were not significantly superior to hybrid or microhybrid resin composites. Compomer and GIC restorations demonstrated considerable shortcomings and had a significant shorter longevity.
Topics: Compomers; Composite Resins; Dental Caries; Dental Restoration, Permanent; Glass Ionomer Cements; Humans; Prospective Studies; Treatment Outcome
PubMed: 35221127
DOI: 10.1016/j.dental.2021.10.018 -
The European Journal of Prosthodontics... Nov 2022The objective of this systematic review was to compare the longevity of direct amalgam and composite resin restorations, in posterior teeth, through clinical,...
OBJECTIVES
The objective of this systematic review was to compare the longevity of direct amalgam and composite resin restorations, in posterior teeth, through clinical, prospective or retrospective studies, with at least 5 years of follow-up.
MATERIALS AND METHODS
Studies published in the last 15 years (from 2006 to 2021) were collected using the PubMed and Medline databases.
RESULTS
The search strategy associated with the established inclusion and exclusion criteria resulted in a total of 17 articles. Factors related to failures in the performance of restorations were analyzed together with the clinical performance results of each material over the years of study, according to the methodology of each article.
CONCLUSIONS
Regardless of the restorative material, the successful results over more than 5 years are due much more to the correct application of the technique, the operator's skill/knowledge and factors related to the patient, such as the type of tooth, number of faces involved in the restoration and oral hygiene.
Topics: Humans; Prospective Studies; Retrospective Studies; Composite Resins; Dental Materials
PubMed: 35438266
DOI: 10.1922/EJPRD_2371Maciel09 -
Clinical Oral Implants Research Mar 2018The goal of Working Group 1 at the 2nd Consensus Meeting of the Osteology Foundation was to comprehensively assess the effects of soft tissue augmentation procedures on... (Review)
Review
Evidence-based knowledge on the aesthetics and maintenance of peri-implant soft tissues: Osteology Foundation Consensus Report Part 1-Effects of soft tissue augmentation procedures on the maintenance of peri-implant soft tissue health.
OBJECTIVES
The goal of Working Group 1 at the 2nd Consensus Meeting of the Osteology Foundation was to comprehensively assess the effects of soft tissue augmentation procedures on peri-implant health or disease.
MATERIALS AND METHODS
A systematic review and meta-analysis on the effects of soft tissue augmentation procedures included a total of 10 studies (mucosal thickness: n = 6; keratinized tissue: n = 4). Consensus statements, clinical recommendations, and implications for future research were based on structured group discussions and a plenary session approval.
RESULTS
Soft tissue grafting to increase the width of keratinized tissue around implants was associated with greater reductions in gingival and plaque indices when compared to non-augmented sites. Statistically significant differences were noted for final marginal bone levels in favor of an apically positioned flap plus autogenous graft vs. all standard-of-care control treatments investigated. Soft tissue grafting (i.e., autogenous connective tissue) to increase the mucosal thickness around implants in the aesthetic zone was associated with significantly less marginal bone loss over time, but no significant changes in bleeding on probing, probing depths, or plaque scores when compared to sites without grafting.
CONCLUSIONS
The limited evidence available supports the use of soft tissue augmentation procedures to promote peri-implant health.
Topics: Alveolar Ridge Augmentation; Connective Tissue; Consensus; Dental Implantation; Dental Implantation, Endosseous; Dental Implants; Gingiva; Humans; Jaw, Edentulous, Partially; Meta-Analysis as Topic; Mucous Membrane; Osteology; Surgical Flaps
PubMed: 29498127
DOI: 10.1111/clr.13110 -
The Journal of Prosthetic Dentistry Apr 2024When restoring endodontically treated teeth, a post system is indicated to retain a core. Clinicians can choose from different post materials and types. However, the... (Meta-Analysis)
Meta-Analysis Review
STATEMENT OF PROBLEM
When restoring endodontically treated teeth, a post system is indicated to retain a core. Clinicians can choose from different post materials and types. However, the literature is inconclusive on the long-term clinical performance of available post systems.
PURPOSE
The purpose of this systematic review and meta-analysis was to analyze the survival and failure rates of endodontically treated teeth restored either with glass-fiber-reinforced or metal posts.
MATERIAL AND METHODS
The research question was formulated by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines by using the Population, Intervention, Comparison, Outcome, Study Type (PICOS) tool. Medline (PubMed), Embase, and Scopus searches complemented by manual search were performed for randomized controlled clinical trials with a follow-up of at least 2 years. Two independent authors performed screening and data extraction of the articles. Meta-analyses were performed with the RevMan software program. Homogeneity was checked by using chi and I tests, and random-effects meta-analyses were applied. Odds ratio and 95% confidence interval were calculated (α=.05). The publication bias was evaluated by using funnel plots and the Begg and Egger tests.
RESULTS
A total of 184 studies were retrieved through the electronic searches, and an additional 4 through the hand search. After title- and abstract-level exclusion, 23 studies remained for full-text analyses, of which 7 were selected for data extraction. Meta-analyses revealed an overall survival rate of 92.8% for endodontically treated teeth restored with glass-fiber-reinforced posts compared with 78.1% of those restored with metal posts. No statistically significant difference (P>.05) was found in the survival, success, or failure rates.
CONCLUSIONS
No statistically significant differences were found between the survival and failure rates of endodontically treated teeth restored either with glass-fiber-reinforced or metal posts. The overall survival rate was 92.8% for glass fiber posts and 78.1% for metal posts. Both are reliable materials when a significant amount of coronal tooth structure is missing and treatment with a post is indicated.
Topics: Humans; Post and Core Technique; Tooth, Nonvital; Survival Rate; Glass; Metals; Tooth Fractures; Composite Resins
PubMed: 35430048
DOI: 10.1016/j.prosdent.2022.01.003 -
Dental Materials : Official Publication... Oct 2015In this study the literature was systematically reviewed to investigate the clinical longevity of anterior composite restorations. (Review)
Review
OBJECTIVE
In this study the literature was systematically reviewed to investigate the clinical longevity of anterior composite restorations.
DATA
Clinical studies investigating the survival of anterior light-cured composite restorations with at least three years of follow-up were screened and main reasons associated with restoration failure were registered.
SOURCES
PubMed, Scopus, and Cochrane databases were searched without restriction on date or language. Reference lists of eligible studies were hand-searched. The grey literature search was not made systematically.
STUDY SELECTION
Two reviewers screened titles and/or abstracts of 2273 unique studies. In total, 41 studies were selected for full-text reading, from which 17 were included in the qualitative synthesis. The included studies evaluated the clinical performance of Class III and/or IV restorations (10 studies), which were placed due to caries, fracture, or replaced old restorations; veneers and full-coverage restorations placed for aesthetic reasons (five studies); and restorations in worn teeth (two studies). Annual failure rates (AFRs) were calculated for each study.
CONCLUSIONS
In total, 1821 restorations were evaluated and the total failure rate was 24.1%. AFRs varied from 0 to 4.1% and survival rates varied from 53.4% to 100%. Class III restorations generally had lower AFRs than the other restorations. Few studies addressed factors associated with failure, which included adhesive technique, composite resin, retreatment risk, and time required to build-up the restoration. Fracture of tooth/restoration was the most common reason for failure, whereas failures related to aesthetic qualities (color, anatomical form, surface stain) were more frequent when restorations were placed for aesthetic reasons.
Topics: Composite Resins; Dental Materials; Dental Restoration Failure; Dental Restoration, Permanent; Humans
PubMed: 26303655
DOI: 10.1016/j.dental.2015.07.005 -
The Cochrane Database of Systematic... Dec 2017Dental caries is a sugar-dependent disease that damages tooth structure and, due to loss of mineral components, may eventually lead to cavitation. Dental caries is the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Dental caries is a sugar-dependent disease that damages tooth structure and, due to loss of mineral components, may eventually lead to cavitation. Dental caries is the most prevalent disease worldwide and is considered the most important burden of oral health. Conventional treatment methods (drill and fill) involve the use of rotary burs under local anaesthesia. The need for an electricity supply, expensive handpieces and highly trained dental health personnel may limit access to dental treatment, especially in underdeveloped regions.To overcome the limitations of conventional restorative treatment, the Atraumatic Restorative Treatment (ART) was developed, mainly for treating caries in children living in under-served areas of the world where resources and facilities such as electricity and trained manpower are limited. ART is a minimally invasive approach which involves removal of decayed tissue using hand instruments alone, usually without use of anaesthesia and electrically driven equipment, and restoration of the dental cavity with an adhesive material (glass ionomer cement (GIC), composite resins, resin-modified glass-ionomer cement (RM-GICs) and compomers).
OBJECTIVES
To assess the effects of Atraumatic Restorative Treatment (ART) compared with conventional treatment for managing dental caries lesions in the primary and permanent teeth of children and adults.
SEARCH METHODS
Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 22 February 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 1), MEDLINE Ovid (1946 to 22 February 2017), Embase Ovid (1980 to 22 February 2017), LILACS BIREME Virtual Health Library (Latin American and Caribbean Health Science Information database; 1982 to 22 February 2017) and BBO BIREME Virtual Health Library (Bibliografia Brasileira de Odontologia; 1986 to 22 February 2017). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) with at least six months' follow-up that compared the effects of ART with a conventional restorative approach using the same or different restorative dental materials to treat caries lesions.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened search results, extracted data from included studies and assessed the risk of bias in those studies. We used standard methodological procedures expected by Cochrane to evaluate risk of bias and synthesise data. Where pooling was appropriate we conducted meta-analyses using the random-effects model. We assessed the quality of the evidence using GRADE criteria.
MAIN RESULTS
We included a total of 15 eligible studies randomising 3760 participants in this review. The age of participants across the studies ranged from 3 to 101 years, with a mean of 25.42 years. 48% of participants were male. All included studies were published between 2002 and 2016. Two of the 15 studies declared that the financial support was from companies that manufacture restorative material. Five studies were individually randomised parallel-group studies; six were cluster-randomised parallel-group studies; and four were randomised studies that used a split-mouth design. Eleven studies evaluated the effects of ART on primary teeth only, and four on permanent teeth. The follow-up period of the included studies ranged from 6 months to 36 months. We judged all studies to be at high risk of bias.For the main comparison of ART compared to conventional treatment using the same material: all but two studies used high-viscosity glass ionomer (H-GIC) as the restorative material; one study used a composite material; and one study used resin-modified glass ionomer cement (RM-GIC)).Compared to conventional treatment using H-GIC, ART may increase the risk of restoration failure in the primary dentition, over a follow-up period from 12 to 24 months (OR 1.60, 95% CI 1.13 to 2.27, five studies; 643 participants analysed; low-quality evidence). Our confidence in this effect estimate is limited due to serious concerns over risk of performance and attrition bias. For this comparison, ART may reduce pain during procedure compared with conventional treatment (MD -0.65, 95% CI -1.38 to 0.07; 40 participants analysed; low-quality evidence)Comparisons of ART to conventional treatment using composite or RM-GIC were downgraded to very low quality due to indirectness, imprecision and high risk of performance and attrition bias. Given the very low quality of the evidence from single studies, we are uncertain about the restoration failure of ART compared with conventional treatment using composite over a 24-month follow-up period (OR 1.11, 95% CI 0.54 to 2.29; one study; 57 participants) and ART using RM-GIC in the permanent teeth of older adults with root caries lesions over a six-month follow-up period (OR 2.71, 95% CI 0.94 to 7.81; one study; 64 participants).No studies reported on adverse events or costs.
AUTHORS' CONCLUSIONS
Low-quality evidence suggests that ART using H-GIC may have a higher risk of restoration failure than conventional treatment for caries lesions in primary teeth. The effects of ART using composite and RM-GIC are uncertain due to the very low quality of the evidence and we cannot rely on the findings. Most studies evaluated the effects of ART on the primary dentition.Well-designed RCTs are required that report on restoration failure at clinically meaningful time points, as well as participant-reported outcomes such as pain and discomfort. Due to the potential confounding effects from the use of different dental materials, a robust body of evidence on the effects of ART compared with conventional treatment using the same restoration material is necessary. We identified four ongoing trials that could provide further insights into this area.
Topics: Adult; Child; Dental Atraumatic Restorative Treatment; Dental Caries; Dental Restoration Failure; Dentition, Permanent; Female; Glass Ionomer Cements; Humans; Male; Randomized Controlled Trials as Topic; Tooth, Deciduous; Toothache
PubMed: 29284075
DOI: 10.1002/14651858.CD008072.pub2 -
Caries Research 2019The aim of this review as part of the preparation for a workshop organized by the European Federation of Conservative Dentistry (EFCD) in conjunction with the European... (Meta-Analysis)
Meta-Analysis
The aim of this review as part of the preparation for a workshop organized by the European Federation of Conservative Dentistry (EFCD) in conjunction with the European Organisation for Caries Research (ORCA) was to systematically analyze available evidence of non-, micro- as well as invasive interventions for root caries lesions (RCLs). For each treatment strategy, a separate systematic review was either performed (micro-invasive and choice of restorative material) or updated (non-invasive and excavation technique) each of them following PRISMA guidelines, and if possible meta-analyses were performed. Besides the general advice to improve tooth brushing with fluoride toothpaste main findings for non-invasive interventions in RCLs, the use of dentifrices containing 5,000 ppm F- as well as professionally applied chlorhexidine varnish or silver diamine fluoride seemed to be more efficacious to arrest root caries compared to conventional fluoride toothpaste or placebo respectively. However, this conclusion is based only on a few randomized clinical trials. For micro-invasive treatments, only 2 studies focusing on sealants were available without clear conclusions. A recent review on the comparison of atraumatic restorative treatment compared with conventional treatment concluded that there is insufficient data to clearly rule out if any difference with regard to restoration longevity between both techniques exists. When restoring coventionally, composites performed better than resin-modified and glass ionomer cements. However, all materials showed rather high annual failure rates in the majority of the studies and evidence is based on a low number of prospective studies with a rather high risk of bias.
Topics: Dental Atraumatic Restorative Treatment; Dentifrices; Glass Ionomer Cements; Humans; Prospective Studies; Root Caries
PubMed: 31412343
DOI: 10.1159/000501588