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Dental Materials : Official Publication... Dec 2023The objective is to compare the preventive effect on secondary caries of glass ionomer cement (GIC) restorations with amalgam or resin-composite restorations. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The objective is to compare the preventive effect on secondary caries of glass ionomer cement (GIC) restorations with amalgam or resin-composite restorations.
METHODS
Two independent researchers conducted a systematic search of English publications in PubMed, Web of Science, Cochrane and Scopus. They selected randomized clinical trials comparing secondary caries incidences around GIC restorations (conventional GIC or resin-modified GIC) with amalgam or resin-composite restorations. Meta-analysis of the secondary-caries incidences with risk ratio (RR) and 95% confidence interval (95% CI) as the effect measure was performed.
RESULTS
This review included 64 studies. These studies included 8310 GIC restorations and 5857 amalgam or resin-composite restorations with a follow-up period from 1 to 10 years. Twenty-one studies with 4807 restorations on primary teeth and thirty-eight studies with 4885 restorations on permanent teeth were eligible for meta-analysis. The GIC restorations had a lower secondary caries incidence compared with amalgam restorations in both primary dentition [RR= 0.55, 95% CI:0.41-0.72] and permanent dentition [RR= 0.20, 95% CI:0.11-0.38]. GIC restorations showed similar secondary caries incidence compared with resin-composite restorations in primary dentition [RR= 0.92, 95% CI:0.77-1.10] and permanent dentition [RR= 0.77, 95% CI:0.39-1.51]. Conventional GIC restorations showed similar secondary caries incidence compared with resin-modified GIC-restored teeth in both primary dentition [RR= 1.12, 95% CI:0.67-1.87] and permanent dentition [RR= 1.63, 95% CI:0.34-7.84].
CONCLUSIONS
GIC restorations showed a superior preventive effect against secondary caries compared to amalgam restorations, and a similar preventive effect against secondary caries compared to resin-composite restorations in both primary and permanent teeth. [PROSPERO Registration ID: CRD42022380959].
Topics: Humans; Dental Restoration, Permanent; Glass Ionomer Cements; Dental Caries Susceptibility; Dental Caries; Composite Resins; Dental Amalgam
PubMed: 37838608
DOI: 10.1016/j.dental.2023.10.008 -
Materials (Basel, Switzerland) Jun 2020In the era of biology-driven endodontics, vital pulp therapies are regaining popularity as a valid clinical option to postpone root-canal treatment. In this sense, many... (Review)
Review
Cytotoxicity and Bioactivity of Dental Pulp-Capping Agents towards Human Tooth-Pulp Cells: A Systematic Review of In-Vitro Studies and Meta-Analysis of Randomized and Controlled Clinical Trials.
In the era of biology-driven endodontics, vital pulp therapies are regaining popularity as a valid clinical option to postpone root-canal treatment. In this sense, many different materials are available in the market for pulp-capping purposes. The main aim of this systematic review and meta-analysis was to examine literature regarding cytotoxicity and bioactivity of pulp-capping agents by exposure of human dental pulp cells of primary origin to these materials. A secondary objective was to evaluate the inflammatory reaction and reparative dentin-bridge formation induced by the different pulp-capping agents on human pulp tissue. A literature search strategy was carried out on , and the databases. The last search was done on 1 May 2020. No filters or language restrictions were initially applied. Two researchers independently selected the studies and extracted the data. In vitro studies were included when human dental pulp cells of primary origin were (in)directly exposed to pulp-capping agents. Parallel or split-mouth randomized or controlled clinical trials (RCT or CCT) were selected to investigate the effects of different pulp-capping agents on the inflammation and reparative bridge-formation capacity of human pulp tissue. Data were synthesized via (95% confidence interval) with fixed or random effects models, depending on the homogeneity of the studies. The (95% confidence interval) were presented for the sake of interpretation. In total, 26 in vitro and 30 in vivo studies were included in the systematic review and meta-analysis, respectively. The qualitative analysis of data suggested that resin-free hydraulic calcium-silicate cements promote cell viability and bioactivity towards human dental pulp cells better than resin-based calcium-silicate cements, glass ionomers and calcium-hydroxide cements. The meta-analysis of the in vivo studies indicated that calcium-hydroxide powder/saline promotes reparative bridge formation better than the popular commercial resin-free calcium-silicate cement Pro-Root MTA (Dentsply-Sirona), although the difference was borderline non-significant ( = 0.06), and better than calcium-hydroxide cements ( < 0.0001). Moreover, resin-free pulp-capping agents fostered the formation of a complete reparative bridge better than resin-based materials ( < 0.001). On the other hand, no difference was found among the different materials tested regarding the inflammatory effect provoked at human pulp tissue. Calcium-hydroxide (CH) powder and Pro-Root MTA (Dentsply-Sirona) have shown excellent biocompatibility in vitro and in vivo when tested on human cells and teeth. Their use after many years of research and clinical experience seems safe and proven for vital pulp therapy in healthy individuals, given that an aseptic environment (rubber dam isolation) is provided. Although evidence suggests that most modern hydraulic calcium-silicate cements promote bioactivity when exposed to human dental pulp cells, care should be taken when these new materials are clinically applied in patients, as small changes in their composition might have big consequences on their clinical efficacy. Pure calcium-hydroxide powder/saline and the commercial resin-free hydraulic calcium-silicate cement Pro-Root MTA (Dentsply-Sirona) are the best options to provide a complete reparative bridge upon vital pulp therapy. CRD42020164374.
PubMed: 32545425
DOI: 10.3390/ma13122670 -
Clinical performance of laminate and non-laminate resin composite restorations: a systematic review.Australian Dental Journal Dec 2015A systematic review was undertaken to determine the clinical outcomes of resin modified glass-ionomer cement or glass-ionomer cement-resin composite (RMGIC/GIC-RC)... (Review)
Review
BACKGROUND
A systematic review was undertaken to determine the clinical outcomes of resin modified glass-ionomer cement or glass-ionomer cement-resin composite (RMGIC/GIC-RC) laminate restorations and flowable resin composite (FRC)-lined RC restorations compared to that of non-laminate RC restorations.
METHODS
Electronic databases were searched and filtered for relevant papers by assessing titles, abstracts and full-text articles. Randomized controlled clinical trials (RCTs) were included, comparing the clinical performance of RMGIC/GIC-RC laminate restorations and FRC-lined restorations with RC restorations as the control. The articles were categorized and critically appraised. Raw data were used for a fixed effects meta-analysis.
RESULTS
Thirteen articles were included in the review. Five evaluated FRC-lined restorations, and eight studies evaluated RMGIC/GIC-RC laminate restorations, comparing with non-laminate RC restorations. Three of eight RMGIC/GIC-RC laminate restorations assessed only postoperative sensitivity. A meta-analysis could only be conducted in three studies with the FRC-lined restorations as the intervention. The meta-analysis found no significant difference in clinical failures between FRC-lined RC restorations and RC restorations with no lining (p > 0.05).
CONCLUSIONS
Based on current clinical evidence, a FRC lining is no more advantageous than RC restorations with no FRC lining. More long-term RCTs are required, particularly for evaluating RMGIC/GIC-RC laminate restorations.
Topics: Acrylic Resins; Composite Resins; Dental Restoration, Permanent; Glass Ionomer Cements; Humans; Polyurethanes
PubMed: 25404178
DOI: 10.1111/adj.12252 -
BMC Oral Health Apr 2023Restoring vital teeth with indirect restorations may threaten dental pulp integrity. However, the incidence of and influential factors on pulp necrosis and periapical... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Restoring vital teeth with indirect restorations may threaten dental pulp integrity. However, the incidence of and influential factors on pulp necrosis and periapical pathosis in such teeth are still unknown. Therefore, this systematic review and meta-analysis aimed to investigate the incidence of and influential factors on pulp necrosis and periapical pathosis of vital teeth following indirect restorations.
METHODS
The search was conducted in five databases, using MEDLINE via PubMed, Web of Science, EMBASE, CINAHL, and Cochrane Library. Eligible clinical trials and cohort studies were included. The risk of bias was assessed using Joanna Briggs Institute's critical appraisal tool and Newcastle-Ottawa Scale. The overall incidences of pulp necrosis and periapical pathosis following indirect restorations were calculated using a random effects model. Subgroup meta-analyses were also performed to determine the potential influencing factors for pulp necrosis and periapical pathosis. The certainty of the evidence was assessed using the GRADE tool.
RESULTS
A total of 5,814 studies were identified, of which 37 were included in the meta-analysis. The overall incidences of pulp necrosis and periapical pathosis following indirect restorations were determined to be 5.02% and 3.63%, respectively. All studies were assessed as having a moderate-low risk of bias. The incidence of pulp necrosis following indirect restorations increased when the pulp status was objectively assessed (thermal/electrical testing). The presence of pre-operative caries or restorations, treatment of anterior teeth, temporization for more than two weeks, and cementation with eugenol-free temporary cement, all increased this incidence. Final impression with polyether and permanent cementation with glass ionomer cement both increased the incidence of pulp necrosis. Longer follow-up periods (> 10 years) and treatment provided by undergraduate students or general practitioners were also factors that increased this incidence. On the other hand, the incidence of periapical pathosis increased when teeth were restored with fixed partial dentures, the bone level was < 35%, and the follow-up was > 10 years. The certainty of the evidence overall was assessed as low.
CONCLUSIONS
Although the incidences of pulp necrosis and periapical pathosis following indirect restorations remain low, many factors affect these incidences that should thus be considered when planning indirect restorations on vital teeth.
DATABASE REGISTRATION
PROSPERO (CRD42020218378).
Topics: Humans; Dental Pulp Necrosis; Incidence; Dental Caries; Dental Cements; Glass Ionomer Cements
PubMed: 37009911
DOI: 10.1186/s12903-023-02826-1 -
BMC Oral Health Jun 2023This systematic review and network meta-analysis aimed to compare the clinical efficacy of bioactive and conventional restorative materials in controlling secondary... (Meta-Analysis)
Meta-Analysis
BACKGROUND
This systematic review and network meta-analysis aimed to compare the clinical efficacy of bioactive and conventional restorative materials in controlling secondary caries (SC) and to provide a classification of these materials according to their effectiveness.
METHODS
A search was performed in Pubmed, Web of Science, Embase, BBO, Lilacs, Cochrane Library, Scopus, IBECS and gray literature. Clinical trials were included, with no language or publication date limitations. Paired and network meta-analyses were performed with random-effects models, comparing treatments of interest and classifying them according to effectiveness in the permanent and deciduous dentition and at 1-year or 2/more years of follow-up. The risk of bias and certainty of evidence were evaluated.
RESULTS
Sixty-two studies were included in the qualitative syntheses and 39 in the quantitative ones. In permanent teeth, resin composite (RC) (RR = 2.00; 95%CI = 1.10, 3.64) and amalgam (AAG) (RR = 1.79; 95%CI = 1.04, 3.09) showed a higher risk of SC than Glass Ionomer Cement (GIC). In the deciduous teeth, however, a higher risk of SC was observed with RC than with AAG (RR = 2.46; 95%CI = 1.42, 4.27) and in GIC when compared to Resin-Modified Glass Ionomer Cement (RMGIC = 1.79; 95%CI = 1.04, 3.09). Most randomized clinical trials studies showed low or moderate risk of bias.
CONCLUSION
There is a difference between bioactive restorative materials for SC control, with GIC being more effective in the permanent teeth and the RMGIC in the deciduous teeth. Bioactive restorative materials can be adjuvants in the control of SC in patients at high risk for caries.
Topics: Humans; Network Meta-Analysis; Dental Caries Susceptibility; Dental Materials; Dental Caries; Composite Resins; Treatment Outcome; Glass Ionomer Cements; Dental Restoration, Permanent
PubMed: 37322456
DOI: 10.1186/s12903-023-03110-y -
Medicina (Kaunas, Lithuania) Dec 2023Zirconia-reinforced lithium silicate (ZLS) ceramic is a new innovative dental material with unique a chemical composition that is designed to combine harmoniously with... (Review)
Review
Zirconia-reinforced lithium silicate (ZLS) ceramic is a new innovative dental material with unique a chemical composition that is designed to combine harmoniously with the appropriate optical properties of lithium disilicate and the enhanced mechanical strength of zirconia. A thorough understanding of ZLS materials is essential for both clinicians and dental technicians. At present, the mechanical behavior and optical properties of the ZLS ceramic system have not been extensively researched, and there is still a lack of consensus regarding the fabrication process and clinical behavior of ZLS all-ceramic restorations. The aim of the present study was to present a selection of comprehensive information concerning zirconia-reinforced lithium silicate ceramics and their optical and mechanical properties, as well as to assess data regarding cementation procedures and clinical outcomes for ZLS all-ceramic restorations. Three electronic databases (PubMed, Web of Science, and the Cochrane Library) were used for the research by two independent reviewers. The search was limited to articles published in the English language, as well as clinical and in vitro studies of color and studies on mechanical behavior and the cementation procedures of ZLS restorations. The exclusion criteria comprised abstracts, questionnaire-based studies, case reports, literature reviews, and studies that were not available in English. Zirconia-reinforced lithium-silicate-based ceramic presents a unique and complex microstructure that increases mechanical resistance but decreases aesthetic appearance, especially its translucency, due to tetragonal zirconia content. A material's thickness, the color of the underlying tooth structure, and the resin cement shade are important factors that influence the final shade and aesthetic appearance of ZLS restorations. Mechanical properties, which are defined by the fracture toughness, flexural strength, elastic modulus, and hardness of ZLS ceramic are higher compared to feldspathic, lithium disilicate, and hybrid ceramics, as well as resin nanoceramics; however, they are lower than translucent or high-translucency zirconia. Acid etching, sandblasting, and laser etching represent the most used methods to prepare the ZLS restoration surfaces for proper bonding procedures.
Topics: Humans; Ceramics; Dentistry; Lithium; Materials Testing; Silicates; Surface Properties
PubMed: 38138238
DOI: 10.3390/medicina59122135 -
Biomimetics (Basel, Switzerland) Mar 2024The popular immediate dentin sealing (IDS) technique is used to improve the bond strength of indirect restorations. This systematic review assessed whether bond strength... (Review)
Review
The popular immediate dentin sealing (IDS) technique is used to improve the bond strength of indirect restorations. This systematic review assessed whether bond strength is affected by the type of aging conditions, bonding agents, flowable resin composites, impression materials, temporary materials, and/or resin cement used within the IDS procedure. A comprehensive database search of PubMed, Embase, Scopus, Ovid Medline, Web of Sciences, Cochrane Library, Dentistry & Oral Sciences Source, and ProQuest was carried out up to 30 January 2024 without publication year or language limitations. Only in vitro full-texts regarding the effect of IDS on bond strength were included, and the quality of their methods was assessed via a Risk of Bias (RoB) test. In total, 1023 pertinent studies were initially found, and 60 articles were selected for review after screening for the title, abstract, and full texts. IDS application improves the bond strength of indirect restorations to dentin and reduces the negative effects of temporary materials on the bond durability of final indirect restorations. Filled dentin bonding agents or combinations with flowable resin composite are preferred to protect the IDS layer from conditioning procedures.
PubMed: 38534867
DOI: 10.3390/biomimetics9030182 -
PloS One 2018Lasers have recently been introduced as an alternative means of conditioning dental ceramic surfaces in order to enhance their adhesive strength to cements and other... (Meta-Analysis)
Meta-Analysis Review
Lasers have recently been introduced as an alternative means of conditioning dental ceramic surfaces in order to enhance their adhesive strength to cements and other materials. The present systematic review and meta-analysis aimed to review and quantitatively analyze the available literature in order to determine which bond protocols and laser types are the most effective. A search was conducted in the Pubmed, Embase and Scopus databases for papers published up to April 2017. PRISMA guidelines for systematic review and meta-analysis were followed. Fifty-two papers were eligible for inclusion in the review. Twenty-five studies were synthesized quantitatively. Lasers were found to increase bond strength of ceramic surfaces to resin cements and composites when compared with control specimens (p-value < 0.01), whereas no significant differences were found in comparison with air-particle abraded surfaces. High variability can be observed in adhesion values between different analyses, pointing to a need to standardize study protocols and to determine the optimal parameters for each laser type.
Topics: Ceramics; Dental Materials; Lasers; Materials Testing
PubMed: 29293633
DOI: 10.1371/journal.pone.0190736 -
Journal of Functional Biomaterials Aug 2023Regenerative dentistry is the operation of restoring dental, oral and maxillofacial tissues. Currently, there are no guidelines for the ideal cement/material in... (Review)
Review
Comparative Biocompatibility and Odonto-/Osteogenesis Effects of Hydraulic Calcium Silicate-Based Cements in Simulated Direct and Indirect Approaches for Regenerative Endodontic Treatments: A Systematic Review.
BACKGROUND
Regenerative dentistry is the operation of restoring dental, oral and maxillofacial tissues. Currently, there are no guidelines for the ideal cement/material in regenerative endodontic treatments (RET). Hydraulic calcium silicate-based cements (hCSCs) are currently the material of choice for RET.
OBJECTIVES
This systematic review was conducted to gather all of the different direct and indirect approaches of using hCSCs in RET in vitro and in vivo, and to ascertain if there are any superiorities to indirect approaches.
METHODS AND MATERIALS
This systematic review was conducted according to the 2020 PRISMA guidelines. The study question according to the PICO format was as follows: Comparison of the biological behavior (O) of stem cells (P) exposed to hCSCs through direct and indirect methods (I) with untreated stem cells (C). An electronic search was executed in Scopus, Google Scholar, and PubMed.
RESULTS
A total of 78 studies were included. Studies were published between 2010 and 2022. Twenty-eight commercially available and eighteen modified hCSCs were used. Seven exposure methods (four direct and three indirect contacts) were assessed. ProRoot MTA and Biodentine were the most used hCSCs and had the most desirable results. hCSCs were either freshly mixed or set before application. Most studies allowed hCSCs to set in incubation for 24 h before application, which resulted in the most desirable biological outcomes. Freshly mixed hCSCs had the worst outcomes. Indirect methods had significantly better viability/proliferation and odonto-/osteogenesis outcomes.
CONCLUSION
Biodentine and ProRoot MTA used in indirect exposure methods result in desirable biological outcomes.
PubMed: 37754860
DOI: 10.3390/jfb14090446 -
The Cochrane Database of Systematic... Dec 2016Root canal therapy is a sequence of treatments involving root canal cleaning, shaping, decontamination and obturation. It is conventionally performed through a hole... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Root canal therapy is a sequence of treatments involving root canal cleaning, shaping, decontamination and obturation. It is conventionally performed through a hole drilled into the crown of the affected tooth, namely orthograde root canal therapy. For teeth that cannot be treated with orthograde root canal therapy, or for which it has failed, retrograde root filling, which seals the root canal from the root apex, is a good alternative. Many materials, such as amalgam, zinc oxide eugenol and mineral trioxide aggregate (MTA), are generally used. Since none meets all the criteria an ideal material should possess, selecting the most efficacious material is of utmost importance.
OBJECTIVES
To determine the effects of different materials used for retrograde filling in children and adults for whom retrograde filling is necessary in order to save the tooth.
SEARCH METHODS
Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 13 September 2016); the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 8) in the Cochrane Library (searched 13 September 2016); MEDLINE Ovid (1946 to 13 September 2016); Embase Ovid (1980 to 13 September 2016); LILACS BIREME Virtual Health Library (1982 to 13 September 2016); and OpenSIGLE (1980 to 2005). ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. We also searched Chinese BioMedical Literature Database (in Chinese, 1978 to 20 September 2016); VIP (in Chinese, 1989 to 20 September 2016); China National Knowledge Infrastructure (in Chinese, 1994 to 20 September 2016); and Sciencepaper Online (in Chinese, to 20 September 2016). No restrictions were placed on the language or date of publication when searching the electronic databases.
SELECTION CRITERIA
We selected randomised controlled trials (RCTs) only that compared different retrograde filling materials, with reported success rate that was assessed by clinical or radiological methods for which the follow-up period was at least 12 months.
DATA COLLECTION AND ANALYSIS
Two review authors extracted data independently and in duplicate. Original trial authors were contacted for any missing information. Two review authors independently carried out risk of bias assessments for each eligible study following Cochrane methodological guidelines.
MAIN RESULTS
We included six studies (916 participants with 988 teeth) reported in English. All the studies had high risk of bias. The six studies examined five different comparisons, including MTA versus intermediate restorative material (IRM), MTA versus super ethoxybenzoic acid cement (Super-EBA), Super-EBA versus IRM, dentine-bonded resin composite versus glass ionomer cement and glass ionomer cement versus amalgam. There was therefore little pooling of data and very little evidence for each comparison.There is weak evidence of little or no difference between MTA and IRM at the first year of follow-up (risk ratio (RR) 1.09; 95% confidence interval (CI): 0.97 to 1.22; 222 teeth; quality of evidence: low). Insufficient evidence of a difference between MTA and IRM on success rate at the second year of follow-up (RR 1.06; 95% CI: 0.89 to 1.25; 86 teeth, 86 participants; quality of evidence: very low). All the other outcomes were based on a single study. There is insufficient evidence of any difference between MTA and Super-EBA at the one-year follow-up (RR 1.03; 95% CI: 0.96 to 1.10; 192 teeth, 192 participants; quality of evidence: very low), and only weak evidence indicating there might be a small increase in success rate at the one-year follow-up in favour of IRM compared to Super-EBA (RR 0.90; 95% CI: 0.80 to 1.01; 194 teeth; quality of evidence: very low). There was also insufficient and weak evidence to show that dentine-bonded resin composite might be a better choice for increasing retrograde filling success rate compared to glass ionomer cement at the one-year follow-up (RR 2.39; 95% CI: 1.60 to 3.59; 122 teeth, 122 participants; quality of evidence: very low). And there was insufficient evidence of a difference between glass ionomer cement and amalgam at both the one-year (RR 0.98; 95% CI: 0.86 to 1.12; 105 teeth; quality of evidence: very low) and five-year follow-ups (RR 1.00; 95% CI: 0.84 to 1.20; 82 teeth; quality of evidence: very low).None of these studies reported an adverse event.
AUTHORS' CONCLUSIONS
Based on the present limited evidence, there is insufficient evidence to draw any conclusion as to the benefits of any one material over another. We conclude that more high-quality RCTs are required.
Topics: Adult; Child; Dental Amalgam; Dental Cements; Glass Ionomer Cements; Humans; Hydroxybenzoate Ethers; Randomized Controlled Trials as Topic; Resin Cements; Root Canal Filling Materials; Root Canal Therapy
PubMed: 27991646
DOI: 10.1002/14651858.CD005517.pub2