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Journal of Dentistry Jan 2016This systematic review was performed to evaluate the clinical outcome of coronal pulpotomy treatment to manage carious vital pulp exposure in permanent posterior teeth... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
This systematic review was performed to evaluate the clinical outcome of coronal pulpotomy treatment to manage carious vital pulp exposure in permanent posterior teeth with closed root apices.
DATA/SOURCES
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline was used. A search of articles published between 1960 January and 2015 July was conducted in PubMed, EMBASE, and CENTRAL databases.
STUDY SELECTION
Only studies that performed full coronal pulpotomy for carious vital pulp exposure of permanent posterior teeth and had clinical and radiographic assessments during at least one-year follow-up were qualified for data analyses. The weighted mean success rate (WSR) was the primary outcome and estimated using DerSimonian-Laird random effects model. Out of 299 articles, six studies were included for the analysis of one-year WSR, and five studies were included in the analysis of two-year WSR. The one-year and two-year WSR were 94% (95% confidence interval (CI): [90,99]) and 92% (CI: [84,100]) respectively. Differences in pulp capping and restoration materials did not significantly affect success rates (Two-year WSR in the MTA and MTA-like products group vs. the calcium hydroxide group: 92% (CI: [85,99]) vs. 88% (CI: [76,100]); the amalgam group vs. the composite group: 92% (CI: [81,100]) vs. 93% (CI: [81,100])).
CONCLUSIONS
Generally, full coronal pulpotomy had a favorable success rate in treating carious vital pulp exposure of permanent mature teeth with closed root apices. More studies with control group of root canal treated teeth and longer follow-up periods are needed.
CLINICAL SIGNIFICANCE
Coronal pulpotomy treatment can be considered as an intermediate treatment option in managing carious vital pulp exposures of permanent teeth with closed root apices. This option may also serve as a substitute to extraction when root canal treatment cannot be performed for low income and uninsured patients or in underserved areas.
Topics: Dental Pulp Capping; Dental Pulp Exposure; Humans; Pulp Capping and Pulpectomy Agents; Pulpitis; Pulpotomy; Treatment Outcome
PubMed: 26687672
DOI: 10.1016/j.jdent.2015.12.005 -
The Cochrane Database of Systematic... May 2012Endodontic treatment, involves removal of the dental pulp and its replacement by a root canal filling. Restoration of root filled teeth can be challenging due to... (Review)
Review
BACKGROUND
Endodontic treatment, involves removal of the dental pulp and its replacement by a root canal filling. Restoration of root filled teeth can be challenging due to structural differences between vital and non-vital root filled teeth. Direct restoration involves placement of a restorative material e.g. amalgam or composite directly into the tooth. Indirect restorations consist of cast metal or ceramic (porcelain) crowns. The choice of restoration depends on the amount of remaining tooth which may influence long term survival and cost. The comparative in service clinical performance of crowns or conventional fillings used to restore root filled teeth is unclear.
OBJECTIVES
To assess the effects of restoration of endodontically treated teeth (with or without post and core) by crowns versus conventional filling materials.
SEARCH METHODS
We searched the following databases: the Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE via OVID, EMBASE via OVID, CINAHL via EBSCO, LILACS via BIREME and the reference lists of articles as well as ongoing trials registries.There were no restrictions regarding language or date of publication. Date of last search was 13 February 2012.
SELECTION CRITERIA
Randomised controlled trials (RCTs) or quasi-randomised controlled trials in participants with permanent teeth which have undergone endodontic treatment. Single full coverage crowns compared with any type of filling materials for direct restoration, as well as indirect partial restorations (e.g. inlays and onlays). Comparisons considered the type of post and core used (cast or prefabricated post), if any.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trial quality and extracted data.
MAIN RESULTS
One trial judged to be at high risk of bias due to missing outcome data, was included. 117 participants with a root filled premolar tooth restored with a carbon fibre post, were randomised to either a full coverage metal-ceramic crown or direct adhesive composite restoration. At 3 years there was no reported difference between the non-catastrophic failure rates in both groups. Decementation of the post and marginal gap formation occurred in a small number of teeth.
AUTHORS' CONCLUSIONS
There is insufficient evidence to support or refute the effectiveness of conventional fillings over crowns for the restoration of root filled teeth. Until more evidence becomes available clinicians should continue to base decisions on how to restore root filled teeth on their own clinical experience, whilst taking into consideration the individual circumstances and preferences of their patients.
Topics: Adult; Crowns; Dental Restoration, Permanent; Female; Humans; Male; Middle Aged; Post and Core Technique; Randomized Controlled Trials as Topic; Tooth Root; Tooth, Nonvital
PubMed: 22592736
DOI: 10.1002/14651858.CD009109.pub2 -
Cadernos de Saude Publica Feb 2019Mercury is a metal found in the environment from natural and anthropogenic sources. It is highly toxic to ecosystems and living beings. Most human exposures come from...
Mercury is a metal found in the environment from natural and anthropogenic sources. It is highly toxic to ecosystems and living beings. Most human exposures come from ingestion of contaminated seafood, outgassing from dental amalgam or occupational exposure (e.g. gold mining), among other cases. Large populations are exposed to mercury, making it a very important issue from the public health perspective. Adverse health effects are commonly seen in the nervous system, but every organ is a potential target, such as the bone marrow. The main goal of this study was to assess the available evidence on human exposure to mercury and its hematological effects. A search strategy was constructed, including key terms (MeSH, text word and equivalents) for querying 2 repositories of master dissertation and PhD thesis (Fiocruz/ARCA and University of São Paulo) and 4 different electronic databases: BVS/LILACS, MEDLINE/PubMed, Scopus and TOXLINE/NIH, for articles published from 1950 to February 2018. There was no language restriction and a tool (EPHPP) was used to assess the quality of included studies. According to pre-established criteria, 80 studies were retrieved, all of them observational (48 case reports, 24 cross-sectional, 6 case series and 2 cohorts), comprising 9,284 people. Despite the fact that most exposed ones (6,012) had normal blood cell count and mercury hematological effects did not seem very usual (1,914 cases: 14 severe and 29 deaths), three studies reported association (β) for anemia, lymphopenia, neutrophilia and basophilia. We concluded that the gathered information pointed to mercury hematotoxic effects, some of them may be serious and even fatal.
Topics: Brazil; Cell Count; Environmental Exposure; Environmental Monitoring; Hematologic Diseases; Hematologic Tests; Humans; Mercury; Mercury Compounds; Mercury Poisoning; Occupational Exposure
PubMed: 30758455
DOI: 10.1590/0102-311X00091618 -
Clinical Oral Investigations May 2020For an ORCA/EFCD consensus, this systematic review assessed the question "How to intervene in the caries process in proximal caries in adolescents and adults". (Meta-Analysis)
Meta-Analysis
OBJECTIVES
For an ORCA/EFCD consensus, this systematic review assessed the question "How to intervene in the caries process in proximal caries in adolescents and adults".
MATERIAL AND METHODS
Separating between the management of initial and cavitated proximal caries lesions, Medline via PubMed was searched regarding non-operative/non-invasive, minimally/micro-invasive and restorative treatment. First priority was systematic reviews or randomized controlled trials (RCTs), otherwise cohort studies. After extraction of data, the potential risk of bias was estimated depending on the study type, and the emerging evidence for conclusions was graded.
RESULTS
Regarding non-invasive/non-operative care (NOC), no systematic reviews or RCTs were found. In cohort studies (n = 12) with a low level of evidence, NOC like biofilm management and fluoride was associated with a low proportion and slow speed of progression of initial proximal lesions. Minimally/micro-invasive (MI) treatments such as proximal sealants or resin infiltration (four systematic reviews/meta-analyses) were effective compared with a non-invasive/placebo control at a moderate level of evidence. Data on restorative treatment came with low evidence (5 systematic reviews, 13 RCTs); with the limitation of no direct comparative studies, sample size-weighted mean annual failure rates of class II restorations varied between 1.2 (bulk-fill composite) and 3.8% (ceramic). Based on one RCT, class II composite restorations may show a higher risk of failure compared with amalgam.
CONCLUSIONS
Proximal caries lesions can be managed successfully with non-operative, micro-invasive and restorative treatment according to lesion stage and caries activity.
CLINICAL RELEVANCE
Proximal caries treatment options like non-operative, micro-invasive and restorative care should be considered individually.
Topics: Adolescent; Adult; Humans; Biofilms; Consensus; Dental Caries; Dental Materials; Dental Restoration, Permanent; Fluorides; Randomized Controlled Trials as Topic
PubMed: 32306093
DOI: 10.1007/s00784-020-03201-y -
The Cochrane Database of Systematic... Feb 2014Composite filling materials have been increasingly used for the restoration of posterior teeth in recent years as a tooth-coloured alternative to amalgam. As with any... (Review)
Review
BACKGROUND
Composite filling materials have been increasingly used for the restoration of posterior teeth in recent years as a tooth-coloured alternative to amalgam. As with any filling material composites have a finite life-span. Traditionally, replacement was the ideal approach to treat defective composite restorations, however, repairing composites offers an alternative more conservative approach to the tooth structure where restorations are partly still serviceable. Repairing the restoration has the potential of taking less time and may sometimes be performed without the use of local anaesthesia hence it may be less distressing for a patient when compared with replacement.
OBJECTIVES
To evaluate the effects of replacing (with resin composite) versus repair (with resin composite) in the management of defective resin composite dental restorations in permanent molar and premolar teeth.
SEARCH METHODS
For the identification of studies relevant to this review we searched the Cochrane Oral Health Group's Trials Register (to 24 July 2013); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 6); MEDLINE via OVID (1946 to 24 July 2013); EMBASE via OVID (1980 to 24 July 2013); BIOSIS via Web of Knowledge (1969 to 24 July 2013); Web of Science (1945 to 24 July 2013); and OpenGrey (to 24 July 2013). Researchers, experts and organisations known to be involved in this field were contacted in order to trace unpublished or ongoing studies. No restrictions were placed on the language or date of publication when searching the electronic databases.
SELECTION CRITERIA
Trials were selected if they met the following criteria: randomised controlled trial (including split-mouth studies), involving replacement and repair of resin composite restorations in adults with a defective molar restoration in a permanent molar or premolar teeth.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed titles and abstracts for each article identified by the searches in order to decide whether the article was likely to be relevant. Full papers were obtained for relevant articles and both review authors studied these. The Cochrane Collaboration statistical guidelines were to be followed for data synthesis.
MAIN RESULTS
The search strategy retrieved 298 potentially eligible studies, after de-duplication. After examination of the titles and abstracts, full texts of potentially relevant studies were retrieved but none of the retrieved studies met the inclusion criteria of the review.
AUTHORS' CONCLUSIONS
There are no published randomised controlled trials relevant to this review question. There is therefore a need for methodologically sound randomised controlled trials that are reported according to the Consolidated Standards of Reporting Trials (CONSORT) statement (www.consort-statement.org/). Further research also needs to explore qualitatively the views of patients on repairing versus replacement and investigate themes around pain, anxiety and distress, time and costs.
Topics: Adult; Composite Resins; Dental Prosthesis Repair; Dental Restoration Failure; Dental Restoration, Permanent; Humans; Retreatment
PubMed: 24510679
DOI: 10.1002/14651858.CD005971.pub3 -
Clinical Oral Investigations May 2014This study systematically reviewed randomized clinical trials (RCTs) investigating the effectiveness of primary molar pulpotomies with mineral trioxide aggregate (MTA)... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
This study systematically reviewed randomized clinical trials (RCTs) investigating the effectiveness of primary molar pulpotomies with mineral trioxide aggregate (MTA) and formocresol. The study also aimed to assess the possible association of reported prognostic factors on the success rate and relative risk using meta-regression analysis.
MATERIALS AND METHODS
A comprehensive literature search using Medline, EMBASE, and Cochrane Central databases up to March 2013 was conducted. After scoring and data extraction of qualified trials (n = 19, representing 1,585 patients), meta-analyses were performed using Mantel-Haenszel model and inverse variance-weighted method.
RESULTS
The results revealed that MTA is more effective than formocresol in primary molars pulpotomy, resulting in a lower failure rate with a relative risk of 0.26 (CI, 0.13-0.49), 0.37 (CI, 0.19-0.70), and 0.41 (CI, 0.25-0.68) for 6-, 12-, and 24-month follow-ups (test for statistical heterogeneity: p = 0.99, p = 0.98, and p = 0.23), respectively. Compared to amalgam restoration, success rate was significantly greater with SS crown (P < 0.05); however, no evidence for association between other reported prognostic factors such as selection of first/second molar, upper/lower jaw, gender, and various follow-up times with treatment success was observed.
CONCLUSIONS
Based on the quality, homogeneity, and sufficient number of included RCTs, primary molar pulpotomy with MTA can produce a higher success rate in comparison with formocresol.
CLINICAL RELEVANCE
When compared with formocresol, MTA pulpotomy is superior in treating primary molars.
Topics: Aluminum Compounds; Calcium Compounds; Drug Combinations; Formocresols; Humans; Oxides; Pulpotomy; Randomized Controlled Trials as Topic; Silicates
PubMed: 24452827
DOI: 10.1007/s00784-014-1189-2 -
The Cochrane Database of Systematic... Feb 2010Amalgam is a common filling material for posterior teeth, as with any restoration amalgams have a finite life-span. Traditionally replacement was the ideal approach to... (Review)
Review
BACKGROUND
Amalgam is a common filling material for posterior teeth, as with any restoration amalgams have a finite life-span. Traditionally replacement was the ideal approach to treat defective amalgam restorations, however, repair offers an alternative more conservative approach where restorations are only partially defective. Repairing a restoration has the potential of taking less time and may sometimes be performed without the use of local anaesthesia hence it may be less distressing for a patient when compared with replacement.
OBJECTIVES
To evaluate the effectiveness of replacement (with amalgam) versus repair (with amalgam) in the management of defective amalgam dental restorations in permanent molar and premolar teeth.
SEARCH STRATEGY
For the identification of studies relevant to this review we searched the Cochrane Oral Health Group Trials Register (to 23rd September 2009); CENTRAL (The Cochrane Library 2009, Issue 4); MEDLINE (1950 to 23rd September 2009); EMBASE (1980 to 23rd September 2009); ISI Web of Science (SCIE, SSCI) (1981 to 22nd December 2009); ISI Web of Science Conference Proceedings (1990 to 22nd December 2009); BIOSIS (1985 to 22nd December 2009); and OpenSIGLE (1980 to 2005). Researchers, experts and organisations known to be involved in this field were contacted in order to trace unpublished or ongoing studies. There were no language limitations.
SELECTION CRITERIA
Trials were selected if they met the following criteria: randomised or quasi-randomised controlled trial, involving replacement and repair of amalgam restorations.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed titles and abstracts for each article identified by the searches in order to decide whether the article was likely to be relevant. Full papers were obtained for relevant articles and both review authors studied these. The Cochrane Collaboration statistical guidelines were to be followed for data synthesis.
MAIN RESULTS
The search strategy retrieved 145 potentially eligible studies, after de-duplication and examination of the titles and abstracts all but three studies were deemed irrelevant. After further analysis of the full texts of the three studies identified, none of the retrieved studies met the inclusion criteria and all were excluded from this review.
AUTHORS' CONCLUSIONS
There are no published randomised controlled clinical trials relevant to this review question. There is therefore a need for methodologically sound randomised controlled clinical trials that are reported according to the Consolidated Standards of Reporting Trials (CONSORT) statement (www.consort-statement.org/). Further research also needs to explore qualitatively the views of patients on repairing versus replacement and investigate themes around pain, distress and anxiety, time and costs.
Topics: Adult; Dental Amalgam; Dental Restoration Failure; Dental Restoration, Permanent; Humans; Retreatment
PubMed: 20166077
DOI: 10.1002/14651858.CD005970.pub2 -
Clinical Oral Investigations Jun 2010The aim was to report on the longevity of restorations placed using the atraumatic restorative treatment (ART) approach compared with that of equivalent placed amalgam... (Comparative Study)
Comparative Study Meta-Analysis Review
UNLABELLED
The aim was to report on the longevity of restorations placed using the atraumatic restorative treatment (ART) approach compared with that of equivalent placed amalgam restorations. Five databases were systematically searched for articles up to 16 March 2009.
INCLUSION CRITERIA
(1) titles/abstracts relevant to the topic; (2) published in English; (3) reporting on 2-arm longitudinal in vivo trials; (4) minimum follow-up period of 12 months.
EXCLUSION CRITERIA
(1) insufficient random or quasi-random allocation of study subjects; (2) not all entered subjects accounted for at trial conclusion; (3) subjects of both groups not followed up in the same way. Fourteen from the initial search of 164 articles complied with these criteria and were selected for review. From these, seven were rejected and seven articles reporting on 27 separate datasets, accepted. Only identified homogeneous datasets were combined for meta-analysis. From the 27 separate computable dichotomous datasets, four yielded a statistically significant improvement of longevity of ART versus amalgam restorations: posterior class V, 28% over 6.3 years; posterior class I, 6% after 2.3 years and 9% after 4.3 years; posterior class II, 61% after 2.3 years. Studies investigating restorations placed in the primary dentition showed no significant differences between the groups after 12 and 24 months. In the permanent dentition, the longevity of ART restorations is equal to or greater than that of equivalent amalgam restorations for up to 6.3 years and is site-dependent. No difference was observed in primary teeth. More trials are needed in order to confirm these results.
Topics: Dental Amalgam; Dental Atraumatic Restorative Treatment; Dental Restoration, Permanent; Follow-Up Studies; Humans; Longitudinal Studies; Randomized Controlled Trials as Topic; Time Factors; Tooth, Deciduous
PubMed: 19688227
DOI: 10.1007/s00784-009-0335-8 -
The Cochrane Database of Systematic... Mar 2014Amalgam has been the traditional material for filling cavities in posterior teeth for the last 150 years and, due to its effectiveness and cost, amalgam is still the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Amalgam has been the traditional material for filling cavities in posterior teeth for the last 150 years and, due to its effectiveness and cost, amalgam is still the restorative material of choice in certain parts of the world. In recent times, however, there have been concerns over the use of amalgam restorations (fillings), relating to the mercury release in the body and the environmental impact following its disposal. Resin composites have become an esthetic alternative to amalgam restorations and there has been a remarkable improvement of its mechanical properties to restore posterior teeth.There is need to review new evidence comparing the effectiveness of both restorations.
OBJECTIVES
To examine the effects of direct composite resin fillings versus amalgam fillings for permanent posterior teeth, primarily on restoration failure.
SEARCH METHODS
We searched the Cochrane Oral Health Group's Trials Register (to 22 October 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 9), MEDLINE via OVID (1946 to 22 October 2013), EMBASE via OVID (1980 to 22 October 2013), and LILACs via BIREME Virtual Health Library (1980 to 22 October 2013). We applied no restrictions on language or date of publication when searching the electronic databases. We contacted manufacturers of dental materials to obtain any unpublished studies.
SELECTION CRITERIA
Randomized controlled trials comparing dental resin composites with dental amalgams in permanent posterior teeth. We excluded studies having a follow-up period of less than three years.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by The Cochrane Collaboration.
MAIN RESULTS
Of the 2205 retrieved references, we included seven trials (10 articles) in the systematic review. Two trials were parallel group studies involving 1645 composite restorations and 1365 amalgam restorations (921 children) in the analysis. The other five trials were split-mouth studies involving 1620 composite restorations and 570 amalgam restorations in an unclear number of children. Due to major problems with the reporting of the data for the five split-mouth trials, the primary analysis is based on the two parallel group trials. We judged all seven trials to be at high risk of bias and we analyzed 3265 composite restorations and 1935 amalgam restorations.The parallel group trials indicated that resin restorations had a significantly higher risk of failure than amalgam restorations (risk ratio (RR) 1.89, 95% confidence interval (CI) 1.52 to 2.35, P value < 0.001 (fixed-effect model) (low-quality evidence)) and increased risk of secondary caries (RR 2.14, 95% CI 1.67 to 2.74, P value < 0.001 (low-quality evidence)) but no evidence of an increased risk of restoration fracture (RR 0.87, 95% CI 0.46 to 1.64, P value = 0.66 (moderate-quality evidence)). The results from the split-mouth trials were consistent with those of the parallel group trials.Adverse effects of dental restorations were reported in two trials. The outcomes considered were neurobehavioral function, renal function, psychosocial function, and physical development. The investigators found no difference in adverse effects between composite and amalgam restorations. However, the results should be interpreted with caution as none of the outcomes were reported in more than one trial.
AUTHORS' CONCLUSIONS
There is low-quality evidence to suggest that resin composites lead to higher failure rates and risk of secondary caries than amalgam restorations. This review reinforces the benefit of amalgam restorations and the results are particularly useful in parts of the world where amalgam is still the material of choice to restore posterior teeth with proximal caries. Though the review found insufficient evidence to support or refute any adverse effects amalgam may have on patients, new research is unlikely to change opinion on its safety and due to the decision for a global phase-down of amalgam (Minamata Convention on Mercury) general opinion on its safety is unlikely to change.
Topics: Acrylic Resins; Child; Composite Resins; Dental Amalgam; Dental Caries; Dental Restoration Failure; Dental Restoration, Permanent; Dentition, Permanent; Humans; Molar; Polyurethanes; Randomized Controlled Trials as Topic
PubMed: 24683067
DOI: 10.1002/14651858.CD005620.pub2 -
International Journal of Dentistry 2020A systematic literature search was conducted in four electronic databases (Ovid via PubMed, Web of Science, Scopus, and CENTRAL) including all available randomised... (Review)
Review
METHODS
A systematic literature search was conducted in four electronic databases (Ovid via PubMed, Web of Science, Scopus, and CENTRAL) including all available randomised controlled trials published in the last 15 years comparing the use of dental amalgam with composite resins in humans with a follow-up period of at least one year. The primary outcome was the Hg concentration in biological fluids (urine, hair, blood, and saliva) with the aim of assessing their reliability as biomarkers of Hg exposure. The risk of bias was assessed through the Cochrane Collaboration tool and the overall quality of evidence through the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system. The results of the meta-analysis were expressed using a random-effects model, and their power was assessed through the trial sequential analysis (TSA).
RESULTS
From the initial 2555 results, only 6 publications were included in the review: five were considered as having high risk of bias, whereas one as having moderate risk. Only two articles were eligible for quantitative analysis. The meta-analysis gathered data from 859 patients but was nevertheless not significant ( = 0.12). The TSA confirmed this evidence revealing that it was due to a lack of statistical power since the required information size (RIS) threshold is not reached.
CONCLUSIONS
The existing evidence revealed that there are not enough data to support the hypothesis that restorations with dental amalgam can cause nephrotoxicity when compared with composite resins restorations.
PubMed: 32849873
DOI: 10.1155/2020/8857238