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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 We contacted manufacturers of dental materials to obtain any unpublished studies.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 -
The Cochrane Database of Systematic... Feb 2014Amalgam 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. Repair of amalgam restorations is often more conservative of the tooth structure than replacement.
OBJECTIVES
To evaluate the effects of replacing (with amalgam) versus repair (with amalgam) in the management of defective amalgam 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 5 August 2013); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 7); MEDLINE via OVID (1946 to 5 August 2013); EMBASE via OVID (1980 to 5 August 2013); BIOSIS via Web of Knowledge (1969 to 5 August 2013); Web of Science (1945 to 5 August 2013) and OpenGrey (to 5 August 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 amalgam restorations in adults with a defective restoration in a molar or premolar tooth/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 201 potentially eligible studies after de-duplication. After examination of the titles and abstracts, full texts of the relevant studies were retrieved but none of these 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, distress and anxiety, time and costs.
Topics: Adult; Dental Amalgam; Dental Restoration Failure; Dental Restoration, Permanent; Humans; Retreatment
PubMed: 24510713
DOI: 10.1002/14651858.CD005970.pub3 -
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 -
SADJ : Journal of the South African... Aug 2012Atraumatic Restorative Treatment (ART) involves using only hand instruments for removing carious tooth tissue and then restoring the resulting cavity with an adhesive... (Comparative Study)
Comparative Study Review
INTRODUCTION
Atraumatic Restorative Treatment (ART) involves using only hand instruments for removing carious tooth tissue and then restoring the resulting cavity with an adhesive restorative material.
OBJECTIVE
To answer the question as to whether, in patients with carious cavities of any class in primary and permanent teeth, ART restorations with high-viscosity glass-ionomer cement (GIC) have a higher failure rate than amalgam restorations placed after drilling, in tooth cavities of the same size, dentition and follow-up period.
METHODS
Thirteen databases were searched for relevant trials up to January 2012. Hand-searching was performed for non indexed journals. References of included trials were checked. Prospective, clinical controlled trials with a followup period of at least one year were selected. The investi gated outcome was restoration failure. Meta-analysis was conducted and internal trial validity was assessed in-depth.
RESULTS
Twenty trials were accepted for review. The majority of the results show no differences between the types of intervention. The current evidence indicates that the failure rate of high-viscosity GIG/ART restorations is not higher than, but is similar to that of conventional amalgam fillings after periods longer than six years. There is a risk that these results are affected by bias and confirmation by further trials is recommended.
Topics: Bias; Dental Amalgam; Dental Atraumatic Restorative Treatment; Dental Restoration Failure; Dental Restoration, Permanent; Glass Ionomer Cements; Humans; Viscosity
PubMed: 23951787
DOI: No ID Found -
International Journal of Paediatric... Nov 2013Atraumatic restorative treatment (ART) has demonstrated good longevity when used for single-surface restorations, but lower success rates are reported for... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Atraumatic restorative treatment (ART) has demonstrated good longevity when used for single-surface restorations, but lower success rates are reported for occlusoproximal surfaces.
AIM
This systematic review and meta-analysis aimed to verify the pooled success rate of occlusoproximal ART restorations in primary teeth considering the outcomes: longevity, pulp damage, or caries lesion progression.
DESIGN
Literature searching was carried out on the studies reporting clinical trials indexed in PubMed and in English language, comprising the outcomes. A meta-analysis was undertaken considering the results from reviewed studies.
RESULTS
An initial search resulted in 126 articles, and three of them were finally selected. The main reasons for excluding articles were the absence of control group, as amalgam, composite resin, or compomer restorations to be compared with ART (hand excavation + high-viscous GIC). The pooled estimate (odds ratio; 95% confidence interval) for ART approach success was 1.04 (0.65-1.66).
CONCLUSION
Atraumatic restorative treatment restorations performed with high-viscous GIC present similar survival/success rates to conventional approach using composite resin or amalgam for occlusoproximal restorations in primary teeth and can be suggested as a good option for occlusoproximal cavities in primary molars. In addition, further randomized controlled clinical investigations concerning occlusoproximal restorations in primary teeth are still necessary.
Topics: Child; Dental Atraumatic Restorative Treatment; Dental Caries; Humans; Tooth, Deciduous
PubMed: 23190278
DOI: 10.1111/ipd.12013 -
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 -
European Archives of Paediatric... Jun 2010A large number of studies concerning the use of compomers in class II cavities in the primary dentition already exist, but the variety of the research perspectives is... (Review)
Review
BACKGROUND
A large number of studies concerning the use of compomers in class II cavities in the primary dentition already exist, but the variety of the research perspectives is even bigger.
AIM
This study therefore intends to abridge and evaluate the existing research through a systematic literature review.
METHODS
In order to gather relevant articles an extended literature research was carried out. The criteria for the evaluation of the resulting articles were based on the article of Kilpatrick and Neumann [2007].
RESULTS
According to the subject of the research, the articles were divided into the following groups: PAM-C; PAM-C and amalgam; PAM-C and GIC; PAM-C and hybrid composites; PAM-C and pre-treatment.
CONCLUSIONS
The findings lead to the conclusion that PAM-C can be an alternative to other restorative materials in the primary dentition in class II cavities, except in the case of teeth with pulpectomies or pulpotomies. The placement of compomers takes longer than placing amalgam, but the procedure consists of fewer steps compared to composites. However, patient-compliance remains essential.
Topics: Child; Child, Preschool; Compomers; Dental Care for Children; Dental Caries; Dental Restoration, Permanent; Humans; Outcome Assessment, Health Care; Tooth, Deciduous
PubMed: 20507807
DOI: 10.1007/BF03262725 -
The Cochrane Database of Systematic... Feb 2010Composite 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 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 effectiveness of replacement (with resin composite) versus repair (with resin composite) in the management of defective resin composite 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 resin composite 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 279 potentially eligible studies, after de-duplication and examination of the titles and abstracts all but four studies were deemed irrelevant. After further analysis of the full texts of the four 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, anxiety and distress, time and costs.
Topics: Adult; Composite Resins; Dental Restoration Failure; Dental Restoration, Permanent; Humans; Retreatment
PubMed: 20166078
DOI: 10.1002/14651858.CD005971.pub2 -
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