-
The Cochrane Database of Systematic... Oct 2009Dental caries (tooth decay) is one of the commonest diseases which afflicts mankind, and has been estimated to affect up to 80% of people in high-income countries.... (Review)
Review
BACKGROUND
Dental caries (tooth decay) is one of the commonest diseases which afflicts mankind, and has been estimated to affect up to 80% of people in high-income countries. Caries adversely affects and progressively destroys the tissues of the tooth, including the dental pulp (nerve), leaving teeth unsightly, weakened and with impaired function. The treatment of lesions of dental caries, which are progressing through dentine and have caused the formation of a cavity, involves the provision of dental restorations (fillings).
OBJECTIVES
To assess the effects of adhesive bonding on the in-service performance and longevity of restorations of dental amalgam.
SEARCH STRATEGY
Databases searched July 2009: the Cochrane Oral Health Group's Trials Register; CENTRAL (The Cochrane Library 2009, Issue 3); MEDLINE (1950 to July 2009); and EMBASE (1980 to July 2009).
SELECTION CRITERIA
Randomised controlled trials comparing adhesively bonded versus traditional non-bonded amalgam restorations in conventional preparations utilising deliberate retention, in adults with permanent molar and premolar teeth suitable for Class I and II amalgam restorations only.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened papers, extracted trial details and assessed the risk of bias in the included study.
MAIN RESULTS
One trial with 31 patients who received 113 restorations was included. At 2 years only 3 out of 53 restorations in the non-bonded group were lost, which was attributed to a lack of retention, and 55 of 60 bonded restorations survived with five unaccounted for at follow-up. Post-insertion sensitivity was not significantly different (P > 0.05) at baseline or 2-year follow-up. No fractures of tooth tissue were reported and there was no significant difference between the groups or matched pairs of restorations in their marginal adaptation (P > 0.05).
AUTHORS' CONCLUSIONS
There is no evidence to either claim or refute a difference in survival between bonded and non-bonded amalgam restorations. This review only found one methodologically sound but somewhat under-reported trial. This trial did not find any significant difference in the in-service performance of moderately sized adhesively bonded amalgam restorations, in terms of their survival rate and marginal integrity, in comparison to non-bonded amalgam restorations over a 2-year period. In view of the lack of evidence on the additional benefit of adhesively bonding amalgam in comparison with non-bonded amalgam, it is important that clinicians are mindful of the additional costs that may be incurred.
Topics: Adult; Dental Amalgam; Dental Bonding; Dental Caries; Dental Restoration Failure; Dental Restoration, Permanent; Humans
PubMed: 19821423
DOI: 10.1002/14651858.CD007517.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 -
Journal of Prosthodontics : Official... Aug 2009The aim of this systematic review was to determine which dowel (post) and core system is the most successful when used in vivo to restore endodontically treated teeth. (Comparative Study)
Comparative Study Review
PURPOSE
The aim of this systematic review was to determine which dowel (post) and core system is the most successful when used in vivo to restore endodontically treated teeth.
MATERIALS AND METHODS
A MEDLINE, a Cochrane, and an EMBASE search (three specified searches) were conducted to identify randomized (RCT) and nonrandomized controlled clinical trials (CCT), cohort (CS), and case control studies (CCS) until January 2008, conducted on humans, and published in English, German, and French, relating to dowel and core systems for restoring endodontically treated teeth. Also, a hand search was conducted, along with contact with the authors when needed.
RESULTS
The MEDLINE, Cochrane, and EMBASE searches identified 997, 141, and 25 published articles, respectively. Ten articles from the MEDLINE and seven articles from the Cochrane search (that were also identified in the MEDLINE search) met the inclusion and validity assessment criteria. Six out of the ten studies were RCTs, two were CCTs, and two CSs. The RCT studies suggest that carbon fiber in resin matrix dowels are significantly better than precious alloy cast dowels (number needed to treat, NNT = 8.30). Tapered gold alloy cast dowels are better than ParaPost gold alloy cast dowels (NNT = 13.15). ParaPost prefabricated dowels are slightly better than ParaPost cast dowels (NNT = 175.4). Glass fiber dowels are significantly better than metal screw dowels (NNT = 5.46), but worse than titanium (NNT =-21.73) (moderately). Carbon fiber dowels are worse than gold alloy cast dowels (significantly) (NNT =-5.81) and than amalgam dowels (NNT =-125) (slightly). The CCT studies suggest that metal dowels are better (NNT = 21.73) but also worse than cast dowels (NNT =-33.33) depending on the remaining amount of coronal hard tissue. Quartz fiber dowels show success rates similar to and worse than glass fiber-reinforced dowels (NNT =-37.03). The results from the CS studies suggest that carbon fiber in resin matrix dowels are better (moderately) than carbon fiber + quartz and quartz fiber dowels. Titanium dowels with a composite build-up are better (moderately) than gold alloy cast dowels.
CONCLUSIONS
According to the studies of the highest levels of evidence, carbon fiber in resin matrix dowels are significantly better than precious alloy cast dowels (RCT). Glass fiber dowels are significantly better than metal screw dowels (RCT) and moderately better than quartz fiber dowels (CCT). Carbon fiber dowels are significantly worse than metal dowels (of precious alloy) (RCT). Prefabricated metal dowels are slightly better than cast dowels (RCT), but moderately worse when no collar of the dentin above the gingiva could be achieved (CCT).
Topics: Carbon; Carbon Fiber; Composite Resins; Dental Alloys; Esthetics, Dental; Evidence-Based Dentistry; Glass Ionomer Cements; Humans; Outcome Assessment, Health Care; Post and Core Technique; Root Canal Filling Materials; Root Canal Therapy
PubMed: 19500237
DOI: 10.1111/j.1532-849X.2009.00472.x -
The Cochrane Database of Systematic... Apr 2009Childhood caries (tooth decay) consists of a form of tooth decay that affects the milk teeth (also known as baby or primary teeth) of children. This may range from tooth... (Review)
Review
BACKGROUND
Childhood caries (tooth decay) consists of a form of tooth decay that affects the milk teeth (also known as baby or primary teeth) of children. This may range from tooth decay in a single tooth to rampant caries affecting all the teeth in the mouth. Primary teeth in young children are vital to their development and every effort should be made to retain these teeth for as long as is possible. Dental fillings or restorations have been used as an intervention to repair these damaged teeth. Oral health professionals need to make astute decisions about the type of restorative (filling) material they choose to best manage their patients with childhood caries. This decision is by no means an easy one as remarkable advances in dental restorative materials over the last 10 years has seen the introduction of a multitude of different filling materials claiming to provide the best performance in terms of durability, aesthetics, symptom relief, etc when placed in the mouth. This review sought to compare the different types of dental materials against each other for the same outcomes.
OBJECTIVES
The objective of this review was to compare the outcomes (including pain relief, survival and aesthetics) for restorative materials used to treat caries in the primary dentition in children. Additionally, the restoration of teeth was compared with extraction and no treatment.
SEARCH STRATEGY
Electronic searches of the following databases were undertaken: the Cochrane Oral Health Group's Trials Register (up to January 2009); CENTRAL (The Cochrane Library 2009, Issue1); MEDLINE (1966 to January 2009); EMBASE (1996 to January 2009); SIGLE (1976 to 2004); and conference proceedings on early childhood caries, restorative materials for paediatric dentistry, and material sciences conferences for dental materials used for children's dentistry (1990 to 2008). The searches attempted to identify all relevant studies irrespective of language.Additionally, the reference lists from articles of eligible papers were searched, handsearching of key journals was undertaken, and personal communication with authors and manufacturers of dental materials was initiated to increase the pool of suitable trials (both published and unpublished) for inclusion into this review.
SELECTION CRITERIA
Randomised controlled trials (RCTs) or quasi-randomised controlled trials with a minimum period of 6 months follow up were included. Both parallel group and split-mouth study designs were considered. The unit of randomisation could be the individual, group (school, school class, etc), tooth or tooth pair. Included studies had a drop-out rate of less than 30%. The eligible trials consisted of young children (children less than 12 years) with tooth decay involving at least one tooth in the primary dentition which was symptomatic or symptom free at the start of the study.
DATA COLLECTION AND ANALYSIS
Data were independently extracted, in duplicate, by two review authors. Disagreements were resolved by consultation with a third review author. Authors were contacted for missing or unclear information regarding randomisation, allocation sequence, presentation of data, etc. A quality assessment of included trials was undertaken. The Cochrane Collaboration statistical guidelines were followed for data analysis.
MAIN RESULTS
Only three studies were included in this review. The Fuks 1999 study assessed the clinical performance of aesthetic crowns versus conventional stainless steel crowns in 11 children who had at least two mandibular primary molars that required a crown restoration. The outcomes assessed at 6 months included gingival health (odds ratio (OR) 0.3; 95% confidence interval (CI) 0.01 to 8.32), restoration failure (OR 3.29; 95% CI 0.12 to 89.81), occlusion, proximal contact and marginal integrity. The odds ratios for occlusion, proximal contact and marginal integrity could not be estimated as no events were recorded at the 6-month evaluation. The Donly 1999 split-mouth study compared a resin-modified glass ionomer (Vitremer) with amalgam over a 36-month period. Forty pairs of Class II restorations were placed in 40 patients (21 males; 19 females; mean age 8 years +/- 1.17; age range 6 to 9 years). Although the study period was 3 years (36 months), only the 6- and 12-month results are reported due to the loss to follow up of patients being greater than 30% for the 24- and 36-month data. Marks 1999a recruited 30 patients (age range 4 to 9 years; mean age 6.7 years, standard deviation 2.3) with one pair of primary molars that required a Class II restoration. The materials tested were Dyract (compomer) and Tytin (amalgam). Loss to follow up at 24 and 36 months was 20% and 43% respectively. This meant that only the 24-month data were useable. For all of the outcomes compared in all three studies, there were no significant differences in clinical performance between the materials tested.No studies were found that compared restorations versus extractions or no treatment as an intervention in children with childhood caries.
AUTHORS' CONCLUSIONS
It was disappointing that only three trials that compared three different types of materials were suitable for inclusion into this review. There were no significant differences found in all three trials for all of the outcomes assessed. Well designed, randomised controlled trials comparing the different types of filling materials for similar outcomes are urgently needed in dentistry. There was insufficient evidence from the three included trials to make any recommendations about which filling material to use.
Topics: Child; Child, Preschool; Compomers; Composite Resins; Crowns; Dental Alloys; Dental Amalgam; Dental Caries; Dental Materials; Dental Restoration, Permanent; Glass Ionomer Cements; Humans; Randomized Controlled Trials as Topic; Tooth, Deciduous
PubMed: 19370602
DOI: 10.1002/14651858.CD004483.pub2 -
Journal of Dentistry Oct 2007To test the hypothesis that the placement of a crown is associated with improved (long term) survival of root canal treated teeth, using a systematic review process of... (Review)
Review
OBJECTIVES
To test the hypothesis that the placement of a crown is associated with improved (long term) survival of root canal treated teeth, using a systematic review process of clinical studies.
DATA SOURCES
Papers referring to single crowns on endodontically treated teeth were located by a MEDLINE search and hand searching. One thousand six hundred and nine references were found, and they were subjected to a systematic review procedure.
STUDY SELECTION
A three-step inclusion-exclusion procedure was applied to identify papers that represented; good scientific practice (GSP), reported results of all patients, restorations on root canal treated teeth (RCT) for more than 2 years and had sufficient data to generate life table analyses. The outcomes were 'survival of RCT restored with crowns' and 'survival of RCT with direct restorations'. Ten studies survived. These data showed an overall mean GSP of 0.605 with a 10-year survival of 81% for crowned RCT and a 10-year survival of 63% for RCT with direct restorations (resin composites, amalgam, cements).
CONCLUSION
RCTs restored with crowns show an acceptable long-term survival of 10 years, while direct restorations have a satisfactory survival only for a short period.
Topics: Acrylic Resins; Composite Resins; Crowns; Dental Amalgam; Dental Restoration Failure; Dental Restoration, Permanent; Humans; Polyurethanes; Survival Analysis; Tooth, Nonvital
PubMed: 17822823
DOI: 10.1016/j.jdent.2007.07.004 -
Clinical Oral Implants Research Jun 2007All dental biomaterials release substances into the oral environment to a varying degree. Various preclinical biocompatibility test systems have been introduced, aiming... (Review)
Review
OBJECTIVES
All dental biomaterials release substances into the oral environment to a varying degree. Various preclinical biocompatibility test systems have been introduced, aiming at an evaluation of the potential risks of dental materials. Potential pathogenic effects of released substances from dental materials have been demonstrated. For the biocompatibility of a biomaterial, it is not only important that minimal diffusable substances are released when it is in body contact--the material must also fulfill the function for which it has been designed. This is also very much dependent on the material properties and its handling properties. The aim of this review was to generate an overview of the present status concerning adverse reactions among patients and personnel.
MATERIALS AND METHODS
A systematic review was performed using a defined search strategy in order to evaluate all MEDLINE-literature published between 1996 and 2006.
RESULTS
The compilation of the literature available has revealed that the majority of studies have been carried out on patients compared with personnel. Adverse reactions towards dental materials do occur, but the prevalence and incidence are difficult to obtain. The results were essentially based on cohort studies. Clinical trials, especially randomized-controlled trials, are in the minority of all studies investigated, with the exception of composite and bonding studies, where clinical trials, but not randomized-controlled trials, represent the majority of studies. Patients and personnel were treated separately in the manuscript. Amalgam studies show the lowest degree of verified material-related diagnosis. Even if objective symptoms related to adverse reactions with polymer resin-based materials have been reported, postoperative sensitivity dominates reports concerning composites/bondings. Verified occupational effects among dental personnel show a low frequency of allergy/toxic reactions. Irritative hand eczema seemed to be more common than in the general population.
CONCLUSIONS
Patient- and personnel-related studies are of variable quality and can be improved. There is a need for a better description of the content of materials. A registry for adverse effects of dental materials would be useful to detect the occurrence of low-incidence events.
Topics: Biocompatible Materials; Dental Materials; Dentistry; Humans; Hypersensitivity; Mouth Diseases; Occupational Diseases; Workforce
PubMed: 17594385
DOI: 10.1111/j.1600-0501.2007.01481.x -
Journal of Public Health Dentistry 2007Amalgam restorations have long been controversial due to their mercury content. Allegations that the mercury may be linked to nervous disorders such as Alzheimer's,... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Amalgam restorations have long been controversial due to their mercury content. Allegations that the mercury may be linked to nervous disorders such as Alzheimer's, chronic fatigue syndrome, and multiple sclerosis (MS) have fueled the calls for the removal of amalgam restorations from dentists' armamentarium. To explore and quantify the association between amalgam restorations and MS we have conducted a systematic review and meta-analysis of the literature.
METHODS
A systematic search in Medline (from 1966 to April 2006), EMBASE (2006, Week 16), and the Cochrane library (Issue 2, 2006) for English-language articles meeting specific definitions of MS and amalgam exposure was conducted. Studies were also identified using the references of retrieved articles. Studies were independently reviewed by two authors and disagreements were resolved by consensus. Studies were selected based on an a priori of defined criteria. Odds ratios (ORs) or relative risks were pooled using the random effects model. Heterogeneity was assessed using Q statistics.
RESULTS
The pooled OR for the risk of MS among amalgam users was consistent, with a slight, nonstatistically significant increase between amalgam use and risk of MS.
CONCLUSION
Future studies that take into consideration the amalgam restoration size and surface area along with the duration of exposure are needed in order to definitively rule out any link between amalgam and MS.
Topics: Dental Amalgam; Humans; Mercury; Multiple Sclerosis; Odds Ratio; Risk Assessment
PubMed: 17436982
DOI: 10.1111/j.1752-7325.2007.00011.x -
European Archives of Paediatric... Mar 2007To review the available literature on the durability of amalgam when used to restore interproximal (class II) cavities in primary molars. (Review)
Review
AIM
To review the available literature on the durability of amalgam when used to restore interproximal (class II) cavities in primary molars.
METHODS
The literature was searched using OVID Medline and EMBASE from 1966 to 2006. The search plan of the electronic databases included: "dental amalgam or amalgam or alloy" and "deciduous or primary or milk or first or baby or natal" or "tooth or teeth or dentition" and "permanent restorations or permanent fillings". Relevant prospective clinical studies were reviewed by 2 reviewers against a set of defined criteria. Papers were graded according to the number of criteria met as A = >90%, B1 = 75%, B2 = 50% and C = <50%.
RESULTS
No study achieved a Grade A; four studies rated Grade B1 and thirteen B2. Seven studies were rated Grade C. A wide range of failure rates for amalgam were reported from 0 - 58%. However, in the context of a controlled clinical environment in a developed country the failure rate varied between 0 and 22%.
CONCLUSION
Amalgam remains an appropriate choice of material for the restoration of the primary dentition. However, factors other than durability are increasingly influencing its use in clinical practice.
Topics: Dental Amalgam; Dental Cavity Preparation; Dental Restoration Failure; Dental Restoration Wear; Dental Restoration, Permanent; Humans; Molar; Survival Analysis; Tooth, Deciduous
PubMed: 17394885
DOI: 10.1007/BF03262564 -
Journal of Endodontics May 2005The purpose of this review was two-fold: (a) to determine which retrograde obturation material(s) best prevents dye/ink penetration in vitro; and (b) to determine... (Comparative Study)
Comparative Study Review
The purpose of this review was two-fold: (a) to determine which retrograde obturation material(s) best prevents dye/ink penetration in vitro; and (b) to determine whether in vitro results agree with in vivo results. A MEDLINE search was conducted to identify in vitro studies published between January 1966 and October, week 4, 2003, conducted on human teeth, and published in English, German, or French language, testing the resistance to retrograde penetration of retrograde filling materials. The MEDLINE search identified 278 published articles. Of those, 115 studies examined the resistance to penetration of various retrograde filling materials, in vitro. Thirty-four studies met all the inclusion and validity criteria. The results indicate that, beyond 10 days in vitro, the most effective retrofilling materials, when measured by dye/ink penetration are: composites>glass ionomer cement>amalgam>orthograde gutta-percha>EBA. The results of these in vitro studies are not congruent with in vivo study results, suggesting a need to re-evaluate the clinical validity and importance of in vitro studies.
Topics: Aluminum Compounds; Calcium Compounds; Composite Resins; Dental Amalgam; Dental Leakage; Dentin-Bonding Agents; Drug Combinations; Glass Ionomer Cements; Gutta-Percha; Humans; Linear Models; Methylmethacrylates; Oxides; Retrograde Obturation; Root Canal Filling Materials; Silicates; Zinc Oxide-Eugenol Cement
PubMed: 15851926
DOI: 10.1097/01.don.0000145034.10218.3f -
Oral Surgery, Oral Medicine, Oral... Nov 2004We sought to systematically review the literature related to oral lichenoid lesions (OLLs) and amalgam restorations. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
We sought to systematically review the literature related to oral lichenoid lesions (OLLs) and amalgam restorations.
STUDY DESIGN
Cohort and case-controlled studies (no randomized controlled trials or controlled clinical trials available) were reviewed with respect to inclusion criteria and data on patients with OLLs, treatment interventions, and the measurement of outcomes.
RESULTS
Fourteen cohort and 5 case-controlled trials met the criteria. The study population consisted of 1158 patients (27% male and 73% female; age range, 23-79 years). From 16% to 91% of patients had positive patch test results for at least 1 mercury compound. Of 1158 patients, 636 had to have their restorations replaced. The follow-up period ranged from 2 months to 9 1/2 years. Complete healing ranged from 37.5% to 100%. The greatest improvements were seen in lesions in close contact with amalgam.
CONCLUSIONS
Protocols must be standardized to obtain valid results. The replacement of amalgam restorations can result in the resolution or improvement of OLLs. Patch testing seems to be of limited value. The topographic relationship between an OLL and an amalgam restoration is a useful--but not conclusive--marker.
Topics: Adult; Aged; Case-Control Studies; Cohort Studies; Dental Amalgam; Dental Restoration, Permanent; Dermatitis, Contact; Female; Follow-Up Studies; Humans; Lichen Planus, Oral; Lichenoid Eruptions; Male; Mercury Compounds; Middle Aged; Patch Tests; Retreatment; Treatment Outcome; Wound Healing
PubMed: 15529127
DOI: 10.1016/j.tripleo.2003.12.027