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The Cochrane Database of Systematic... Jul 2017Dental sealants were introduced in the 1960s to help prevent dental caries, mainly in the pits and fissures of occlusal tooth surfaces. Sealants act to prevent bacteria... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Dental sealants were introduced in the 1960s to help prevent dental caries, mainly in the pits and fissures of occlusal tooth surfaces. Sealants act to prevent bacteria growth that can lead to dental decay. Evidence suggests that fissure sealants are effective in preventing caries in children and adolescents compared to no sealants. Effectiveness may, however, be related to caries incidence level of the population. This is an update of a review published in 2004, 2008 and 2013.
OBJECTIVES
To compare the effects of different types of fissure sealants in preventing caries in occlusal surfaces of permanent teeth in children and adolescents.
SEARCH METHODS
Cochrane Oral Health's Information Specialist searched: Cochrane Oral Health's Trials Register (to 3 August 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2016, Issue 7), MEDLINE Ovid (1946 to 3 August 2016), and Embase Ovid (1980 to 3 August 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials to 3 August 2016. No restrictions were placed on language or date of publication.
SELECTION CRITERIA
Randomised controlled trials (RCTs) comparing sealants with no sealant or a different type of sealant material for preventing caries of occlusal surfaces of premolar or molar teeth in children and adolescents aged up to 20 years. Studies required at least 12 months follow-up. We excluded studies that compared compomers to resins/composites.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened search results, extracted data and assessed risk of bias of included studies. We presented outcomes for caries or no caries on occlusal surfaces of permanent molar teeth as odds ratio (OR) or risk ratio (RR). We used mean difference (MD) for mean caries increment. All measures were presented with 95% confidence intervals (CI). We conducted meta-analyses using a random-effects model for comparisons where there were more than three trials; otherwise we used the fixed-effect model. We used GRADE methods to assess evidence quality.
MAIN RESULTS
We included 38 trials that involved a total of 7924 children; seven trials were new for this update (1693 participants). Fifteen trials evaluated the effects of resin-based sealant versus no sealant (3620 participants in 14 studies plus 575 tooth pairs in one study); three trials with evaluated glass ionomer sealant versus no sealant (905 participants); and 24 trials evaluated one type of sealant versus another (4146 participants). Children were aged from 5 to 16 years. Trials rarely reported background exposure to fluoride of trial participants or baseline caries prevalence. Resin-based sealant versus no sealant: second-, third- and fourth-generation resin-based sealants prevented caries in first permanent molars in children aged 5 to 10 years (at 24 months follow-up: OR 0.12, 95% CI 0.08 to 0.19, 7 trials (5 published in the 1970s; 2 in the 2010s), 1548 children randomised, 1322 children evaluated; moderate-quality evidence). If we were to assume that 16% of the control tooth surfaces were decayed during 24 months of follow-up (160 carious teeth per 1000), then applying a resin-based sealant would reduce the proportion of carious surfaces to 5.2% (95% CI 3.13% to 7.37%). Similarly, assuming that 40% of control tooth surfaces were decayed (400 carious teeth per 1000), then applying a resin-based sealant would reduce the proportion of carious surfaces to 6.25% (95% CI 3.84% to 9.63%). If 70% of control tooth surfaces were decayed, there would be 19% decayed surfaces in the sealant group (95% CI 12.3% to 27.2%). This caries-preventive effect was maintained at longer follow-up but evidence quality and quantity was reduced (e.g. at 48 to 54 months of follow-up: OR 0.21, 95% CI 0.16 to 0.28, 4 trials, 482 children evaluated; RR 0.24, 95% CI 0.12 to 0.45, 203 children evaluated). Although studies were generally well conducted, we assessed blinding of outcome assessment for caries at high risk of bias for all trials (blinding of outcome assessment is not possible in sealant studies because outcome assessors can see and identify sealant). Glass ionomer sealant versus no sealant: was evaluated by three studies. Results at 24 months were inconclusive (very low-quality evidence). One sealant versus another sealant: the relative effectiveness of different types of sealants is unknown (very low-quality evidence). We included 24 trials that directly compared two different sealant materials. Comparisons varied in terms of types of sealant assessed, outcome measures chosen and duration of follow-up. Adverse events: only four trials assessed adverse events. No adverse events were reported.
AUTHORS' CONCLUSIONS
Resin-based sealants applied on occlusal surfaces of permanent molars are effective for preventing caries in children and adolescents. Our review found moderate-quality evidence that resin-based sealants reduced caries by between 11% and 51% compared to no sealant, when measured at 24 months. Similar benefit was seen at timepoints up to 48 months; after longer follow-up, the quantity and quality of evidence was reduced. There was insufficient evidence to judge the effectiveness of glass ionomer sealant or the relative effectiveness of different types of sealants. Information on adverse effects was limited but none occurred where this was reported. Further research with long follow-up is needed.
Topics: Acrylic Resins; Adolescent; Child; Child, Preschool; Dental Caries; Dental Occlusion; Dentition, Permanent; Humans; Molar; Pit and Fissure Sealants; Randomized Controlled Trials as Topic; Silicon Dioxide
PubMed: 28759120
DOI: 10.1002/14651858.CD001830.pub5 -
The Cochrane Database of Systematic... Oct 2016Childhood 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 METHODS
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: 27748505
DOI: 10.1002/14651858.CD004483.pub3 -
Medicina Oral, Patologia Oral Y Cirugia... Sep 2016Rare diseases (RD) are those that present a lower prevalence than 5 cases per 10.000 population. The main objective of this review was to study the effect on oral health... (Review)
Review
BACKGROUND
Rare diseases (RD) are those that present a lower prevalence than 5 cases per 10.000 population. The main objective of this review was to study the effect on oral health in rare diseases, while the secondary objective of the study is theme upgrade.
MATERIAL AND METHODS
Comparative observational case-control studies were analysed and a systematic review was conducted in PubMed. Each rare disease listed on the statistical data record of the Health Portal of the Ministry of Equality, Health and Social Policies Board of Andalusia was associated with "oral health". The variables studied included dental, oral mucosa and occlusion alterations, oral pathologies (caries, periodontal disease) and other alterations (mouth breathing, parafunctional habits, etc). A bias analysis of the variable caries was conducted.
RESULTS
Six RD were selected through our inclusion and exclusion criteria (hypogammaglobulinemia, Rett syndrome, Marfan syndrome, Prader-Willi syndrome, cystic fibrosis and Cri du chat syndrome) in a total of 8 publications, of which four trials were classified as high risk of bias and one of them as medium risk. There were not trials with low risk of bias.
CONCLUSIONS
The main statistically significant differences found by Syndrome compared to a control group were in Hypogammaglobulinemia with a greater tendency to enamel hypoplasia and dry mouth. The Rett syndrome had, as well, a greater tendency to an anterior open bite, ogival palate, bruxism, mouth breathing and tongue thrusting. Prader-Willi syndrome had a tendency of dental erosion, and Cri du chat syndrome showed a higher association to Tannerella forsythia.
Topics: Bruxism; Cri-du-Chat Syndrome; Dental Caries; Humans; Oral Health; Rare Diseases
PubMed: 27475682
DOI: 10.4317/medoral.20972 -
Journal of Periodontology Jun 2016Multiple variables have been shown to affect early marginal bone loss (MBL). Among them, the location of the microgap with respect to the alveolar bone crest, occlusion,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Multiple variables have been shown to affect early marginal bone loss (MBL). Among them, the location of the microgap with respect to the alveolar bone crest, occlusion, and use of a polished collar have traditionally been investigated as major contributory factors for this early remodeling. Recently, soft tissue thickness has also been investigated as a possible factor influencing this phenomenon. Hence, this study aims to further evaluate the influence of soft tissue thickness on early MBL around dental implants.
METHODS
Electronic and manual literature searches were performed by two independent reviewers in several databases, including Medline, EMBASE, and Cochrane Oral Health Group Trials Register, for articles up to May 2015 reporting soft tissue thickness at time of implant placement and MBL with ≥12-month follow-up. In addition, random effects meta-analyses of selected studies were applied to analyze the weighted mean difference (WMD) of MBL between groups of thick and thin peri-implant soft tissue. Metaregression was conducted to investigate any potential influences of confounding factors, i.e., platform switching design, cement-/screw-retained restoration, and flapped/flapless surgical techniques.
RESULTS
Eight articles were included in the systematic review, and five were included in the quantitative synthesis and meta-analyzed to examine the influence of tissue thickness on early MBL. Meta-analysis for the comparison of MBL among selected studies showed a WMD of -0.80 mm (95% confidence interval -1.18 to -0.42 mm) (P <0.0001), favoring the thick tissue group. Metaregression of the selected studies failed to demonstrate an association among MBL and confounding factors.
CONCLUSION
The current study demonstrates that implants placed with an initially thicker peri-implant soft tissue have less radiographic MBL in the short term.
Topics: Alveolar Bone Loss; Alveolar Process; Bone Diseases, Metabolic; Dental Implantation, Endosseous; Dental Implants; Humans; Surgical Flaps
PubMed: 26777766
DOI: 10.1902/jop.2016.150571 -
The Cochrane Database of Systematic... Dec 2015The Cochrane Oral Health Group withdrew this review as of Issue 12, 2015. The review is out of date and does not meet current Cochrane methodological standards. The... (Review)
Review
The Cochrane Oral Health Group withdrew this review as of Issue 12, 2015. The review is out of date and does not meet current Cochrane methodological standards. The editorial group responsible for this previously published document have withdrawn it from publication.
Topics: Adult; Dental Clasps; Dental Occlusion; Denture Retention; Denture, Complete; Humans; Mastication; Mouth, Edentulous; Patient Satisfaction
PubMed: 26623564
DOI: 10.1002/14651858.CD004941.pub3 -
North American Journal of Medical... Sep 2015Association between sarcoidosis and antiphospholipid syndrome (APS) is rare with few reported cases. We sought to systematically review the published cases of APS with... (Review)
Review
Association between sarcoidosis and antiphospholipid syndrome (APS) is rare with few reported cases. We sought to systematically review the published cases of APS with sarcoidosis to better characterize the demographics, clinical characteristics, treatment, and the outcome of this association. Systematic electronic search for case report, case series, and related articles published until May 2014 was carried out and relevant data were extracted and analyzed. Four cases of APS with sarcoidosis were identified exclusively in females. These cases were seen in the sixth decade of life. Pulmonary embolism and central retinal artery occlusion were the presenting thrombotic events. All the patients were treated with lifelong anticoagulation with warfarin. During the median follow-up period of 5.5 months, additional thrombotic events were not observed. Although rare, sarcoidosis may be associated with APS. Further reporting of the cases will help to better establish this association, elucidate pathogenesis, and define clinical characteristics and outcomes.
PubMed: 26605200
DOI: 10.4103/1947-2714.166213 -
T-scan III system diagnostic tool for digital occlusal analysis in orthodontics - a modern approach.Prilozi (Makedonska Akademija Na... 2014This systematic literature review was performed to establish the mechanism, methodology, characteristics, clinical application and opportunities of the T-Scan III System... (Review)
Review
INTRODUCTION
This systematic literature review was performed to establish the mechanism, methodology, characteristics, clinical application and opportunities of the T-Scan III System as a diagnostic tool for digital occlusal analysis in different fields of dentistry, precisely in orthodontics.
METHODS
Searching of electronic databases, using MEDLINE and PubMed, hand searching of relevant key journals, and screening of reference lists of included studies with no language restriction was performed. Publications providing statistically examined data were included for systematic review.
RESULTS
Twenty potentially relevant Randomized Controlled Trials (RCTs) were identified. Only ten met the inclusion criteria. The literature demonstrates that using digital occlusal analysis with T-Scan III System in orthodontics has significant advantage with regard to the capability of measuring occlusal parameters in static positions and during dynamic of the mandible.
CONCLUSION
Within the scope of this systematic review, there is evidence to support that T-Scan system is rapid and accurate in identifying the distribution of the tooth contacts and it shows great promise as a clinical diagnostic screening device for occlusion and for improving the occlusion after various dental treatments. Additional clinical studies are required to advance the indication filed of this system. Importance of using digital occlusal T-Scan analysis in orthodontics deserves further investigation.
Topics: Dental Occlusion; Diagnosis, Computer-Assisted; Humans; Orthodontics; Randomized Controlled Trials as Topic; Temporomandibular Joint Disorders
PubMed: 25532097
DOI: 10.2478/prilozi-2014-0020 -
The Angle Orthodontist May 2015To investigate the body of evidence in the literature about the most favorable time for initiating orthodontic treatment in patients with severe crowding caused by tooth... (Review)
Review
OBJECTIVE
To investigate the body of evidence in the literature about the most favorable time for initiating orthodontic treatment in patients with severe crowding caused by tooth size arch length deficiency (TSALD).
MATERIALS AND METHODS
Electronic databases (PubMed, Ovid Medline, Scopus, Virtual Health Library, and The Cochrane Library) were searched for articles published between 1900 and April 2014. Studies were included that evaluated treatment of patients with severe crowding caused TSALD, who were treated with first premolar extraction. The association between the stage of development of occlusion at which treatment was started, and the primary and/or secondary outcomes of early and late treatment were investigated.
RESULTS
After application of the eligibility criteria and reading of the full texts, six articles were included in the final review. Of these six articles, all of which were retrospective, four showed that the primary outcome (correction of severe crowding) of the early and late groups was improved, but without statistically significant differences after treatment. Therefore, the findings of secondary outcomes in the literature (postretention crowding relapse, duration of total and active treatment [treatment with appliances], external apical root resorption, and soft tissue profile) were the target of this study. These studies presented low or moderate methodological quality and control of bias.
CONCLUSIONS
Both early and late extraction had a similar effect on correction of crowding. Early treatment had two favorable secondary outcomes (less relapse and reduced active treatment time) vs late treatment. However, the levels of evidence were not sufficient to assert which protocol was superior.
Topics: Bicuspid; Cephalometry; Dental Arch; Humans; Malocclusion; Odontometry; Orthodontics, Corrective; Time Factors; Tooth Extraction; Treatment Outcome
PubMed: 25208231
DOI: 10.2319/050814-332.1 -
Journal of Vascular and Interventional... Jun 2014Percutaneous transluminal angioplasty (PTA) is an established treatment for dysfunctional hemodialysis fistulas. This article systematically reviews evidence for... (Review)
Review
Percutaneous transluminal angioplasty (PTA) is an established treatment for dysfunctional hemodialysis fistulas. This article systematically reviews evidence for predictors of patency after PTA. Outcomes assessed were primary, assisted primary, and secondary patency after intervention, and findings were summarized descriptively. This review included 11 nonrandomized observational studies of 965 fistulas in 939 patients. Follow-up ranged from 0 days to 10 years. Study quality was overall suboptimal. Newer fistulas and longer lesion length may be associated with primary patency loss after PTA. Further studies are needed to confirm these findings, to identify potentially modifiable factors, and to guide the testing of new endovascular devices.
Topics: Angioplasty, Balloon; Arteriovenous Shunt, Surgical; Graft Occlusion, Vascular; Humans; Renal Dialysis; Time Factors; Treatment Outcome; Vascular Patency
PubMed: 24703320
DOI: 10.1016/j.jvir.2014.02.010 -
Journal of Dental Research Dec 2013The aim of this study was to assess the survival rate of titanium implants placed in irradiated jaws. MEDLINE, EMBASE, and CENTRAL were searched for studies assessing... (Review)
Review
The aim of this study was to assess the survival rate of titanium implants placed in irradiated jaws. MEDLINE, EMBASE, and CENTRAL were searched for studies assessing implants that had been placed in nongrafted sites of irradiated patients. Random effects meta-analyses assessed implant loss in irradiated versus nonirradiated patients and in irradiated patients treated with hyperbaric oxygen (HBO) therapy. Of 1,051 potentially eligible publications, 15 were included. A total of 10,150 implants were assessed in the included studies, and of these, 1,689 (14.3%) had been placed in irradiated jaws. The mean survival rate in the studies ranged from 46.3% to 98.0%. The pooled estimates indicated a significant increase in the risk of implant failure in irradiated patients (risk ratio: 2.74; 95% confidence interval: 1.86, 4.05; p < .00001) and in maxillary sites (risk ratio: 5.96; 95% confidence interval: 2.71, 13.12; p < .00001). Conversely, HBO therapy did not reduce the risk of implant failure (risk ratio: 1.28; 95% confidence interval: 0.19, 8.82; p = .80). Radiotherapy was linked to higher implant failure in the maxilla, and HBO therapy did not improve implant survival. Most included publications reported data on machined implants, and only 3 studies on HBO therapy were included. Overall, implant therapy appears to be a viable treatment option for reestablishing adequate occlusion and masticatory conditions in irradiated patients.
Topics: Dental Implantation, Endosseous; Dental Implants; Dental Prosthesis Design; Dental Restoration Failure; Humans; Hyperbaric Oxygenation; Jaw; Orthognathic Surgical Procedures; Radiotherapy; Risk Factors; Survival Analysis
PubMed: 24158336
DOI: 10.1177/0022034513504947