Durability of amalgam in the restoration of class II cavities in primary molars: a systematic review of the literature

Evaluating Glass Ionomer Cement Longevity in the Primary and Permanent Teeth-An Umbrella Review

The aim of this umbrella review was to evaluate the longevity of glass ionomer cement (GIC) as a restorative material for primary and permanent teeth. Research in the literature was conducted in three databases (MedLine/PubMed, Web of Science, and Scopus). The inclusion criteria were: (1) to be a systematic review of clinical trials that (2) evaluated the clinical longevity of GICs as a restorative material in primary and/or permanent teeth; the exclusion criteria were: (1) not being a systematic review of clinical trials; (2) not evaluating longevity/clinical performance of GICs as a restorative material; and (3) studies of dental restorative materials in teeth with enamel alterations, root caries, and non-carious cervical lesions. Twenty-four eligible articles were identified, and 13 were included. The follow-up periods ranged from 6 months to 6 years. Different types of GICs were evaluated in the included studies: resin-modified glass ionomer cement (RMGIC), compomers, and low- and high-viscosity glass ionomer cement. Some studies compared amalgam and composite resins to GICs regarding longevity/clinical performance. Analyzing the AMSTAR-2 results, none of the articles had positive criteria in all the evaluated requisites, and none of the articles had an a priori design. The criteria considered for the analysis of the risk of bias of the included studies were evaluated through the ROBIS tool, and the results of this analysis showed that seven studies had a low risk of bias; three studies had positive results in all criteria except for one criterion of unclear risk; and two studies showed a high risk of bias. GRADE tool was used to determine the quality of evidence; for the degree of recommendations, all studies were classified as Class II, meaning there was still conflicting evidence on the clinical performance/longevity of GICs and their recommendations compared to other materials. The level of evidence was classified as Level B, meaning that the data were obtained from less robust meta-analyses and single randomized clinical trials. To the best of our knowledge, this is the first umbrella review approaching GIC in permanent teeth. GICs are a good choice in both dentitions, but primary dentition presents more evidence, especially regarding the atraumatic restorative treatment (ART) technique. Within the limitation of this study, it is still questionable if GIC is a good restorative material in the medium/long term for permanent and primary dentition. Many of the included studies presented a high risk of bias and low quality. The techniques, type of GIC, type of cavity, and operator experience highly influence clinical performance. Thus, clinical decision-making should be based on the dental practitioner's ability, each case analysis, and the patient's wishes. More evidence is needed to determine which is the best material for definitive restorations in permanent and primary dentition.

Compomers for the restorative treatment of dental caries in primary teeth: An umbrella review

OBJECTIVES

This umbrella review comprehensively appraised the evidence on the use of compomers in comparison to other dental filling materials for restorative treatment of decayed primary teeth.

DATA

The literature search was conducted based on the question: "Is the use of compomers as a dental filling material more successful in the restorative treatment of decayed primary teeth than other dental filling materials?" No language restriction was applied and systematic reviews published up to May 2023 were included. The ROBIS tool was used to assess the methodological quality of the included systematic reviews. Data were extracted for narrative synthesis, considering the restoration failure/success outcomes.

SEARCH

Online search was conducted in three databases (PubMed/Medline, Embase and Cochrane library).

STUDY SELECTION

The electronic search yielded a total of 779 publications. Finally, 18 systematic reviews were included in this umbrella review. Four systematic reviews presented a low risk of bias, 11 presented an unclear risk of bias and three presented a high risk of bias. Most systematic reviews presenting low risk of bias reported no difference in the success rates of compomers compared to other dental filling materials used for restoration of decayed primary teeth. Studies that found a significant difference or that made clear recommendations towards the use of compomers were commonly rated with a high risk of bias.

CONCLUSION

Compomers are similar to other dental filling materials for the placement of direct restorations in primary teeth.

CLINICAL SIGNIFICANCE

The results of this umbrella review indicate a similar clinical performance of compomers compared to other materials containing a resin component for direct restoration in primary teeth. Therefore, the choice of restorative material will depend on multiple factors, such as clinician's skills/preferences, patients' wishes, costs, and cavity type/location.

Clinical Effectiveness of Restorative Materials for the Restoration of Carious Primary Teeth: An Umbrella Review

Since untreated dental caries remain a worldwide burden, this umbrella review aimed to assess the quality of evidence on the clinical effectiveness of different restorative materials for the treatment of carious primary teeth. A literature search in electronic bibliographic databases was performed to find systematic reviews with at least two-arm comparisons between restorative materials and a follow-up period ≥12 months. Reviews retrieved were screened; those eligible were selected, and the degree of overlap was calculated using the 'corrected covered area' (CCA). Data were extracted and the risk of bias was assessed using the ROBIS tool. Fourteen systematic reviews with a moderate overlap (6% CCA) were included. All materials studied performed similarly and were equally efficient for the restoration of carious primary teeth. Amalgam and resin composite had the lowest mean failure rate at 24 months while high-viscosity and metal-reinforced glass ionomer cements had the highest. At 36 months, high-viscosity glass ionomer cements showed the highest failure rate with compomer showing the lowest. Most reviews had an unclear risk of bias. Within the limitations of the review, all materials have acceptable mean failure rates and could be recommended for the restoration of carious primary teeth.

Effectiveness of Hall Technique for Primary Carious Molars: A Systematic Review and Meta-analysis

Aim

The objective of the present systematic review was to assess the outcomes of Hall technique (HT) on primary carious molars and compared it with the conventional dental restorations.

Materials and methods

The systematic review was registered with Prospero registry (CRD42015020445) to answer the following research question: Is HT a better restorative option compared to other techniques for restoration of carious primary molars? In addition to exploring various health sciences databases, hand search was also done using following key terms in different permutations: (Hall technique OR Hall's technique OR preformed metal crown OR stainless steel crown) AND (caries OR carious molar OR deciduous tooth OR baby tooth OR milk tooth OR primary tooth). The outcome of interest was success of the restoration achieved with either method.

Results

Five studies were included (two RCTs, one quasi-experimental trial, and two retrospective). A total of 1775 teeth were assessed, of which 1325 teeth were restored using HT. The retrospective studies showed no difference between HT and other methods whereas the RCTs and quasi-experimental favored HT over other treatment modalities. Meta-analysis significantly favored HT over conventional restorations [risk ratio 5.55 (3.31–9.30)] (p value ≤ 0.001).

Conclusion

HT appeared demonstrated higher success and significantly outperformed the conventional restorations.

How to cite this article

Badar SB, Tabassum S, Khan FR, et al. Effectiveness of Hall Technique for Primary Carious Molars: A Systematic Review and Meta-analysis. Int J Clin Pediatr Dent 2019;12(5):445–452.

Critical appraisal of methodological quality of Systematic Reviews and Meta-analysis in Paediatric Dentistry journals

OBJECTIVE

To systematically assess the methodological quality of Systematic Reviews (SRs) and Meta-Analyses (MA) published in Paediatric Dentistry journals and to analyse the relationship between the authors, journals, country, review topic, and the year of publication to the methodological quality of SRs and MA.

DESIGN

Paediatric Dentistry journals ranked in the top five of the h5 index of Google Scholar Metrics were selected. SRs with MA were searched independently by two reviewers using PubMed and Scopus databases until December 2017. Methodological quality was assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR) tool. Statistical significance was set at P < 0.05 and Mann-Whitney U test and Kruskal-Wallis test was employed for comparing the AMSTAR score with the journal characteristics.

RESULTS

Finally, 24 SRs with MA were included. The overall AMSTAR score of SRs and MA published in paediatric dentistry journals was 7.08 ± 2.41. No statistically significant differences were found between the country, journal or focus of study to the quality of SRs except the number of authors and the year of publication (P < 0.05).

CONCLUSIONS

The quality of SRs and MA in leading Paediatric Dentistry journals were evaluated with AMSTAR tool and areas where quality could be improved were identified.

The Hall Technique and conventional restorative treatment in New Zealand children's primary oral health care - clinical outcomes at two years

BACKGROUND

New Zealand children's oral health care is mostly provided in primary care oral health clinics. Little is known about treatment outcomes.

HYPOTHESIS/AIM

To investigate different treatment outcomes of primary molar carious lesions in a sample of children in primary care.

DESIGN

Quasi-experimental study of 180 5- to 8-year-old children. Each child had one carious primary molar treated by a dental therapist with a plastic restorative material (PRM) or a pre-formed stainless steel crown placed with the Hall Technique (HT). After 2 years, restorative outcomes were categorised as success, minor failure, or major failure. Data were analysed using Chi-square tests.

RESULTS

A total of 147 (82%) children were followed up; mean follow-up period 25 months (range: 21-35 months). Failure was observed significantly more in the PRM group (32%) than the HT group (6%). When baseline carious lesions were radiographically deep with marginal ridge breakdown (MRB), there was a higher proportion of major failures than when they were shallow without MRB (33% and 1%, respectively; P < 0.001). Among the deep lesions, those treated with the HT showed better success than PRM.

CONCLUSIONS

There was a much higher success rate in the children treated with HT than PRM. Deep carious lesions responded better to HT than PRM.

Mercury in dental amalgam: Are our health care workers at risk?

Dental amalgam in fillings exposes workers to mercury. The exposure to mercury was investigated among 1871 dental health care workers. The aim of the study was to evaluate the risk of mercury exposure among dental compared to nondental health care workers and to determine other risk factors for mercury exposure. Respondents answered questionnaires to obtain demographic, personal, professional, and workplace information and were examined for their own amalgam fillings. Chronic mercury exposure was assessed through urinary mercury levels. In total, 1409 dental and 462 nondental health care workers participated in the study. Median urine mercury levels for dental and nondental health care workers were 2.75 μg/L (interquartile range [IQR] = 3.0175) and 2.66 μg/L (IQR = 3.04) respectively. For mercury exposure, there were no significant risk factor found among the workers involved within the dental care. The Mann-Whitney test showed that urine mercury levels were significantly different between respondents who eat seafood more than 5 times per week compared to those who eat it less frequently or not at all (p = 0.003). The urinary mercury levels indicated significant difference between dental workers in their practice using squeeze cloths (Mann-Whitney test, p = 0.03). Multiple logistic regression showed that only the usage of cosmetic products that might contain mercury was found to be significantly associated with the urinary mercury levels (odds ratio [OR] = 15.237; CI: 3.612-64.276). Therefore, mean urinary mercury levels of health care workers were low. Exposure to dental amalgam is not associated with high mercury exposure. However, usage of cosmetic products containing mercury and high seafood consumption may lead to the increase of exposure to mercury.

IMPLICATIONS

Exposure to the high levels of mercury from dental amalgam can lead to serious health effects among the dental health care workers. Nationwide chronic mercury exposure among dental personnel was assessed through urinary mercury levels. Findings suggest low urinary mercury levels of these health care workers. Exposure to dental amalgam is not associated with high mercury exposure. However, the usage of cosmetic products containing mercury and high seafood consumption may lead to the increase of exposure to mercury.

Materials for Paediatric Dentistry. Part 1: Background to the Treatment of Carious Primary Teeth

Dental caries is a disease that affects many people, including children, and presents numerous challenges to healthcare providers. As clinicians it is important that we consider the advantages and disadvantages of treating carious primary teeth, and make an informed decision about when it is appropriate or not. This paper describes the background to the treatment of carious primary teeth, looking at the differences between primary and permanent teeth, and the relevance of this. It also suggests points to consider when looking at restoration survival studies, as the ability to appraise the literature critically is important for us all in this 'evidence-based' age. CPD/Clinical Relevance: Our early life experiences have the ability to shape our future attitudes and behaviour. Children with carious teeth require careful management so that pain and suffering is minimized, and positive attitudes towards dentistry are fostered.

Developmental defects of enamel and dentine: challenges for basic science research and clinical management

Abnormalities of enamel and dentine are caused by a variety of interacting factors ranging from genetic defects to environmental insults. The genetic changes associated with some types of enamel and dentine defects have been mapped, and many environmental influences, including medical illnesses that can damage enamel and dentine have been identified. Developmental enamel defects may present as enamel hypoplasia or hypomineralization while dentine defects frequently demonstrate aberrant calcifications and abnormalities of the dentine-pulp complex. Clinically, developmental enamel defects often present with problems of discolouration and aesthetics, tooth sensitivity, and susceptibility to caries, wear and erosion. In contrast, dentine defects are a risk for endodontic complications resulting from dentine hypomineralization and pulpal abnormalities. The main goals of managing developmental abnormalities of enamel and dentine are early diagnosis and improvement of appearance and function by preserving the dentition and preventing complications. However, despite major advances in scientific knowledge regarding the causes of enamel and dentine defects, further research is required in order to translate the knowledge gained in the basic sciences research to accurate clinical diagnosis and successful treatment of the defects.

Laser in caries treatment--patients' experiences and opinions

OBJECTIVES

The aim of this study was to obtain a deeper understanding of patient's experiences and perspectives after dental caries treatment with Er:YAG laser technology.

METHODS

Twelve patients aged 15-30 years who had undergone at least one laser caries excavation agreed to participate in an interview study. All the interviews were tape recorded and transcribed by a transcription agency. The transcribed texts were analysed using manifest and latent qualitative content analysis.

RESULTS

The categories in this study were identified as choosing laser, understanding laser, encouraging dental care and my oral health. The motivation for laser treatment was described as dental fear in general, specific fear of needles or discomfort with the drill. The informants described the dentist's role as initiators of treatment and willing or unwilling facilitators. Laser treatment was described as safer and more carefully considered treatment. They felt generally safe with laser and were able to relax during the treatment. All interviewers described a positive impression of the laser, and words like 'up to date' and 'future-oriented' were used to describe laser. Laser treatment was considered less painful.

CONCLUSIONS

The results indicate that patients find laser a feasible and convenient treatment option.

Developmental enamel defects in the primary dentition: aetiology and clinical management

Developmental enamel defects, presenting as enamel hypoplasia or opacities are caused by damage or disruption to the developing enamel organ as a result of inherited and acquired systemic conditions. The high prevalence of these defects in the primary dentition demonstrates the vulnerability of the teeth to changes in the pre- and postnatal environment. The presence of enamel hypoplasia increases the risk of primary teeth to early childhood caries and tooth wear as the defective enamel is thinner, more plaque retentive and less resistant to dissolution in acid compared to normal enamel. The purpose of this paper was to critically review the aetiology and clinical complications of developmental enamel defects in the primary dentition and propose recommendations for the clinical management of affected teeth.

Restoration of class II cavities in primary molar teeth with conventional and resin modified glass ionomer cements: a systematic review of the literature

AIM

To review the literature concerning the restoration of primary teeth with glass ionomer (GIC) or resin modified glass ionomer cement (RMGI) used in conventional class II cavities.

METHODS

A search of the literature identified through Medline between 1966 and 2006 using the key words: glass ionomer, resin modified, glass polyalkenoate, deciduous/primary teeth. Studies that used ART or tunnel preparations were excluded. Papers of relevant clinical studies (prospective and retrospective) were assessed and graded using predetermined criteria. Papers were graded according to the number of criteria met as (A >90%, B1 = 75%, B2 = 50%, C <50%).

RESULTS

The search identified 411 papers, from which an application of the inclusion criteria yielded 20 studies. Of these, 2 were rated B1 and 18 B2. Failure rates varied from 6.6% to 60% for GIC, and from 2% to 24% for RMGI.

CONCLUSION

GIC cannot be recommended for class II cavities in primary molars. There is evidence that RMGIC can perform successfully in small to moderate sized class II restorations.

Association between caries location and restorative material treatment provided

OBJECTIVES

This cross-sectional study by the Northwest PRECEDENT practitioners correlated the location of caries diagnosed in the past 12 months with treatment provided.

METHODS

An oral health survey was conducted on up to 20 patients per practice for 101 practises in the Northwest PRECEDENT network. A total of 1943 eligible patients were randomly assessed for the location of and treatment provided for caries lesions diagnosed within the past 12 months. Regression analysis using generalized estimating equations (GEE) was performed to assess association of treatment to tooth location and surface characterization, adjusting for age, practice location (urban/rural), dentist gender, and experience level. The analysis accounts for clustering by practice using robust variance estimates.

RESULTS

Overall, 55.4% of patients exhibited recent caries and 42.8% received treatment for at least one permanent tooth. 18% of treated teeth were treated with amalgam, and 72% were treated with composite. This percentage varied as a function of tooth surface characteristics, patient characteristics, and dentist characteristics. The results suggest that restoration selection does depend on tooth type and which surfaces are being restored. The odds of a molar receiving an amalgam restoration are 2.44 (95% CI=1.81-3.30) times higher as compared to a bicuspid, adjusting for all other covariates. When the restoration includes the occlusal surface of a tooth the odds are 0.42 (95% CI=0.20-0.89) times as great that amalgam will be placed. When the restoration includes the mesial or distal surface of the tooth the odds for amalgam restoration are 2.49 (95% CI=1.25-4.95) times higher compared to when it does not include these surfaces.

CONCLUSION

Restorative material choice varied based on caries location and practitioner gender.

The longevity of different restorations in primary teeth

BACKGROUND AND AIM

This paper reviews three published papers and adds results from a fourth study which aimed to determine which restorative material would be the best alternative(s) to amalgam (AM) in primary teeth.

DESIGN

All studies had a practice-based design and were part of the routine treatment of children and adolescents. The clinicians were assigned which materials to use in a randomised matter in the first three studies which lasted for 7-8 years. In the fourth study conducted 4 years after the initial studies, the clinicians were free to select the restorative materials.

RESULTS AND CONCLUSIONS

Resin modified glass ionomer (RMGI) and compomer (COM) restorations showed similar longevity compared with AM, whereas conventional GI restorations showed significantly shorter longevity. The studies indicated that the 'new and improved' materials based on in vitro tests did not always show enhanced clinical properties. In the last study, where clinicians freely selected the restorative materials they used in their practices, seven used COM, one used conventional GI materials and one used a combination of the two types of material.

Stainless steel crown versus modified open-sandwich restorations for primary molars: a 2-year randomized clinical trial

OBJECTIVE

The aim of this study was to investigate the clinical performance and survival of stainless steel crown (SSC) restoration and modified open-sandwich technique using resin-modified glass ionomer cement.

DESIGN

Randomized clinical trial.

SETTING

General dental practice.

MATERIALS AND METHODS

A total of 87 children aged 4-7 years at baseline with one or more primary molars that have undergone pulp therapy were randomly assigned to receive either SSC or modified open-sandwich restoration. One hundred and sixty restorations were placed and evaluated after 6, 12, 18, and 24 months using the Ryge criteria.

RESULTS

Comparable survival rates were observed for both SSC and modified open-sandwich restoration. With only four SSCs and six modified open-sandwich restorations failing over 24 months, the survival rates were high for both materials (2-year survival rate: 95.0% for SSCs and 92.5% for modified open-sandwich restorations). Significantly better gingival health (P < 0.05) was observed for the modified open-sandwich restorations compared with SSCs, as only one modified open-sandwich restoration was rated Charlie compared to 13 SSCs. No significant differences were observed between the two materials for marginal integrity, proximal contact, occlusion, or recurrent caries.

CONCLUSION

The 2-year results indicated that the modified open-sandwich restoration is an appropriate alternative to SSC in extensive restorations, particularly where aesthetic considerations are important.