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Ge KX, Quock R, Chu CH, Yu OY. The preventive effect of glass ionomer cement restorations on secondary caries formation: A systematic review and meta-analysis. Dent Mater 2023; 39:e1-e17. [PMID: 37838608 DOI: 10.1016/j.dental.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/19/2023] [Accepted: 10/05/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVE The objective is to compare the preventive effect on secondary caries of glass ionomer cement (GIC) restorations with amalgam or resin-composite restorations. METHODS Two independent researchers conducted a systematic search of English publications in PubMed, Web of Science, Cochrane and Scopus. They selected randomized clinical trials comparing secondary caries incidences around GIC restorations (conventional GIC or resin-modified GIC) with amalgam or resin-composite restorations. Meta-analysis of the secondary-caries incidences with risk ratio (RR) and 95% confidence interval (95% CI) as the effect measure was performed. RESULTS This review included 64 studies. These studies included 8310 GIC restorations and 5857 amalgam or resin-composite restorations with a follow-up period from 1 to 10 years. Twenty-one studies with 4807 restorations on primary teeth and thirty-eight studies with 4885 restorations on permanent teeth were eligible for meta-analysis. The GIC restorations had a lower secondary caries incidence compared with amalgam restorations in both primary dentition [RR= 0.55, 95% CI:0.41-0.72] and permanent dentition [RR= 0.20, 95% CI:0.11-0.38]. GIC restorations showed similar secondary caries incidence compared with resin-composite restorations in primary dentition [RR= 0.92, 95% CI:0.77-1.10] and permanent dentition [RR= 0.77, 95% CI:0.39-1.51]. Conventional GIC restorations showed similar secondary caries incidence compared with resin-modified GIC-restored teeth in both primary dentition [RR= 1.12, 95% CI:0.67-1.87] and permanent dentition [RR= 1.63, 95% CI:0.34-7.84]. CONCLUSIONS GIC restorations showed a superior preventive effect against secondary caries compared to amalgam restorations, and a similar preventive effect against secondary caries compared to resin-composite restorations in both primary and permanent teeth. [PROSPERO Registration ID: CRD42022380959].
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Affiliation(s)
| | - Ryan Quock
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China; Department of Restorative Dentistry and Prosthodontics, School of Dentistry, The University of Texas Health Science Center at Houston, TX, USA
| | - Chun-Hung Chu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Ollie Yiru Yu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.
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Dhar V, Pilcher L, Fontana M, González-Cabezas C, Keels MA, Mascarenhas AK, Nascimento M, Platt JA, Sabino GJ, Slayton R, Tinanoff N, Young DA, Zero DT, Pahlke S, Urquhart O, O'Brien KK, Carrasco-Labra A. Evidence-based clinical practice guideline on restorative treatments for caries lesions: A report from the American Dental Association. J Am Dent Assoc 2023; 154:551-566.e51. [PMID: 37380250 DOI: 10.1016/j.adaj.2023.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/07/2023] [Accepted: 04/01/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND An expert panel convened by the American Dental Association (ADA) Council on Scientific Affairs together with the ADA Science and Research Institute's program for Clinical and Translational Research conducted a systematic review and developed recommendations for the treatment of moderate and advanced cavitated caries lesions in patients with vital, nonendodontically treated primary and permanent teeth. TYPES OF STUDIES REVIEWED The authors searched for systematic reviews comparing carious tissue removal (CTR) approaches in Ovid MEDLINE, Embase, Cochrane Database of Systematic Reviews, and Trip Medical Database. The authors also conducted a systematic search for randomized controlled trials comparing direct restorative materials in Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. The authors used the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the certainty of the evidence and formulate recommendations. RESULTS The panel formulated 16 recommendations and good practice statements: 4 on CTR approaches specific to lesion depth and 12 on direct restorative materials specific to tooth location and surfaces involved. The panel conditionally recommended for the use of conservative CTR approaches, especially for advanced lesions. Although the panel conditionally recommended for the use of all direct restorative materials, they prioritized some materials over the use of others for certain clinical scenarios. PRACTICAL IMPLICATIONS The evidence suggests that more conservative CTR approaches may decrease the risk of adverse effects. All included direct restorative materials may be effective in treating moderate and advanced caries lesions on vital, nonendodontically treated primary and permanent teeth.
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Pilcher L, Pahlke S, Urquhart O, O'Brien KK, Dhar V, Fontana M, González-Cabezas C, Keels MA, Mascarenhas AK, Nascimento MM, Platt JA, Sabino GJ, Slayton RL, Tinanoff N, Young DA, Zero DT, Tampi MP, Purnell D, Salazar J, Megremis S, Bienek D, Carrasco-Labra A. Direct materials for restoring caries lesions: Systematic review and meta-analysis-a report of the American Dental Association Council on Scientific Affairs. J Am Dent Assoc 2023; 154:e1-e98. [PMID: 36610925 DOI: 10.1016/j.adaj.2022.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/26/2022] [Accepted: 09/28/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND The goal of restoring caries lesions is to protect the pulp, prevent progression of the disease process, and restore the form and function of the tooth. The purpose of this systematic review was to determine the effect of different direct restorative materials for treating cavitated caries lesions on anterior and posterior primary and permanent teeth. TYPE OF STUDIES REVIEWED The authors included parallel and split-mouth randomized controlled trials comparing the effectiveness of direct restorative materials commercially available in the United States placed in vital, nonendodontically treated primary and permanent teeth. Pairs of reviewers independently conducted study selection, data extraction, and assessments of risk of bias and certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation approach. The authors conducted pair-wise meta-analyses to summarize the evidence and calculated measures of association and their 95% CIs. RESULTS Thirty-eight randomized controlled trials were eligible for analysis, which included data on Class I and Class II restorations on primary teeth and Class I, Class II, Class III, Class V, and root surface restorations on permanent teeth. Included studies assessed the effect of amalgam, resin composite, compomer, conventional glass ionomer cement, resin-modified glass isomer cement, and preformed metal crowns. Moderate to very low certainty evidence suggested varying levels of effectiveness across restorative materials. CONCLUSIONS AND PRACTICAL IMPLICATIONS Owing to a relatively low event rate across various outcomes indicating restoration failure, there was limited evidence to support important differences between direct restorative materials used in practice.
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Badr C, Spagnuolo G, Amenta F, Khairallah C, Mahdi SS, Daher E, Battineni G, Baba NZ, Zogheib T, Qasim SSB, Daher T, Chintalapudi N, Zogheib CM. A Two-Year Comparative Evaluation of Clinical Performance of a Nanohybrid Composite Resin to a Flowable Composite Resin. J Funct Biomater 2021; 12:jfb12030051. [PMID: 34564200 PMCID: PMC8482203 DOI: 10.3390/jfb12030051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/31/2021] [Accepted: 09/06/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: This prospective in vivo study aimed to compare the clinical behavior of a flowable composite resin (Genial Universal Flo, GC) and a nanohybrid universal composite resin (Tetric Evo Ceram, Ivoclar Vivadent) used in Class I and II direct esthetic restorations in posterior teeth. Methods: A total of 108 Class I and II direct restorations were performed in patients aged between 20 and 60 years. The originality of this study lies in the fact that both materials were placed in pairs, in the same clinical environment (i.e., the same patient and the same type of tooth). The evaluations were performed now of restoration and after 2-weeks, 6-, 12-, and 24-months intervals using clinical examination, clinical photographs, and radiological examination, according to modified USPHS criteria. Statistical analysis was performed using the Fisher exact test and chi-square analysis. Results: At baseline, the universal composite resin showed better esthetic properties such as surface luster, surface staining marginal staining. Both materials regressed significantly over time with no significant difference between groups. Conclusions: Both flowable and nanohybrid composite resins exhibit acceptable clinical performance. The present 24 months of evaluation of different composites showed that the G-ænial Universal Flo could be an effective esthetic material for posterior restoration. No significant difference between both materials over time concerning surface luster, surface staining, and marginal staining.
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Affiliation(s)
- Carelle Badr
- Department of Esthetic and Restorative Dentistry, School of Dentistry, Saint Joseph University of Beirut, Beirut 1004 2020, Lebanon; (C.B.); (C.K.); (E.D.); (T.D.); (C.M.Z.)
| | - Gianrico Spagnuolo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, 80131 Napoli, Italy
- Institute of Dentistry, I. M. Sechenov First Moscow State Medical University, 119435 Moscow, Russia
- Correspondence:
| | - Francesco Amenta
- Center of Clinical Research, Telemedicine & Telepharmacy Department, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy; (F.A.); (S.S.M.); (G.B.); (N.C.)
| | - Carlos Khairallah
- Department of Esthetic and Restorative Dentistry, School of Dentistry, Saint Joseph University of Beirut, Beirut 1004 2020, Lebanon; (C.B.); (C.K.); (E.D.); (T.D.); (C.M.Z.)
| | - Syed Sarosh Mahdi
- Center of Clinical Research, Telemedicine & Telepharmacy Department, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy; (F.A.); (S.S.M.); (G.B.); (N.C.)
- Department of Community Dentistry, Jinnah Medical and Dental College, Sohail University, Karachi 74800, Pakistan
| | - Elie Daher
- Department of Esthetic and Restorative Dentistry, School of Dentistry, Saint Joseph University of Beirut, Beirut 1004 2020, Lebanon; (C.B.); (C.K.); (E.D.); (T.D.); (C.M.Z.)
| | - Gopi Battineni
- Center of Clinical Research, Telemedicine & Telepharmacy Department, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy; (F.A.); (S.S.M.); (G.B.); (N.C.)
| | - Nadim Z. Baba
- Advanced Specialty Education Program in Implant Dentistry, School of Dentistry, Loma Linda University, Loma Linda, CA 92354, USA;
| | - Tatiana Zogheib
- Department of Orthodontics and Dentofacial Orthopedics, International University of Catalunya, 08017 Sant Cugat del Vallés, Barcelona, Spain;
| | | | - Tony Daher
- Department of Esthetic and Restorative Dentistry, School of Dentistry, Saint Joseph University of Beirut, Beirut 1004 2020, Lebanon; (C.B.); (C.K.); (E.D.); (T.D.); (C.M.Z.)
| | - Nalini Chintalapudi
- Center of Clinical Research, Telemedicine & Telepharmacy Department, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy; (F.A.); (S.S.M.); (G.B.); (N.C.)
| | - Carina Mehanna Zogheib
- Department of Esthetic and Restorative Dentistry, School of Dentistry, Saint Joseph University of Beirut, Beirut 1004 2020, Lebanon; (C.B.); (C.K.); (E.D.); (T.D.); (C.M.Z.)
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Garbim JR, Laux CM, Tedesco TK, Braga MM, Raggio DP. Atraumatic restorative treatment restorations performed in different settings: systematic review and meta-analysis. Aust Dent J 2021; 66:430-443. [PMID: 34407233 DOI: 10.1111/adj.12871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/04/2021] [Accepted: 08/15/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND There are potential barriers to using the atraumatic restorative treatment (ART) approach in conventional dental offices, as many professionals assume that it is only used for field conditions. This systematic review and meta-analysis evaluated the survival data of ART restorations in permanent and primary teeth when performed in and out of the conventional environment. METHODS Searches were performed on PubMed/MEDLINE, Scopus, Web of Science, and Open Grey databases up to April 2020. Studies that evaluated ART restorations were prospective and had survival rate data were included. The risk of bias was evaluated by Rob 2.0 and ROBINS-I tools. Meta-analyses were carried out considering as outcome the survival rate of primary and permanent teeth. Subgroups analysis was performed for setting and type of cavity (occlusal or multi-surface). RESULTS Thirty-four studies were included. For primary teeth, in general, the overall percentage of survival rate was not influenced by setting, ranging up to 71% in 12 months to 65% in 36 months. Similarly, for permanent teeth, the overall percentage of survival rate was not influenced by setting, ranging up to 96% in 12 months to 61% in 36 months. CONCLUSION ART is a feasible approach for field settings as well as conventional dental offices. PROSPERO CRD42020184680.
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Affiliation(s)
- Jonathan Rafael Garbim
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Caroline Mariano Laux
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | | | | | - Daniela Prócida Raggio
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
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Jiang M, Fan Y, Li KY, Lo ECM, Chu CH, Wong MCM. Factors affecting success rate of atraumatic restorative treatment (ART) restorations in children: A systematic review and meta-analysis. J Dent 2020; 104:103526. [PMID: 33188846 DOI: 10.1016/j.jdent.2020.103526] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Aim of this systematic review was to summarize the factors that affect the success rate of atraumatic restorative treatment (ART) restorations in children. DATA/SOURCES Two independent reviewers conducted a literature search in the databases PubMed, Medline and Web of Science until October 2019 with no initial time limit. Articles reporting on clinical outcomes of ART restorations placed in children were included. STUDY SELECTION A total of 67 articles were included in this review reporting on clinical outcomes of ART restorations placed in children in 47 studies. The overall estimated success rate and 95 % confidence interval (CI) of ART restorations were 0.71 (0.65-0.77) and 0.67 (0.56-0.78) at the 12-month and the 24-month follow-up, respectively. Operator was one of the significant factors associated with the success rate of ART restorations. ART restorations placed by dental students/therapists had a significantly lower success rate compared with those placed by dentists. Besides, type of restoration (single-surface vs. multiple-surface restoration) was also associated with the success rate of ART restorations. Other factors including dentition, restorative material, clinical setting, and moisture control method had no significant influence on the success rate of ART restorations in children. CONCLUSION It is concluded that ART approach can be used to manage cavitated caries lesions in children. Operator and type of restoration are significant factors influencing the success rate of ART restorations. CLINICAL SIGNIFICANCE This study provides valuable information on the factors that affect success rate of ART restorations in children, which helps clinicians to make informed decisions on provision of ART restorations in children.
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Affiliation(s)
- Meng Jiang
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Yanpin Fan
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Kar Yan Li
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | | | - Chun Hung Chu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - May Chun Mei Wong
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China.
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Efficacy of GC Gold Label 9 and GC Miracle Mix ® Restorations using Atraumatic Restorative Treatment (ART) in Rural Settings: A Randomized Controlled Trial. J Clin Pediatr Dent 2020; 44:148-153. [PMID: 32644894 DOI: 10.17796/1053-4625-44.3.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: This study compared the longevity of high strength posterior glass ionomer and metal-reinforced glass ionomer using ART in rural settings within an 18-month observation period. Study Design: A nonblinded parallel design randomized controlled trial was conducted among children who attended dental outreach programs in a rural area of Southern India. Atraumatic Restorative Treatment (ART) was performed in 92 permanent posterior teeth with either high strength posterior glass ionomer or metal-reinforced glass ionomer restorations. The allocation ratio was 1:1. Restorations were evaluated at 1, 6, 12 and 18 months after placement. Results: The success rate of metal-reinforced glass ionomer restorations was 100%, 95.4%, 90.4% and 87.2% as compared to high strength posterior glass ionomer whose success rates were 100%, 93%, 85% and 61.8% at the four follow ups respectively. There was a statistically significant difference between the success rate of the two materials at the end of 18 months with the metal-reinforced glass ionomer restorations having a higher success rate (p=0.015). Conclusions : Although the clinical performance of both materials were largely similar, the metal-reinforced glass ionomer restorations had a higher success rate than the conventional GIC at the end of 18 months of follow-up.
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Faustino-Silva DD, Figueiredo MC. Atraumatic restorative treatment—ART in early childhood caries in babies: 4 years of randomized clinical trial. Clin Oral Investig 2019; 23:3721-3729. [DOI: 10.1007/s00784-019-02800-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 01/10/2019] [Indexed: 01/08/2023]
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Comparison of ART and conventional techniques on clinical performance of glass-ionomer cement restorations in load bearing areas of permanent and primary dentitions: A systematic review. J Dent 2018; 78:1-21. [DOI: 10.1016/j.jdent.2018.07.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 07/04/2018] [Accepted: 07/10/2018] [Indexed: 01/17/2023] Open
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de Amorim RG, Frencken JE, Raggio DP, Chen X, Hu X, Leal SC. Survival percentages of atraumatic restorative treatment (ART) restorations and sealants in posterior teeth: an updated systematic review and meta-analysis. Clin Oral Investig 2018; 22:2703-2725. [PMID: 30232622 DOI: 10.1007/s00784-018-2625-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 09/06/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of the present study is to update the results of two previous meta-analyses, published in 2006 and 2012, on the survival percentages of atraumatic restorative treatment (ART) restorations and ART sealants. The current meta-analysis includes Chinese publications not investigated before. MATERIALS AND METHODS Until February 2017, six databases were interrogated (two English, one Portuguese, one Spanish and two Chinese). Using six exclusion criteria, a group of six independent reviewers selected 43 publications from a total of 1958 potentially relevant studies retrieved. Confidence intervals and/or standard errors were calculated and the heterogeneity variance of the survival rates was estimated. RESULTS The survival percentages and standard errors of single-surface and multiple-surface ART restorations in primary posterior teeth over the first 2 years were 94.3% (± 1.5) and 65.4% (± 3.9), respectively; for single-surface ART restorations in permanent posterior teeth over the first 3 years, they were 87.1% (± 3.2); and for multiple-surface ART restorations in permanent posterior teeth over the first 5 years, they were 77% (± 9.0). The mean annual dentine-carious-lesion-failure percentages in previously sealed pits and fissures using ART sealants in permanent posterior teeth over the first 3 and 5 years were 0.9 and 1.9%, respectively. CONCLUSIONS ART single-surface restorations presented high survival percentages in both primary and permanent posterior teeth, whilst ART multiple-surface restorations presented lower survival percentages. ART sealants presented a high-caries-preventive effect. CLINICAL RELEVANCE ART is an effective evidence-based option for treating and preventing carious lesions in primary and permanent posterior teeth.
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Affiliation(s)
| | - J E Frencken
- Department of Oral Function and Prosthetic Dentistry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - D P Raggio
- Orthodontics and Pediatric Dentistry Department, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - X Chen
- State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - X Hu
- State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - S C Leal
- Department of Dentistry, Faculty of Health Sciences, University of Brasília, Brasília, Brazil
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Raggio DP, Hesse D, Lenzi TL, Guglielmi CAB, Braga MM. Is Atraumatic restorative treatment an option for restoring occlusoproximal caries lesions in primary teeth? A systematic review and meta-analysis. Int J Paediatr Dent 2013. [PMID: 23190278 DOI: 10.1111/ipd.12013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Daniela P Raggio
- Department of Pediatric Dentistry, School of Dentistry, Universidade de São Paulo, São Paulo, Brazil
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Mickenautsch S, Yengopal V. Direct contra naïve-indirect comparison of clinical failure rates between high-viscosity GIC and conventional amalgam restorations: an empirical study. PLoS One 2013; 8:e78397. [PMID: 24205220 PMCID: PMC3810255 DOI: 10.1371/journal.pone.0078397] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 09/11/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Naïve-indirect comparisons are comparisons between competing clinical interventions' evidence from separate (uncontrolled) trials. Direct comparisons are comparisons within randomised control trials (RCTs). The objective of this empirical study is to test the null-hypothesis that trends and performance differences inferred from naïve-indirect comparisons and from direct comparisons/RCTs regarding the failure rates of amalgam and direct high-viscosity glass-ionomer cement (HVGIC) restorations in permanent posterior teeth have similar direction and magnitude. METHODS A total of 896 citations were identified through systematic literature search. From these, ten and two uncontrolled clinical longitudinal studies for HVGIC and amalgam, respectively, were included for naïve-indirect comparison and could be matched with three out twenty RCTs. Summary effects sizes were computed as Odds ratios (OR; 95% Confidence intervals) and compared with those from RCTs. Trend directions were inferred from 95% Confidence interval overlaps and direction of point estimates; magnitudes of performance differences were inferred from the median point estimates (OR) with 25% and 75% percentile range, for both types of comparison. Mann-Whitney U test was applied to test for statistically significant differences between point estimates of both comparison types. RESULTS Trends and performance differences inferred from naïve-indirect comparison based on evidence from uncontrolled clinical longitudinal studies and from direct comparisons based on RCT evidence are not the same. The distributions of the point estimates differed significantly for both comparison types (Mann-Whitney U = 25, n(indirect) = 26; n(direct) = 8; p = 0.0013, two-tailed). CONCLUSION The null-hypothesis was rejected. Trends and performance differences inferred from either comparison between HVGIC and amalgam restorations failure rates in permanent posterior teeth are not the same. It is recommended that clinical practice guidance regarding HVGICs should rest on direct comparisons via RCTs and not on naïve-indirect comparisons based on uncontrolled longitudinal studies in order to avoid inflation of effect estimates.
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Affiliation(s)
- Steffen Mickenautsch
- Systematic Review initiative for Evidence-based Minimum Intervention in Dentistry/Department of Community Dentistry, Faculty of Health Sciences, University of the Witwatersrand - Johannesburg, South Africa
| | - Veerasamy Yengopal
- Systematic Review initiative for Evidence-based Minimum Intervention in Dentistry/Department of Community Dentistry, Faculty of Health Sciences, University of the Witwatersrand - Johannesburg, South Africa
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Colak H, Dülgergil CT, Dalli M, Hamidi MM. Early childhood caries update: A review of causes, diagnoses, and treatments. J Nat Sci Biol Med 2013; 4:29-38. [PMID: 23633832 PMCID: PMC3633299 DOI: 10.4103/0976-9668.107257] [Citation(s) in RCA: 300] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Dental caries (decay) is an international public health challenge, especially amongst young children. Early childhood caries (ECC) is a serious public health problem in both developing and industrialized countries. ECC can begin early in life, progresses rapidly in those who are at high risk, and often goes untreated. Its consequences can affect the immediate and long-term quality of life of the child's family and can have significant social and economic consequences beyond the immediate family as well. ECC can be a particularly virulent form of caries, beginning soon after dental eruption, developing on smooth surfaces, progressing rapidly, and having a lasting detrimental impact on the dentition. Children experiencing caries as infants or toddlers have a much greater probability of subsequent caries in both the primary and permanent dentitions. The relationship between breastfeeding and ECC is likely to be complex and confounded by many biological variables, such as mutans streptococci, enamel hypoplasia, intake of sugars, as well as social variables, such as parental education and socioeconomic status, which may affect oral health. Unlike other infectious diseases, tooth decay is not self-limiting. Decayed teeth require professional treatment to remove infection and restore tooth function. In this review, we give detailed information about ECC, from its diagnosis to management.
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Affiliation(s)
- Hakan Colak
- Kirikkale University Dental Faculty, Department of Restorative Dentistry, Kirikkale, Turkey
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Tüzüner T, Ulusu T. Effect of antibacterial agents on the surface hardness of a conventional glass-ionomer cement. J Appl Oral Sci 2012; 20:45-9. [PMID: 22437677 PMCID: PMC3928771 DOI: 10.1590/s1678-77572012000100009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Accepted: 05/30/2010] [Indexed: 02/05/2023] Open
Abstract
UNLABELLED In atraumatic restorative treatment (ART), caries removal with hand excavation instruments is not as efficient as that with rotary burs in eliminating bacteria under the glass ionomer cements (GICs). Thus, different antibacterial agents have been used in recent studies to enhance the antibacterial properties of the GICs, without jeopardizing their basic physical properties. OBJECTIVE The objective of this study was to evaluate the effect of antibacterial agents on the surface hardness of a conventional GIC (Fuji IX) using Vickers microhardness [Vickers hardness number (VHN)] test. MATERIAL AND METHODS Cetrimide (CT), cetylpyridinium chloride (CPC) and chlorhexidine (CHX) were added to the powder and benzalkonium chloride (BC) was added to the liquid of Fuji IX in concentrations of 1% and 2%, and served as the experimental groups. A control group containing no additive was also prepared. After the completion of setting reaction, VHN measurements were recorded at 1, 7, 15, 30, 60, and 90 days after storage in 37°C distilled water. A one-way ANOVA was performed followed by a Dunnett t test and Tamhane T2 tests and also repeated measurements ANOVA was used for multiple comparisons in 95% confidence interval. RESULTS VHN results showed significant differences between the control and the experimental groups at all time periods (p<0.05 for all). Significant differences were observed between all study periods for individual groups (p<0.05). After 7 days, VHNs were decreased in all experimental groups while they continued to increase in the control group. BC and CHX groups demonstrated the least whereas CT and CPC groups exhibited most adverse effect on the hardness of set cements. CONCLUSIONS Despite the decreased microhardness values in all experimental groups compared to the controls after 7 up to 90 days, incorporating certain antibacterial agents into Fuji IX GIC showed tolerable microhardness alterations within the limitations of this in vitro study.
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Affiliation(s)
- Tamer Tüzüner
- Department of Pedodontics, Faculty of Dentistry, Karadeniz Technical University, Trabzon, Turkey.
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Frencken JE, Leal SC, Navarro MF. Twenty-five-year atraumatic restorative treatment (ART) approach: a comprehensive overview. Clin Oral Investig 2012; 16:1337-46. [PMID: 22824915 PMCID: PMC3443346 DOI: 10.1007/s00784-012-0783-4] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 06/25/2012] [Indexed: 12/05/2022]
Abstract
Background The atraumatic restorative treatment (ART) approach was born 25 years ago in Tanzania. It has evolved into an essential caries management concept for improving quality and access to oral care globally. Results Meta-analyses and systematic reviews have indicated that the high effectiveness of ART sealants using high-viscosity glass ionomers in carious lesion development prevention is not different from that of resin fissure sealants. ART using high-viscosity glass ionomer can safely be used to restore single-surface cavities both in primary and in permanent posterior teeth, but its quality in restoring multiple surfaces in primary posterior teeth cavities needs to be improved. Insufficient information is available regarding the quality of ART restorations in multiple surfaces in permanent anterior and posterior teeth. There appears to be no difference in the survival of single-surface high-viscosity glass-ionomer ART restorations and amalgam restorations. Discussion The use of ART results in smaller cavities and in high acceptance of preventive and restorative care by children. Because local anaesthesia is seldom needed and only hand instruments are used, ART is considered to be a promising approach for treating children suffering from early childhood caries. ART has been implemented in the public oral health services of a number of countries, and clearly, proper implementation requires the availability of sufficient stocks of good high-viscosity glass ionomers and sets of ART instruments right from the start. Textbooks including chapters on ART are available, and the concept is being included in graduate courses at dental schools in a number of countries. Recent development and testing of e-learning modules for distance learning has increasingly facilitated the distribution of ART information amongst professionals, thus enabling more people to benefit from ART. However, this development and further research require adequate funding, which is not always easily obtainable. The next major challenge is the continuation of care to the frail elderly, in which ART may play a part. Conclusion ART, as part of the Basic Package of Oral Care, is an important cornerstone for the development of global oral health and alleviating inequality in oral care.
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Affiliation(s)
- Jo E Frencken
- Department of Global Oral Health, College of Dental Sciences, Radboud University Nijmegen Medical Centre, Philips van Leijdenlaan 25, 6525 AX, Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
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de Amorim RG, Leal SC, Frencken JE. Survival of atraumatic restorative treatment (ART) sealants and restorations: a meta-analysis. Clin Oral Investig 2012; 16:429-41. [PMID: 21274581 PMCID: PMC3308010 DOI: 10.1007/s00784-011-0513-3] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 01/10/2011] [Indexed: 11/18/2022]
Abstract
UNLABELLED The purpose of this study is to perform a systematic investigation plus meta-analysis into survival of atraumatic restorative treatment (ART) sealants and restorations using high-viscosity glass ionomers and to compare the results with those from the 2005 ART meta-analysis. Until February 2010, four databases were searched. Two hundred four publications were found, and 66 reported on ART restorations or sealant survival. Based on five exclusion criteria, two independent reviewers selected the 29 publications that accounted for the meta-analysis. Confidence intervals (CI) and or standard errors were calculated and the heterogeneity variance of the survival rates was estimated. Location (school/clinic) was an independent variable. The survival rates of single-surface and multiple-surface ART restorations in primary teeth over the first 2 years were 93% (CI, 91-94%) and 62% (CI, 51-73%), respectively; for single-surface ART restorations in permanent teeth over the first 3 and 5 years it was 85% (CI, 77-91%) and 80% (CI, 76-83%), respectively and for multiple-surface ART restorations in permanent teeth over 1 year it was 86% (CI, 59-98%). The mean annual dentine lesion incidence rate, in pits and fissures previously sealed using ART, over the first 3 years was 1%. No location effect and no differences between the 2005 and 2010 survival rates of ART restorations and sealants were observed. The short-term survival rates of single-surface ART restorations in primary and permanent teeth, and the caries-preventive effect of ART sealants were high. CLINICAL RELEVANCE ART can safely be used in single-surface cavities in both primary and permanent teeth. ART sealants have a high caries preventive effect.
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Affiliation(s)
- Rodrigo G. de Amorim
- Department of Dentistry, Faculty of Health Science, University of Brasilia, Brasília, Federal District Brazil
| | - Soraya C. Leal
- Department of Dentistry, Faculty of Health Science, University of Brasilia, Brasília, Federal District Brazil
| | - Jo E. Frencken
- Department of Global Oral Health, College of Dental Sciences, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Navarro MFDL, Modena KCDS, Freitas MCCDA, Fagundes TC. Transferring ART research into education in Brazil. J Appl Oral Sci 2011; 17 Suppl:99-105. [PMID: 21499663 PMCID: PMC5467380 DOI: 10.1590/s1678-77572009000700017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED The aim of this study was to evaluate the teaching of the Atraumatic Restorative Treatment (ART) approach in Brazilian dental schools. MATERIALS AND METHODS A questionnaire on this subject was sent to Pediatric Dentistry, Operative Dentistry and Public Health Dentistry professors. The questions approached the following subjects: the method used to teach ART, the time spent on its teaching, under which discipline it is taught, for how many years ART has been taught and its effect on the DMFT index. RESULTS A total of 70 out of 202 dental schools returned the questionnaire. The ART approach is taught in the majority of the Brazilian dental schools (96.3%), and in most of these schools it is taught both in theory and in clinical practice (62.9%). The majority (35.3%) of professors teach ART for 8 hours, and most often as part of the Pediatric Dentistry discipline (67.6%). It has been taught for the last 7 to 10 years in 34.3% of dental schools. Most professors did not observe a change in the DMFT index with this approach. There is a diversity in the teaching of ART in Brazil in terms of the number of hours spent, the teaching method (theory and practice), and the disciplines involved in its teaching. CONCLUSIONS It is necessary to address the training of professors in the ART approach for the whole country. An educational model is proposed whereby a standard ART module features as part of other preventive and restorative caries care educational modules. This will facilitate and standardize the introduction and adoption of the ART approach in undergraduate education in Brazil.
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Affiliation(s)
- Maria Fidela de Lima Navarro
- Department of Dental Materials, Endodontics and Operative Dentistry, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil.
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Efficiency of different polyacrylic acid concentrations on the smear layer, after ART technique, by Scanning Electron Microscopy (SEM). Eur Arch Paediatr Dent 2011; 11:232-5. [PMID: 20932397 DOI: 10.1007/bf03262753] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIM To assess the efficiency of different polyacrylic acid concentrations on the removal of the smear layer after caries removal with hand and rotary instruments in affected dentine of primary teeth. STUDY DESIGN In vitro study. METHODS Six exfoliated primary molars with carious lesions were divided into two groups for caries removal: (1) hand instrument or (2) low speed bur. Each tooth was cut into four pieces. One piece assigned as control surface and the other three surfaces were actively treated with either 40% Fuji IXGP Liquid (GC America), or 40% Fuji IXGP Liquid diluted with water, and 25% Ketac Molar(TM) Conditioner (3M-ESPE). Surfaces were prepared for scanning electron microscopy (SEM). All images were submitted to an analysis by an experienced SEM professional, regarding presence or absence of smear layer and dentinal demineralization pattern. Chi-squared test was carried out (5% significance). RESULTS There was no difference concerning the presence of a smear layer in relation to the method of caries removal, and 40% Fuji IXGP diluted with water causes a higher demineralization when compared with the control group of teeth (p=0.01). CONCLUSION Treatments with polyacrylic acid are indicated prior to glass ionomer cement application in primary teeth.
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Abstract
The success of ART as a caries management approach is supported by more than 20 years of scientific evidence. ART follows the contemporary concepts of modern cariology and restorative dentistry. It challenges treatment concepts such as step-wise excavation and the need for complete removal of affected dentine. The ART approach so far has mainly used high-viscosity glass-ionomer as the sealant and restorative material. Cariostatic and remineralization properties have been ascribed to this material which requires further research to establish its clinical relevance. The adhesion of high-viscosity glass-ionomer to enamel in pits and fissures is apparently strong, as its remnants, blocking the pits and fissures, have been considered a possible reason for the low prevalence of carious lesion development after the glass-ionomer has clinically disappeared from it. Encapsulated high-viscosity glass-ionomers may lead to higher restoration survival results than those of the hand-mixed version and should, therefore, not be neglected when using ART. Similarly, the use of resin-modified glass-ionomer with ART should be researched. The effectiveness of ART when compared to conventional caries management approaches has been shown in numerous studies. Proper case selection is an important factor for long-lasting ART restoration survival. This is based on the caries risk situation of the individual, the size of the cavity opening, the strategic position of the cavitated tooth and the presence of adequate caries control measures. As the operator is one of the main causes for failure of ART restorations, attending a well-conducted ART training course is mandatory for successful implementation of ART.
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Affiliation(s)
- Gustavo Fabián Molina
- Department of Dental Materials, The Dental Faculty, National University of Córdoba, Argentina.
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