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Reda SA, Hussein YF, Riad M. The impact of Bis-GMA free and Bis-GMA containing resin composite as posterior restoration on marginal integrity: a randomized controlled clinical trial. BMC Oral Health 2023; 23:1022. [PMID: 38114979 PMCID: PMC10731870 DOI: 10.1186/s12903-023-03759-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/12/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND There have been concerns surrounding the utilization of Bis-GMA, a type of bisphenol A (BPA) derivative, within the dental industry. The aim of this study was to compare the performance of bulk fill Bis-GMA-free resin composite class II restorations in respect of its marginal integrity in comparison to bulk fill Bis-GMA-containing resin composite class II restorations over a 12-month period in a parallel clinical trial utilizing a split-mouth, double-blind, randomized strategy. METHODS 20 patients participated in this study. Each patient has received one pair of class II posterior restorations, Bis-GMA-free (Admira fusion x-tra), and Bis-GMA containing (x-tra fil) on each side of the mouth (split-mouth strategy), (n = 40). The restorations' marginal integrity was evaluated based on Ryge's criteria (modified USPHS) at baseline (after 1 week), as well as 1 month, 3 months, 6 months, 9 months, and after 12 months of follow-up by two calibrated examiners. The statistical analyses utilizing the Friedman and Wilcoxon tests, the significance level was adjusted to 0.05. RESULTS Following the 12-month period, all patients attended the recall visits to evaluate the restorations. The Wilcoxon signed-rank and Friedman tests, revealed that both types of bulk fill had 100% of Alpha (A) scores at baseline and after 1 month with no significant statistical differences. After 3, 6, 9, and 12 months, both tested bulk fill restorations showed Bravo (B) score with Bis-GMA free 10% and 5% for Bis-GMA containing with no statistically significant difference (p ≤ 0.05) for clinical marginal integrity parameter in USPHS criteria. CONCLUSIONS Bis-GMA-free resin composites demonstrated satisfactory, marginal integrity compared with Bis-GMA-containing resin composites within 12 months. TRIAL REGISTRATION The protocol of the current study was registered at www. CLINICALTRIALS gov , with the identification number NCT05480852 on 29/07/2022. All procedures involving human participants were performed in accordance with the ethical standards of the Research Ethics Committee of the Faculty of Dentistry, Minia University, Egypt, under the approval number 419 on 27/06/2020.
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Affiliation(s)
- Sara Ahmed Reda
- Operative Dentistry Department, Faculty of Dentistry, Minia University, Minia, Egypt
| | - Yasser Fathi Hussein
- Dental Biomaterials Department, Faculty of Dentistry, Minia University, Minia, 61519, Egypt
| | - Mona Riad
- Conservative Dentistry Department, Faculty of Dentistry, Cairo University, 11 El-Saraya St, Manial, Cairo, 11553, Egypt.
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2
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Amend S, Seremidi K, Kloukos D, Bekes K, Frankenberger R, Gizani S, Krämer N. Clinical Effectiveness of Restorative Materials for the Restoration of Carious Primary Teeth: An Umbrella Review. J Clin Med 2022; 11:jcm11123490. [PMID: 35743560 PMCID: PMC9225564 DOI: 10.3390/jcm11123490] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Stefanie Amend
- Department of Paediatric Dentistry, University Medical Centre Giessen and Marburg (Campus Giessen), Medical Centre for Dentistry, Justus-Liebig-University Giessen, Schlangenzahl 14, 35392 Giessen, Germany;
- Correspondence:
| | - Kyriaki Seremidi
- Department of Paediatric Dentistry, Athens School of Dentistry, National & Kapodistrian University of Athens, 2 Thivon Str, Goudi, 115 27 Athens, Greece; (K.S.); (S.G.)
| | - Dimitrios Kloukos
- Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland;
| | - Katrin Bekes
- Department of Paediatric Dentistry, University Clinic of Dentistry, Medical University Vienna, Sensengasse 2a, 1090 Vienna, Austria;
| | - Roland Frankenberger
- Department of Operative Dentistry, Endodontics and Paediatric Dentistry, University Medical Centre Giessen and Marburg (Campus Marburg), Medical Centre for Dentistry, Philipps-University Marburg, Georg–Voigt–Str. 3, 35039 Marburg, Germany;
| | - Sotiria Gizani
- Department of Paediatric Dentistry, Athens School of Dentistry, National & Kapodistrian University of Athens, 2 Thivon Str, Goudi, 115 27 Athens, Greece; (K.S.); (S.G.)
| | - Norbert Krämer
- Department of Paediatric Dentistry, University Medical Centre Giessen and Marburg (Campus Giessen), Medical Centre for Dentistry, Justus-Liebig-University Giessen, Schlangenzahl 14, 35392 Giessen, Germany;
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3
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Is the clinical performance of composite resin restorations in posterior teeth similar if restored with incremental or bulk-filling techniques? A systematic review and meta-analysis. Clin Oral Investig 2022; 26:2281-2297. [DOI: 10.1007/s00784-021-04337-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 12/04/2021] [Indexed: 11/26/2022]
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4
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Mickenautsch S. Are Most of the Published Clinical Trial Results in Restorative Dentistry Invalid? An Empirical Investigation. Rev Recent Clin Trials 2021; 15:122-130. [PMID: 32316900 DOI: 10.2174/1574887115666200421110732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/09/2020] [Accepted: 04/13/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND To establish the number of invalid clinical trial reports in restorative dentistry, due to lack of effective randomisation and/or inadequate sample size and whether this number changed, during the 1990-2019 period. METHODS Databases were searched up to 14 July 2019 without limitations regarding publication language. A Journal hand search and reference check were conducted for trial reports. Selection criteria were: reporting on a prospective, controlled clinical trial; relevance to placing direct tooth restorations in human vital teeth; direct comparison between restorative materials concerning tooth restoration longevity; trial report published from 1990. Randomisation reported (Yes/No) and treatment group sample size ≥ 200 were applied as criteria, using the deductive falsification approach for trial report appraisal. RESULTS 683 trial reports were appraised. 660 lacked effective randomisation. Of the remaining 23 reports, only 2 included a sample size of more than 200 restored teeth (mean number per treatment group 87; Standard deviation = 108.51). 92.5% of all treatment groups had a sample size of < 200. Randomisation reporting increased and sample size remained essentially unchanged between 1990 and 2019. CONCLUSION Most of the published clinical trial results in restorative dentistry were judged invalid, due to lack of effective randomisation and adequate sample size. These results are in line with previous findings. Evidence-based recommendations on how to improve trial methodology are available in the dental/medical literature.
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Affiliation(s)
- Steffen Mickenautsch
- System Initiative/Department of Community Dentistry, School of Oral Health Sciences, Faculty of Health Sciences, University of the Witwatersrand, 7 York Rd., Parktown/Johannesburg 2193, South Africa
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5
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Zhang A, Ye N, Aregawi W, Zhang L, Salah M, VanHeel B, Chew HP, Fok ASL. A Review of Mechano-Biochemical Models for Testing Composite Restorations. J Dent Res 2021; 100:1030-1038. [PMID: 34365857 DOI: 10.1177/00220345211026918] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Due to the severe mechano-biochemical conditions in the oral cavity, many dental restorations will degrade and eventually fail. For teeth restored with resin composite, the major modes of failure are secondary caries and fracture of the tooth or restoration. While clinical studies can answer some of the more practical questions, such as the rate of failure, fundamental understanding on the failure mechanism can be obtained from laboratory studies using simplified models more effectively. Reviewed in this article are the 4 main types of models used to study the degradation of resin-composite restorations, namely, animal, human in vivo or in situ, in vitro biofilm, and in vitro chemical models. The characteristics, advantages, and disadvantages of these models are discussed and compared. The tooth-restoration interface is widely considered the weakest link in a resin composite restoration. To account for the different types of degradation that can occur (i.e., demineralization, resin hydrolysis, and collagen degradation), enzymes such as esterase and collagenase found in the oral environment are used, in addition to acids, to form biochemical models to test resin-composite restorations in conjunction with mechanical loading. Furthermore, laboratory tests are usually performed in an accelerated manner to save time. It is argued that, for an accelerated multicomponent model to be representative and predictive in terms of both the mode and the speed of degradation, the individual components must be synchronized in their rates of action and be calibrated with clinical data. The process of calibrating the in vitro models against clinical data is briefly described. To achieve representative and predictive in vitro models, more comparative studies of in vivo and in vitro models are required to calibrate the laboratory studies.
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Affiliation(s)
- A Zhang
- Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - N Ye
- Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - W Aregawi
- Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - L Zhang
- Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA.,The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - M Salah
- Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA.,Faculty of Dentistry, Ain-Shams University, Cairo, Egypt
| | - B VanHeel
- Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - H P Chew
- Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - A S L Fok
- Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
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6
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Durão MDA, de Andrade AKM, do Prado AM, Veloso SRM, Maciel LMT, Montes MAJR, Monteiro GQDM. Thirty-six-month clinical evaluation of posterior high-viscosity bulk-fill resin composite restorations in a high caries incidence population: interim results of a randomized clinical trial. Clin Oral Investig 2021; 25:6219-6237. [PMID: 33821322 DOI: 10.1007/s00784-021-03921-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study compared the clinical performance of two bulk-fill (BF) and one conventional resin composite in a population with a high caries incidence. MATERIALS AND METHODS A total of 138 class I and II restorations were performed and randomly divided into three groups (n = 46) with equal allocation: Filtek BF (FBF; 3M ESPE), Tetric EvoCeram BF (TBF; Ivoclar Vivadent), and control Filtek Z250 (Z250; 3M ESPE). The evaluations were performed using the USPHS and FDI criteria at baseline and after 12 and 36 months by a previously calibrated evaluator. The Friedman and Wilcoxon tests for paired data were used for statistical analysis (α = 0.05). RESULTS The DMFT index at baseline was 9.44, with 87% from the decayed component. After 36 months, 108 restorations (n = 36) were evaluated. Two failures were observed for TBF at marginal adaptation and recurrence of caries, resulting in a survival rate of 94.44% and an annual failure rate (AFR) of 1.26%. No equivalence was observed between the criteria for surface roughness, marginal adaptation, and discoloration. CONCLUSIONS The 36-month clinical performance of high-viscosity BF resin composites was comparable to conventional incremental-filled resin composites. The FDI criteria better presented the restorations' clinical success. However, in the case of failure, both criteria provided the same result. CLINICAL RELEVANCE High-viscosity bulk-fill resin composites showed excellent performance after 36 months in a high caries incidence population. It can be considered a simplified alternative restoration method that reduces operating time and minimizes possible operator errors.
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Affiliation(s)
- Márcia de Almeida Durão
- Faculdade de Odontologia, Universidade de Pernambuco, Av. Gov. Agamenon Magalhães, s/n; Santo Amaro, Recife, Pernambuco, 50.100-010, Brazil
| | - Ana Karina Maciel de Andrade
- Departamento de Dentística Restauradora, Faculdade de Odontologia, Universidade Federal da Paraíba, Cidade Universitária, s/n -, Castelo, Branco III, Paraíba, 58.051-085, Brazil
| | - Amanda Maciel do Prado
- Faculdade de Odontologia, Universidade de Pernambuco, Av. Gov. Agamenon Magalhães, s/n; Santo Amaro, Recife, Pernambuco, 50.100-010, Brazil
| | - Sirley Raiane Mamede Veloso
- Faculdade de Odontologia, Universidade de Pernambuco, Av. Gov. Agamenon Magalhães, s/n; Santo Amaro, Recife, Pernambuco, 50.100-010, Brazil
| | - Lynn Morena Tavares Maciel
- Faculdade de Odontologia, Universidade de Pernambuco, Av. Gov. Agamenon Magalhães, s/n; Santo Amaro, Recife, Pernambuco, 50.100-010, Brazil
| | | | - Gabriela Queiroz de Melo Monteiro
- Faculdade de Odontologia, Universidade de Pernambuco, Av. Gov. Agamenon Magalhães, s/n; Santo Amaro, Recife, Pernambuco, 50.100-010, Brazil.
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7
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Zhang H, Wang L, Hua L, Guan R, Hou B. Randomized controlled clinical trial of a highly filled flowable composite in non-carious cervical lesions: 3-year results. Clin Oral Investig 2021; 25:5955-5965. [PMID: 33797635 DOI: 10.1007/s00784-021-03901-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This prospective, randomized, split-mouth clinical trial assessed the 3-year clinical performance of a highly filled flowable composite and a conventional paste-type composite in non-carious cervical lesions (NCCLs). MATERIALS AND METHODS A total of 84 NCCLs in 27 subjects were included in this split-mouth design study and randomly divided into two groups: a highly filled flowable composite Clearfil Majesty ES Flow group (ES, n = 42) and a conventional paste-type composite Majesty group (MJ, n = 42). Clearfil SE Bond was used following the manufacturer's instructions. The restorations were evaluated at baseline (BL) and 1, 2, and 3 years using FDI (World Dental Federation) criteria. Data were analysed by a paired chi-squared test for intergroup comparisons and the Friedman test for intragroup comparisons (α = 0.05). RESULTS Both groups had a 97.3% retention rate at the 3-year evaluation. The acceptable scores (FDI scores 1-3) for each criterion exhibited no significant difference between the MJ and ES groups at any time point (p = 1.00). The marginal adaptation performance of ES was significantly better than that of MJ at every evaluation point (p < 0.05). CONCLUSIONS The 3-year clinical performance of ES in NCCLs was similar to that of MJ. When the restorations were clinically acceptable, ES showed better marginal adaptation than MJ. CLINICAL RELEVANCE Compared with conventional paste-type composites, highly filled flowable composites showed similar clinical performance and better marginal adaptation for restoring NCCLs after 3 years. TRIAL REGISTRATION TRN: ChiCTR1900028484 . Date of registration: December 22, 2019, retrospectively registered.
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Affiliation(s)
- Haiying Zhang
- Department of Endodontics, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Luxuan Wang
- Department of Endodontics, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Lin Hua
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Rui Guan
- Department of Endodontics, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Benxiang Hou
- Department of Endodontics, Beijing Stomatological Hospital, Capital Medical University, Beijing, China.
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8
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Delgado AHS, Jamal H, Young A, Ashley P. Scoping review of trials evaluating adhesive strategies in pediatric dentistry: where do simplified strategies lie? BMC Oral Health 2021; 21:33. [PMID: 33468122 PMCID: PMC7816513 DOI: 10.1186/s12903-021-01395-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adhesive restorations allow a conservative approach to caries management and are increasingly used as a restorative option in pediatric dentistry. Placement can be difficult in children because of the cooperation required for multiple bonding steps. Due to this, it is vital to assess if novel, simpler strategies have been featured in clinical trials and if clinical trials are researching the different existing adhesive strategies. METHODS This review followed Preferred Reporting Items for Systematic Reviews and Meta-analysis adapted for Scoping Reviews (PRISMA-ScR) guidelines. PubMed/Medline, Cochrane Central, Scopus and EMBASE were used for systematic search, using free keywords and controlled search terms. Clinical trials of children requiring a restorative intervention which featured adhesive strategies were included. Only peer-reviewed trials of primary teeth restored with resin composites, published in the last 10-year period were eligible. Data charting was accomplished independently by two reviewers, and studies were summarized according to their date, type, intervention, sample size, observation period, outcomes and conclusions. Quality assessment was performed using Cochrane's Risk of Bias 2.0 tool. RESULTS 700 potentially relevant references were found, which after a rigorous inclusion scheme, resulted in a total of 8 eligible clinical trials. Out of these, 7 were randomized clinical trials. Most trials featured a split-mouth design and the observation period ranged from 12 to 36 months. The trials evaluated interventions of two self-adhesive composites, two bulk-fill composites, two novel composites, one compomer and eight adhesives from different strategies. Most studies (4/8) included were judged to raise some concerns regarding risk of bias, while two were classified as high risk and two as low. CONCLUSION Few studies comparing adhesive strategies were found, especially adhesives in sound substrates. The existing studies do not reflect all current approaches that could be used in pediatric dentistry. Further studies addressing bioactive composites and contemporary adhesives are necessary.
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Affiliation(s)
- António H. S. Delgado
- Department of Biomaterials and Tissue Engineering, Royal Free Hospital, UCL Medical School, UCL Eastman Dental Institute, Rowland Hill Street, Hampstead, London, NW3 2PF UK
| | - Hasan Jamal
- Unit of Paediatric Dentistry, Department of Craniofacial Growth and Development, UCL Eastman Dental Institute, London, UK
| | - Anne Young
- Department of Biomaterials and Tissue Engineering, Royal Free Hospital, UCL Medical School, UCL Eastman Dental Institute, Rowland Hill Street, Hampstead, London, NW3 2PF UK
| | - Paul Ashley
- Department of Biomaterials and Tissue Engineering, Royal Free Hospital, UCL Medical School, UCL Eastman Dental Institute, Rowland Hill Street, Hampstead, London, NW3 2PF UK
- Unit of Paediatric Dentistry, Department of Craniofacial Growth and Development, UCL Eastman Dental Institute, London, UK
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9
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Araujo MP, Al-Yaseen W, Innes NP. A road map for designing and reporting clinical trials in paediatric dentistry. Int J Paediatr Dent 2020; 31 Suppl 1:14-22. [PMID: 33222306 DOI: 10.1111/ipd.12746] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/17/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Unless clinical trials are well-designed, there is a risk that they will not be usable to improve patient care. AIM This paper discusses some factors important in designing clinical trials in paediatric dentistry. It uses the prevention and management of dental caries in children as the lens through which to look at these. FINDINGS Amongst the factors to consider are clear research questions and objectives; appropriate outcomes and outcome measures; sample size calculation and the level of randomisation; methods for random allocation; and operator/assessor training. Experts in trial design including statisticians and a trialist should be consulted early in the design process. The aspects of trial design unique to cariology trials such as 'clustering' of data items, mixed dentition issues and those related to trials involving children (communication, consent etc) should be considered. Comprehensive reporting of trial results is essential. CONCLUSION There are many readily available resources and tools to help the researcher design a trial of good quality that will yield results useful to the research community and beyond, to those who will implement the findings and ultimately those who will benefit from them.
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Affiliation(s)
- Mariana Pinheiro Araujo
- NHS Education for Scotland, Dental Clinical Effectiveness, Dundee Dental Education Centre - DDEC, Small's Wynd, Dundee, UK
| | - Waraf Al-Yaseen
- Applied Clinical Research and Public Health, School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Nicola Patricia Innes
- Applied Clinical Research and Public Health, School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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Durão MDA, Andrade AKMD, Santos MDCMDS, Montes MAJR, Monteiro GQDM. Clinical Performance of Bulk-Fill Resin Composite Restorations Using the United States Public Health Service and Federation Dentaire Internationale Criteria: A 12-Month Randomized Clinical Trial. Eur J Dent 2020; 15:179-192. [PMID: 33242913 PMCID: PMC8184274 DOI: 10.1055/s-0040-1718639] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective
This study was aimed to compare the 12-month clinical performance of two full-body bulk-fill resin composites Filtek bulk fill/3M ESPE (FBF) and Tetric EvoCeram bulk fill/Ivoclar Vivadent (TBF) and a conventional microhybrid resin composite Filtek Z250/3M ESPE (Z250) using the modified the United States Public Health Service (USPHS) and Federation Dentaire Internationale (FDI) criteria. Also, the agreement between the two evaluation criteria was evaluated at baseline and after 12 months of follow-up.
Materials and Methods
A total of 138 class I and II restorations were placed in posterior teeth (split-mouth design) of 46 volunteers following manufacturer’s instructions and bonded with a self-etching bonding agent (Clear fill SE Bond/Kuraray). The restorations were evaluated at baseline and after 12 months of follow-up by three previously calibrated dentists (Cohen’s
K
= 0.84).
Statistical Analysis
Fisher’s exact test and Pearson’s Chi-squared test were used to evaluating the homogeneity of distribution of the clinical characteristics. Friedman’s test was applied to evaluate differences among the resin composites. The results obtained for the USPHS and FDI criteria at the different observation times were compared using the Wilcoxon test. A level of significance of 0.05 was adopted for all tests.
Results
After 12 months (recall rate, 78.3%,
n
= 36 patients), the overall success rate was 99.07% for both criteria. Only one failed restoration (0.93%) was detected for each system during follow-up in the TBF group.
Conclusion
The bulk-fill resin composites showed satisfactory clinical performance compared with conventional resin composite after 12 months. The percentage of the acceptable scores was significantly higher for the USPHS criteria, due to discrepancies in the score description for each criterion.
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Affiliation(s)
- Márcia de Almeida Durão
- School of Dentistry, University of Pernambuco, Avenida Agamenon Magalhães, S/N - Santo Amaro - Recife - PE, Brazil
| | - Ana Karina Maciel de Andrade
- Department of Restorative Dentistry, Dental School, Universidade Federal da Paraíba, Cidade Universitária, Brazil
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Arbildo-Vega HI, Lapinska B, Panda S, Lamas-Lara C, Khan AS, Lukomska-Szymanska M. Clinical Effectiveness of Bulk-Fill and Conventional Resin Composite Restorations: Systematic Review and Meta-Analysis. Polymers (Basel) 2020; 12:polym12081786. [PMID: 32785019 PMCID: PMC7464794 DOI: 10.3390/polym12081786] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/01/2020] [Accepted: 08/07/2020] [Indexed: 12/11/2022] Open
Abstract
The objective of this systematic review and meta-analysis was to determine the clinical effectiveness of bulk-fill and conventional resin in composite restorations. A bibliographic search was carried out until May 2020, in the biomedical databases Pubmed/MEDLINE, EMBASE, Scopus, CENTRAL and Web of Science. The study selection criteria were: randomized clinical trials, in English, with no time limit, with a follow-up greater than or equal to 6 months and that reported the clinical effects (absence of fractures, absence of discoloration or marginal staining, adequate adaptation marginal, absence of post-operative sensitivity, absence of secondary caries, adequate color stability and translucency, proper surface texture, proper anatomical form, adequate tooth integrity without wear, adequate restoration integrity, proper occlusion, absence of inflammation and adequate point of contact) of restorations made with conventional and bulk resins. The risk of bias of the study was analyzed using the Cochrane Manual of Systematic Reviews of Interventions. Sixteen articles were eligible and included in the study. The results indicated that there is no difference between restorations with conventional and bulk resins for the type of restoration, type of tooth restored and restoration technique used. However, further properly designed clinical studies are required in order to reach a better conclusion.
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Affiliation(s)
- Heber Isac Arbildo-Vega
- Department of General Dentistry, Dentistry School, Universidad San Martín de Porres, Chiclayo 14012, Peru;
- Department of General Dentistry, Dentistry School, Universidad Particular de Chiclayo, Chiclayo 14012, Peru
| | - Barbara Lapinska
- Department of General Dentistry, Medical University of Lodz, 92-213 Lodz, Poland;
| | - Saurav Panda
- Department of Periodontics and Oral Implantology, Siksha ‘O’ Anusandhan Univeristy, Bhubaneswar 751003, India;
- Department of Biomedical, Surgical and Dental Sciences, Universita Degli Studi di Milano, 20122 Milano, Italy
| | - César Lamas-Lara
- Department of General Dentistry, Stomatology School, Universidad Peruana Los Andes, Lima 15072, Peru;
| | - Abdul Samad Khan
- Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia;
| | - Monika Lukomska-Szymanska
- Department of General Dentistry, Medical University of Lodz, 92-213 Lodz, Poland;
- Correspondence: ; Tel.: +48-42-675-74-61
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Abstract
Randomized control trial (RCT) methodology has compared interventions for the prevention and management of dental caries since the late 1960s. Despite almost 50 years and evidence of significant wastage within the wider biomedical research field, there has been little investigation into what works well and where weaknesses lie. This paper aims to draw attention to areas for improvement within cariology clinical trial methodology by summarizing systematic reviews on interventions and outcomes, and using examples to illustrate some challenges with intervention delivery fidelity, outcome analyses, and intervention co-production. Trial design stage choices are critical to ensure that optimum information is obtained when testing interventions. Intervention choice, outcome choice, and analyses are particularly important, and cariology trials have specific issues associated with them. A systematic search and review of cariology RCTs found 650 RCT reports. Social Network Analysis of interventions revealed a high degree of separation between prevention and management trials, gaps in clinically important comparisons, and a tendency for there to be comparisons within groups; e.g., comparison of interventions within the same, rather than different, levels of invasiveness. Outcomes measured for the same trial reports show: a focus on restoration performance and individual/population caries burden; the growing use of carious lesion activity and economic-related outcomes; and sparse, although an increase in the use of, patient-reported/patient-centered outcomes. Fidelity of adherence to complex interventions can be challenging to measure but is important in interpreting trial findings. Involving target populations in intervention design, delivery, and relating it to the planned rollout, are opportunities to ensure intervention relevance and improved uptake. Outcomes analyses should consider the minimum clinically important differences and outcome relevance measures for the target population. Factors underlying trialists' comparator and outcome choices need to be identified, and there is a need to ensure that a minimum dataset of outcomes allow for combination and comparisons of trial data for systematic review.
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Affiliation(s)
- N P T Innes
- 1 Paediatric Dentistry, Dundee Dental Hospital and School, University of Dundee, Dundee, UK
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13
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Chen J, Li Z, Liu B, Gan X, Li C, Yu H. Quality improvement in randomized controlled trial abstracts in prosthodontics since the publication of CONSORT guideline for abstracts: a systematic review. J Dent 2018; 74:23-29. [PMID: 29742449 DOI: 10.1016/j.jdent.2018.04.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/23/2018] [Accepted: 04/27/2018] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES This study aimed to compare the reporting quality of randomized controlled trial (RCT) abstracts in prosthodontics before and after the publication of Consolidated Standards of Reporting Trials (CONSORT) guideline for abstracts and identify the characteristics associated with better reporting quality. SOURCES PubMed was searched for RCT abstracts published from 2001 to 2007 (pre-CONSORT period) and from 2010 to 2016 (post-CONSORT period) in six leading prosthodontic journals. STUDY SELECTION After applying the inclusion/exclusion criteria, 131 RCT abstracts were selected. The t test was performed to compare the overall quality between the two periods. Univariable and multivariable linear regressions were used to identify any factors relating to the reporting quality. The level of significance was set at P < 0.05. DATA The investigators extracted data and scored the abstracts independently based on CONSORT. The mean overall CONSORT score was 5.20 and 6.11 in the pre- and post-CONSORT samples, respectively. Significant changes were observed in reporting for only three items: title, conclusions, and trial registration. Most abstracts adequately reported interventions, objectives, and conclusions (>90%), but failed to report recruitment and outcome in the results section (<3%). Funding was not reported in both periods. The reporting quality was related to a higher impact factor, structured format, and published after CONSORT. CONCLUSIONS The quality of RCT abstracts in prosthodontics improved over time, but adherence to the CONSORT guideline for abstracts was still suboptimal.
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Affiliation(s)
- Junsheng Chen
- State Key Laboratory of Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, PR China
| | - Zhi Li
- State Key Laboratory of Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, PR China
| | - Beilei Liu
- State Key Laboratory of Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, PR China
| | - Xueqi Gan
- State Key Laboratory of Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, PR China
| | - Chunjie Li
- State Key Laboratory of Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, PR China.
| | - Haiyang Yu
- State Key Laboratory of Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, PR China.
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14
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Veloso SRM, Lemos CAA, de Moraes SLD, do Egito Vasconcelos BC, Pellizzer EP, de Melo Monteiro GQ. Clinical performance of bulk-fill and conventional resin composite restorations in posterior teeth: a systematic review and meta-analysis. Clin Oral Investig 2018; 23:221-233. [PMID: 29594349 DOI: 10.1007/s00784-018-2429-7] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/19/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The purpose of this systematic review was to compare the clinical performance of bulk-fill resin composites with conventional resin composites used for direct restorations of posterior teeth. METHODS This review followed the PRISMA statement. This review was registered at PROSPERO (registration number CRD42016053436). A search of the scientific literature was performed by two independent reviewers using the PubMed/MEDLINE, Embase, The Cochrane Library, and Web of Science databases from commencement until January 2018. The research question was "Do bulk-fill resin composites have a clinical performance comparable to conventional resin composites in posterior restorations?" Only studies evaluating class I and II direct restorations in permanent teeth with a follow-up period of at least 1 year were included. The RevMan 5 program was used for meta-analysis, calculating the relative risk (RR) and 95% confidence interval (CI) of the dichotomous outcome (restoration failure or success). RESULTS Ten articles were selected, comprising 941 analyzed restorations. The mean follow-up period was 33.6 months (12-72 months). No statistically significant differences in the failure rate were observed between conventional and base/flowable bulk-fill resin composites (p = 0.31; RR 1.49; 95% CI 0.69-3.25) or full-body/sculptable bulk-fill resin composites (p = 0.12; RR 1.89; 95% CI 0.84-4.24). CONCLUSIONS The present systematic review and meta-analysis indicate similar clinical performances of bulk-fill and conventional resin composites over a follow-up period of 12 to 72 months. CLINICAL SIGNIFICANCE Based on the results of this study, the bulk-fill resin composites could be an alternative for direct restorations in posterior teeth. However, clinical trials of longer duration are required.
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Affiliation(s)
- Sirley Raiane Mamede Veloso
- Dental School, Universidade de Pernambuco/FOP-UPE, Av. General Newton Cavalcanti, 1650; Tabatinga, Camaragibe, PE, 54.756-220, Brazil
| | - Cleidiel Aparecido Araújo Lemos
- Araçatuba Dental School, UNESP - Univ Estadual Paulista , R. José Bonifácio, 1193; Vila Mendonca, Araçatuba, SP, 16015-050, Brazil
| | - Sandra Lúcia Dantas de Moraes
- Dental School, Universidade de Pernambuco/FOP-UPE, Av. General Newton Cavalcanti, 1650; Tabatinga, Camaragibe, PE, 54.756-220, Brazil
| | | | - Eduardo Piza Pellizzer
- Araçatuba Dental School, UNESP - Univ Estadual Paulista , R. José Bonifácio, 1193; Vila Mendonca, Araçatuba, SP, 16015-050, Brazil
| | - Gabriela Queiroz de Melo Monteiro
- Dental School, Universidade de Pernambuco/FOP-UPE, Av. General Newton Cavalcanti, 1650; Tabatinga, Camaragibe, PE, 54.756-220, Brazil.
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15
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Schwendicke F, Blunck U, Tu YK, Göstemeyer G. Does Classification of Composites for Network Meta-analyses Lead to Erroneous Conclusions? Oper Dent 2018; 43:213-222. [DOI: 10.2341/16-344-lit] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARY
Objectives:
Composites can be classified differently, according to manufacturer information, filler particle size, resin-monomer base, or viscosity, for example. Using clinical trial data, network meta-analyses aim to rank different composite material classes. Dentists then use these ranks to decide whether to use specific materials. Alternatively, annual failure rates (AFRs) of materials can be assessed, not requiring any classification for synthesis. It is unclear whether different classification systems lead to different rankings of the same material (ie, erroneous conclusions). We aimed to evaluate the agreement of material rankings between different classification systems.
Methods:
A systematic review was performed via MEDLINE, Cochrane Central Register of Controlled Trials, and EMBASE. Randomized controlled trials published from 2005-2015 that investigated composite restorations placed in load-bearing cavitated lesions in permanent teeth were included. Network meta-analyses were performed to rank combinations of composite classes (according to manufacturer, filler particle size, resin-monomers, viscosity) and adhesives. Material combinations were additionally ranked using AFRs.
Results:
A total of 42 studies (6088 restorations, 2325 patients) were included. The ranking of most material class combinations showed significant agreement between classifications (R2 ranged between 0.03 and 0.56). Comparing material combinations using AFRs had low precision and agreement with other systems. AFRs were significantly correlated with follow-up periods of trials.
Conclusion:
There was high agreement between rankings of identical materials in different classification systems. Such rankings thus allow cautious deductions as to the performance of a specific material. Syntheses based on AFRs might lead to erroneous results because AFRs are determined by follow-up periods and have low precision.
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Affiliation(s)
- F Schwendicke
- Falk Schwendicke, PhD, DDS, MDPH, Department of Operative and Preventive Dentistry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - U Blunck
- Uwe Blunck, DMD, Department of Operative and Preventive Dentistry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Y-K Tu
- Yu-Kang Tu, PhD, College of Public Health, Institute of Epidemiology and Preventive Medicine, Taipei, Taiwan
| | - G Göstemeyer
- Gerd Göstemeyer, DDS, Department of Operative and Preventive Dentistry, Charité Universitätsmedizin Berlin, Berlin, Germany
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16
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Opdam N, Collares K, Hickel R, Bayne S, Loomans B, Cenci M, Lynch C, Correa M, Demarco F, Schwendicke F, Wilson N. Clinical studies in restorative dentistry: New directions and new demands. Dent Mater 2018; 34:1-12. [DOI: 10.1016/j.dental.2017.08.187] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/24/2017] [Indexed: 10/18/2022]
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17
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Schwendicke F, Opdam N. Clinical studies in restorative dentistry: Design, conduct, analysis. Dent Mater 2017; 34:29-39. [PMID: 28988780 DOI: 10.1016/j.dental.2017.09.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 08/28/2017] [Accepted: 09/15/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Clinical studies should be one main aspect underlying dentists' decision-making towards dental materials. Study design, conduct, analysis and reporting impact on the usefulness of studies. We discuss problems with current studies and highlight areas where improvement might be possible. METHODS Based on systematically and non-systematically collected data, we demonstrate where and why current studies in clinical dentistry deliver less-than-optimal results. Lending from general medicine, we suggest ways forward for clinical dental material science. RESULTS Randomized controlled (efficacy) trials remain a major pillar in dental material science, as they reduce selection bias and, if well-designed and conducted, have high internal validity. Given their costs and limited external validity, alternatives like practice-based or pragmatic controlled trials or observational studies can complement the evidence-base. Prior to conduct, researchers should focus on study comparators and setting (answering questions with relevance to clinical dentistry), and pay attention to statistical power, considering the study aim (superiority or non-inferiority trial), the expected event rate, and attrition. Study outcomes should be chosen on the basis of a core outcome set or, if not available, involving patients and other stakeholders. Studies should be registered a priori, and reporting should adhere to standards. Possible clustering should be accounted for during statistical analysis. SIGNIFICANCE Many clinical studies in dental material science are underpowered, and of limited validity and usefulness for daily decision-making. Dental researchers should mirror existing efforts in other medical fields in making clinical studies more valid and applicable, thus contributing to better dental care.
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Affiliation(s)
- Falk Schwendicke
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Aßmannshauser Str. 4-6, 14199 Berlin, Germany.
| | - Niek Opdam
- Radboud University Medical Centre, College of Dental Sciences, P.O. Box 9101, NL 6500 HB Nijmegen, The Netherlands.
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18
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Impact of Selection Bias on Treatment Effect Size Estimates in Randomized Trials of Oral Health Interventions: A Meta-epidemiological Study. J Dent Res 2017; 97:5-13. [DOI: 10.1177/0022034517725049] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Emerging evidence suggests that design flaws of randomized controlled trials can result in over- or underestimation of the treatment effect size (ES). The objective of this study was to examine associations between treatment ES estimates and adequacy of sequence generation, allocation concealment, and baseline comparability among a sample of oral health randomized controlled trials. For our analysis, we selected all meta-analyses that included a minimum of 5 oral health randomized controlled trials and used continuous outcomes. We extracted data, in duplicate, related to items of selection bias (sequence generation, allocation concealment, and baseline comparability) in the Cochrane Risk of Bias tool. Using a 2-level meta-meta-analytic approach with a random effects model to allow for intra- and inter-meta-analysis heterogeneity, we quantified the impact of selection bias on the magnitude of ES estimates. We identified 64 meta-analyses, including 540 randomized controlled trials analyzing 137,957 patients. Sequence generation was judged to be adequate (at low risk of bias) in 32% ( n = 173) of trials, and baseline comparability was judged to be adequate in 77.8% of trials. Allocation concealment was unclear in the majority of trials ( n = 458, 84.8%). We identified significantly larger treatment ES estimates in trials that had inadequate/unknown sequence generation (difference in ES = 0.13; 95% CI: 0.01 to 0.25) and inadequate/unknown allocation concealment (difference in ES = 0.15; 95% CI: 0.02 to 0.27). In contrast, baseline imbalance (difference in ES = 0.01, 95% CI: –0.09 to 0.12) was not associated with inflated or underestimated ES. In conclusion, treatment ES estimates were 0.13 and 0.15 larger in trials with inadequate/unknown sequence generation and inadequate/unknown allocation concealment, respectively. Therefore, authors of systematic reviews using oral health randomized controlled trials should perform sensitivity analyses based on the adequacy of sequence generation and allocation concealment.
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