Does low-cost GIC have the same survival rate as high-viscosity GIC in atraumatic restorative treatments? A RCT

The preventive effect of glass ionomer restorations on new caries formation: A systematic review and meta-analysis

OBJECTIVE

To investigate the effectiveness of glass ionomer cement (GIC) restorations on preventing new caries in primary or permanent dentitions compared with other types of restorations.

DATA

Randomized controlled clinical trials evaluating caries experience increment or caries incidence in patients with GIC restorations, including conventional GIC (CGIC) and resin-modified GIC (RMGIC) restorations, were included.

SOURCES

A systematic search of publications in English was conducted in PubMed/Medline, Web of Science, Cochrane, and Scopus databases.

STUDY SELECTION/RESULTS

This review included 10 studies reporting caries preventive effect of GIC restorations and selected 5 studies for meta-analysis. Patients with GIC restorations showed lower caries incidence compared with other restorations in primary and permanent dentition [RR=0.67, 95% CI:0.55-0.82, p<0.0001]. Patients with CGIC restorations showed lower caries incidence compared with amalgam restorations [RR=0.57, 95% CI:0.43-0.76, p=0.0001] and RMGIC restorations [RR=0.70, 95% CI:0.56-0.87, p=0.002], but no statistical difference with composite resin restorations [RR=0.73, 95% CI:0.51-1.04, p=0.08] in primary dentition. Patients with RMGIC restorations showed no statistical differences of caries incidence compared with composite resin restorations in primary and permanent dentition [RR=0.83, 95% CI:0.56-1.22, p=0.33].

CONCLUSIONS

GIC restorations presented a better preventive effect on new caries than other restorations did in primary and permanent dentitions. CGIC restorations presented a better caries preventive effect on new caries than RMGIC and amalgam restorations in primary dentitions did. RMGIC restorations showed similar preventing effect on new caries with composite resin restorations in primary and permanent dentitions.

CLINICAL SIGNIFICANCE

This review affirmed the potential of GIC in preventing new caries development in the dentition.

Clinical effectiveness of restorative materials for the restoration of carious primary teeth without pulp therapy: a systematic review

Purpose

To systematically search the available evidence and evaluate the clinical effectiveness of restorative materials for restoration of carious primary teeth. The findings aimed to support the European Academy of Paediatric Dentistry (EAPD) guidelines development.

Methods

Literature search was performed by searching 4 electronic databases for eligible randomised controlled clinical trials (RCTs) comparing restorative materials for the restoration of carious primary teeth up to December 28th, 2020. Quality assessment was performed with the revised Cochrane risk-of-bias tool for randomized trials (RoB 2).

Results

Of 1685 identified articles 29 RCTs were finally deemed as eligible for inclusion. Annual failure rates were: Amalgam 1–28%; atraumatic restorative treatment 1.2–37.1%; glass-ionomer cement (GIC) 7.6–16.6%, metal-reinforced GIC 29.9%, resin-modified GIC 1.9–16.9%, high-viscosity GIC 2.9–25.6%; glass carbomer ≤ 46.2%; compomer 0–14.7%; composite resin (CR) 0–19.5%, bulk-fill CR 0–16.9%; zirconia crowns 3.3%, composite strip crowns 15%, and preformed metal crowns (Hall-Technique) 3.1%. Secondary caries, poor marginal adaptation, loss of retention, and fracture of restoration were reported as reasons for failure. Four studies were evaluated at unclear and 25 at high risk of bias. Clinical and methodological heterogeneity, and the diversity of tested materials across included studies did not allow for meta-analyses.

Conclusions

Within the limitations of this systematic review, namely, the heterogeneity and the overall high risk of bias among included studies, clear recommendations based on solid evidence for the best restorative approach in primary teeth cannot be drawn. There is a need for future thoroughly implemented RCTs evaluating restorations in primary teeth to close this knowledge gap.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40368-022-00725-7.

Atraumatic restorative treatment restorations performed in different settings: systematic review and meta-analysis

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.

Consensus on glass-ionomer cement thresholds for restorative indications

OBJECTIVE

The aim of this paper is to present the results of a consensus meeting on the threshold property requirements for the clinical use of conventional glass-ionomer cements (GICs) for restorative indications.

METHODS

Twenty-one experts on GICs evaluated the results of tests on mechanical and optical properties of 18 different brands of restorative GICs: Bioglass R [B], Chemfil Rock [CR], Equia Forte [EF], Gold Label 2 [GL2], Gold Label 9 [GL9], Glass Ionomer Cement II [GI], Ionglass [IG], Ion Z [IZ], Ionomaster [IM], Ionofil Plus [IP], Ionostar Plus [IS], Ketac Molar Easymix [KM], Magic Glass [MG], Maxxion R [MA], Riva Self Cure [R], Vidrion R [V], Vitro Fil [VF] and Vitro Molar [VM]. All experiments were carried out by a team of researchers from Brazil and England following strict protocols, under the same laboratory conditions throughout, and maintaining data integrity.

RESULTS

There was consensus on: determining as primary properties of the material: compressive strength, microhardness, acid erosion and fluoride release, and as secondary properties: contrast ratio and translucency parameter, in order to rank the materials. Seven brands were below the thresholds for restorative indications: IZ, IM, IG, MA, VF, B and MG.

CONCLUSIONS

Based on the primary properties adopted as being essential for restorative indications, the conventional restorative GICs that met the thresholds and could be considered suitable as long-term restorative materials were: EF, GI, GL9, KM, IP, GL2, IS, CR, V, VM and R. A decision-making process to select the best GIC must also include results from clinical trials.

CLINICAL SIGNIFICANCE

This study provides a ranking of GICs that could be considered suitable as long-term restorative materials based on their main properties.

Twelve-month evaluation of the atraumatic restorative treatment approach for class III restorations: An interventional study

BACKGROUND

Atraumatic restorative treatment (ART) may be appropriate for populations without accessibility and affordability. More data are required regarding the success rate of ART in anterior teeth.

AIM

To evaluate the clinical performance of restoring class III cavities in anterior teeth of permanent dentition using the ART approach.

METHODS

A longitudinal interventional field study was carried out at two rural primary health centers, Tumkur district, India. A total of 54 teeth in 39 patients were evaluated for the survival rate of class III restorations in permanent anterior teeth using the ART approach in children and adult populations. Evaluation of ART restoration was carried out using Frencken J criteria, the mean procedure time, patient acceptance and reported pain severity during the ART approach were evaluated using a visual analog scale. Calculation of the cost of ART was also performed.

RESULTS

The mean time taken to perform the ART procedure was 14.79 ± 5.8 min with the majority of patients reporting only mild pain. At 6 mo follow-up, 72.2% remained in a good state, but this reduced to 27% at 12 mo. The cumulative survival rate of the restorations was 94.4% at 6 mo and 80.9% at 12 mo follow-up. Estimation of the direct cost for a single class III restoration was 186.50 INR (2.64 USD).

CONCLUSION

ART may be a good comprehensive option for basic oral health care for underserved or inaccessible populations, and preventive care for patients.