ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Restorations with Resin-Modified Glass Ionomer May Exhibit Greater Longevity than Resin Composites for Patients with Coarse Diets
Clinical Question In adolescent and adult patients with coarse diets, how do resin composites and resin-modified glass ionomers compare as restorative materials in regard to retention 1 year after placement?
Clinical Bottom Line For patients with coarse diets, resin-modified glass ionomer restorations appear to be more retentive than those consisting solely of resin composites; however, the primary evidence is based on a single trial of 44 patients with a total of 287 restorations evaluated. Another trial found that dietary coarseness is a factor that can negatively affect glass ionomer cement restorations. Additional research is indicated to further address the correlation between coarse diets and restoration materials.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 25453001 Adeleke/201244 adult patients with non-carious cervical lesions and coarse dietsRandomized Controlled Trial
Key resultsRestorations of non-carious lesions consisting of resin-modified glass ionomer were retained at an overall rate of 91.0%, which is significantly higher than the 74.1% retention of resin composites at a 12-month post-restoration evaluation (P<0.05). Deep lesions – those greater than 2.0 mm in depth – showed no significant difference in retention in regard to the material used, but shallower lesions had significant findings of 25.6% and 5.3% retention, respectively (P<0.05). Wear resistance and secondary caries incidence was noted as similar and not significant for the two materials.
#2) 21703078 Kemoli/2011804 pediatric patients with proximal, primary molar cavitiesRandomized Controlled Trial
Key resultsThis RCT examined a number of factors impacting the survival of different types of glass ionomer restorations, including dietary findings. Post-restoration meal data was obtained from 536 patients, and the 2-hour and 2-year survival rates of patients who ingested “hard” foods was significantly less than those who ate “mixture” or “soft” foods, regardless of glass ionomer used (chi-square = 8.34, P=0.002). The overall 2-year survival rate of the 648 restorations for all meal types available for final evaluation was approximately 31%.
Evidence Search PubMed search: (("glass ionomer"[Supplementary Concept] OR "glass ionomer"[All Fields]) AND ("diet"[MeSH Terms] OR "diet"[All Fields])) OR (("glass ionomer"[Supplementary Concept] OR "glass ionomer"[All Fields]) AND ("food"[MeSH Terms] OR "food"[All Fields])) OR (("composite resins"[MeSH Terms] OR ("composite"[All Fields] AND "resins"[All Fields]) OR "composite resins"[All Fields] OR ("resin"[All Fields] AND "composite"[All Fields]) OR "resin composite"[All Fields]) AND ("diet"[MeSH Terms] OR "diet"[All Fields]))
Comments on
The Evidence
Validity: Both trials enrolled similar starting groups for their test and control individuals. The Adeleke trial utilized both materials in each patient’s mouth, allowing for exposure to identical oral conditions and treatments. Additionally, both trials maintained adequate follow-up for the evaluations in scope and time intervals. The Adeleke trial could not be identified as a double-blind study, but the Kemoli trial was explicitly labeled as such. For the Kemoli trial, post-restoration meal data was only obtained for 67% of the patients, but the overall completion rate for each trial group was greater than 80%. Neither trial reported any competing interests. Perspective: Dietary considerations are often difficult to qualify or quantify for patients, but they can be important in deciding on restorative materials to be used for a patient. Between the two studies, both pediatric and adult patients were evaluated in terms of how diet affected the longevity of their restorations. While the Kemoli trial did not address a comparison between the two restoration mediums, it did further identify the importance of evaluating a patient’s diet – especially the post-restoration meal – on the likelihood of retention. Regional and cultural dietary differences should be considered when identifying materials that will provide the most functional and reliable restoration available for the patient.
Applicability Oral health professionals should consider patient diet in their evaluation of restorative materials. Both trials examined diets that are in many ways different than standard Westernized fare, perhaps limiting the findings from being readily generalized to all patient groups. Resin-modified glass ionomers are widely available and have properties that make them valuable in certain situations, so additional research in their relationship to diet may provide additional instances in which their use is indicated more so than other materials.
Specialty/Discipline (General Dentistry) (Restorative Dentistry)
Keywords Resin-modified glass ionomers, glass ionomers, resin composite, diet, restoration survival
ID# 2838
Date of submission: 04/02/2015spacer
E-mail nashtd@livemail.uthscsa.edu
Author Daniel Nash
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Georgiana S. Gross, MPH
Faculty mentor/Co-author e-mail grossg@uthscsa.edu
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