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Title Similar Survival Rates Of Bonded Amalgam And Non-bonded Amalgam Restorations
Clinical Question In a patient requiring an amalgam restoration, does a bonded amalgam restoration have a better survival rate than a traditional non-bonded amalgam restoration?
Clinical Bottom Line There is no evidence to determine whether there is a difference in survival rate between bonded and non-bonded amalgam restorations. (See Comments on the CAT below)
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) 19821423Fedorowicz/200931 patients (21 males, 10 females, no age specified) were selected for the study.Systematic Review
Key resultsThere were 31 adult patients with 113 restorations on permanent molar and premolar teeth suitable for Class I and II amalgam restorations. N = 113 restorations. Size, location and number per participant were unreported but 35 matched pairs were compared and analyzed. No deliberate provision of undercuts or retention in any preparations were present. Group 1: 60 adhesively bonded amalgam restorations were placed. Dycal (LD Caulk) liner; ED primer (Kuraray); Panavia 21TC (Kuraray); Oxyguard II gel (Kuraray); Dispersalloy amalgam (Dentsply) were types of material used in this group as restorations.Group 2: 53 non-bonded amalgam restorations. Dycal (LD Caulk) liner; Dispersalloy amalgam (Dentsply) were used on this group as restorations. At 2 years only 3 out of 53 restorations in the non-bonded group were lost, which was attributed to a lack of retention, and 55 of 60 bonded restorations survived with five unaccounted for at follow-up. 50 out of 53 non-bonded restorations survived after 24 months post-placement. There was no significant difference between the survival of bonded vs. non-bonded restorations over a two year period (p = 0.115).
Evidence Search "Dental Amalgam"[Mesh] "Dental Restoration Failure"[Mesh] "Dental Caries/therapy"[Mesh] "Dental Bonding/methods"[Mesh] ...view in PubMed
Comments on
The Evidence
The type of study design was a systematic review. The patients were similar at the start requiring class I and II amalgam restorations on the permanent molar and premolar teeth. The study was not a double blind study as the participants were not aware of the interventions but the dentists were aware. The compliance was adequate, with unclear risk of bias, and no competing interests, but perhaps a 2-year period follow-up was not adequate. Failure of the restoration was not clearly defined, but appears to refer to total or partial loss of the box part of the restoration.
Applicability The subjects in this study would be representative of the future patients in need of a class I or II amalgam restorations in the vital posterior teeth. The treatment would be feasible in any general dentist setting, but there would be a potential risk of post-operative sensitivity. The patients’ expectations would be an amalgam restoration with high survival rate.
Specialty/Discipline (General Dentistry) (Restorative Dentistry)
Keywords dental restoration; amalgam; dental bonding
ID# 630
Date of submission: 04/05/2010spacer
E-mail Laiyh@livemail.uthscsa.edu
Author Yen Hong Lai
Co-author(s) e-mail
Faculty mentor/Co-author Joseph Connor, DDS
Faculty mentor/Co-author e-mail connorj@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Meredith Dugoni (South Jordan, UT) on 10/04/2012
I conducted a PubMed search on this top in October 2012 and found one recently published article on this topic, PMID 22186810 . This recent (2011) comparative in vitro study showed the amalgam bonding technique is more effective than using retention grooves or proximal boxes in providing resistance to amalgam restoration displacement. This finding is significant because it suggests it may no longer be necessary to remove excess sound tooth structure during cavity preparations. The study used 40 total extracted teeth with only 10 teeth in each study group. The small sample size and use of extracted teeth are both limitations to the study design. The most recent Systemic Review is the original CAT article by Fedorowicz which is a higher level of evidence than the study by Gupta.

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