Title	Glass Ionomer Restorations Of Root Surface Caries Are More Resistant To Recurrent Caries Than Amalgam In Fluoride Users
Clinical Question	In a patient with root surface caries that is to be treated with a restoration, would an amalgam restoration or a glass ionomer restoration be more effective in preventing recurrent caries?
Clinical Bottom Line	Glass ionomer restorations had a greater potential than amalgam for remineralization of root surface lesions, and therefore less development of recurrent caries at the cavosurface margins. (See Comments on the CAT below)
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 12636121 Haveman/2003 111 restorations with the gingival cavosurface margin on the root in 9 xerostomic patients. Randomized Controlled Trial Key results 95 (86%) of the 111 restorations were evaluated at the 2-year recall appointment. They analyzed 2-year data using an analysis of variance for repeated measures and Fisher’s post hoc test. There was no significant difference between glass ionomer vs. amalgam restorations in regards to caries at the cavo-surface margin (CSM) among fluoride users. All of the restorations with caries at the CSM developed in the 3 patients who were less than 50% compliant with regards to daily use of fluoride gel. These 3 patients with glass ionomer restorations had a significantly lower rate of caries at the CSM than did patients with amalgam restorations (p < 0.05). 9699447 Creanor/1998 28 extracted human premolar teeth with artificially placed root surface lesions. In vitro Research Key results Results showed that varying degrees of subsurface demineralization and remineralization were evident, with a laminated appearance in lesions adjacent to the glass ionomer. There was higher remineralization in the glass ionomer-filled cavities than with the amalgam-filled cavities. In the water-cycled group, glass ionomer showed an increase in mineral content on tooth structure adjacent to the restoration (p < 0.05), while no changes were observed on tooth structure adjacent to the amalgam-filled cavities.
Evidence Search	"Root Caries"[Mesh] OR “Class V”[All Fields] AND "Dental Amalgam"[Mesh] AND "Glass Ionomer Cements"[Mesh]
Comments on The Evidence	The in vitro study type represents the lowest level of evidence available in regards to study design. These results are only from extracted premolar teeth with artificially placed lesions. The study assumes that remineralization is the main factor in the prevention of recurrent caries and that an in vitro study is comparable to the actual environment of the oral cavity without the factors of salivary flow or the oral hygiene status of a patient. However, in the randomized clinical trial where salivary flow and oral hygiene were accounted for, tooth structure adjacent to glass ionomer restorations in non-fluoride compliant patients had a lower caries rate than tooth structure adjacent to amalgam restorations.
Applicability	Caries high-risk patients with root surface caries who do not routinely use topical fluoride.
Specialty	(General Dentistry) (Restorative Dentistry)
Keywords	Class V, root surface caries, glass ionomer, amalgam
ID#	770
Date of submission	03/15/2011
E-mail	suhj@livemail.uthscsa.edu
Author	Judy Suh
Co-author(s)
Co-author(s) e-mail
Faculty mentor	James B. Summitt, DDS, MS
Faculty mentor e-mail	SUMMITT@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?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) by Liporoni, Priscila; Moncrief, Dionte' (San Antonio, TX) on 08/18/2013 A PubMed search produced a more pertinent article to the clinical question. DeMoor et. al., 2011 (PMID 19997859 ),also found that glass ionomers provided clinical caries inhibition. This study was conducted over a 24 month period on patients with cervical caries and xerostomia.