ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Atraumatic Restorative Treatment Has Demonstrated Similar Levels of Survival Rate and Efficacy When Compared to Conventional Amalgam Fillings
Clinical Question In a patient in an under served population, is the implementation of atraumatic restorative treatment (ART) an acceptable alternative to traditional amalgam treatment with regard to restoration survival rate and efficacy?
Clinical Bottom Line The implementation of atraumatic restorative treatment (ART) is an acceptable alternative to traditional amalgam treatment with regard to survival rate and efficacy for periods greater than 1 year. These results are tentative, however, pending further high quality randomized controlled trials.
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) 23951787Mickenautsch/2012Patients exhibiting any class of carious lesion of primary and permanent dentition.Meta-Analysis
Key resultsFrom the 52 extracted data sets, four provided evidence in favor of ART, three favored amalgam, and 45 showed no statistical significance (P=0.12-0.99). Data sets in favor of ART had a reduced restoration failure rate between 5-35%, while the data sets that favored amalgam were between 2-6%. Using a random-effects model, no difference was found between either intervention when calculated as a risk ratio and an odds ratio (95% confidence interval). Trials accepted showed similar failure rates in both interventions for periods as long as six years. Research gaps identified were due to insufficient numbers of trials or small sample sizes. These results should be interpreted cautiously as selection/detection-performance bias and attrition bias were identified. The unabridged version of this systematic review update is freely available on-line in the June 2012 Journal of Minimum Intervention in Dentistry at http://www.jmid.org.
Evidence Search (atraumatic[All Fields] AND restorative[All Fields] AND ("therapy"[Subheading] OR "therapy"[All Fields] OR "treatment"[All Fields] OR "therapeutics"[MeSH Terms] OR "therapeutics"[All Fields])) AND amalgam[All Fields] AND (Meta-Analysis[ptyp] OR systematic[sb])
Comments on
The Evidence
Validity: Two review authors independently searched 13 databases including hand-searching for non-indexed journals. There were no language restrictions. Only relevant prospective, clinical controlled trials (up to January 2012) with a minimum 1 year follow-up period were selected. Twenty trials met selection criteria for review. 11 trials used a parallel group design while the other trials followed a split-mouth design. Meta-analyses were conducted for each data set and homogenous groupings of data sets. Based on the current research available, the author suggests further randomized controlled trials utilizing a parallel group design, intervention randomization, and allocation concealment methods. Perspective: While this systematic review provides compelling evidence concerning the longevity of ART, its comprehensive nature also reveals the need for further high quality RCTs. However, until further trials are conducted this represents the best evidence concerning the performance of ART when compared to amalgam.
Applicability Patients are identified by gender and mean age. Ages of patients included in this review range from 2-78 yrs. Medical and dental status are not used as identifying factors. Based on this systematic review, patients in under served populations would benefit from ART techniques in communities where other options may not be readily available or accessible.
Specialty/Discipline (Public Health) (General Dentistry) (Pediatric Dentistry) (Restorative Dentistry)
Keywords Atraumatic restorative treatment and amalgam
ID# 2643
Date of submission: 02/24/2014spacer
E-mail gallowayn@livemail.uthscsa.edu
Author Nathaniel Galloway
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Suman Challa, BDS, MS
Faculty mentor/Co-author e-mail challas@uthscsa.edu
Basic Science Rationale
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