ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Resin-Modified Glass Ionomer Cement May Be More Effective Than Amalgam at Reducing the Amount of Enamel Demineralization/Recurrent Caries Occurring at the Margins of Class II Restorations in Primary Molars
Clinical Question In a healthy child requiring a class II restoration in a primary molar, are glass ionomer cement restorations more effective than amalgam restorations in their ability to inhibit recurrent caries?
Clinical Bottom Line Two clinical trials indicate that resin-modified glass ionomer cement restorations may be more effective than amalgam restorations at reducing the amount of recurrent caries at the margins of class II preparations. However, due to the small sample size, the results should be interpreted with caution.
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) 10570589Donly/199940 children in need of two class II restorations in primary molars, ages 6-9 yrs.Split-Mouth Design
Key resultsIn this study of 40 subjects, there was a significant difference between the resin-modified glass ionomer cement restorations and the amalgam restorations in terms of longevity at 3-years follow-up (p<.03). It was also demonstrated that there was less recurrent caries or enamel demineralization at the margin of class II preparations restored with resin-modified glass ionomer cement compared to amalgam restorations (p<.0001).
#2) 11817797Dutta/2001120 children in need of class II restorations in primary molars, ages 4-9.Randomized Controlled Trial
Key resultsIn this study involving 120 children, significantly less recurrent caries were found in resin-modified glass ionomer cement restorations (4.7%) compared to amalgam restorations (12.5%) at 12 months follow-up (p<0.05). When considering marginal integrity, preservation of anatomic form, and recurrent caries combined, the resin-modified glass ionomer cement group (83.1%) was more successful compared to the group that received an amalgam (72%). (p<0.05).
Evidence Search (("glass ionomer"[Supplementary Concept] OR "glass ionomer"[All Fields]) AND amalgam[All Fields] AND recurrent[All Fields] AND ("dental caries"[MeSH Terms] OR ("dental"[All Fields] AND "caries"[All Fields]) OR "dental caries"[All Fields] OR "caries"[All Fields]) AND ("tooth, deciduous"[MeSH Terms] OR ("tooth"[All Fields] AND "deciduous"[All Fields]) OR "deciduous tooth"[All Fields] OR ("primary"[All Fields] AND "dentition"[All Fields]) OR "primary dentition"[All Fields])) AND "loattrfull text"[sb]
Comments on
The Evidence
Validity: Dutta and colleagues reported a randomized controlled trial. Both groups were similar at the start and there was greater than an 80% completion rate. The groups were treated the same, and all restorations were placed by the same pedodontist. There was adequate follow up and compliance. Recall bias was unlikely and no competing interests were reported. Donly and colleagues reported a split-mouth design. Both groups were also similar at the beginning, and there was a completion rate of greater than 80%. The groups were also treated the same, and there was adequate follow up and compliance. Recall bias was also unlikely and no competing interests were reported. Perspective: One of my primary concerns is that both of the studies were published more than 10 years ago. There has been no subsequent follow up since 2001, so there is no current evidence on the topic. Also, both studies confirm the lack of available clinical methods or a “gold standard” to determine recurrent caries on the margins of class II preparations. I feel that further studies should incorporate a longer follow-up period in order to get more accurate results, in determining if a direct restorative material placed in the primary dentition might be a better choice than a stainless steel crown.
Applicability The use of a resin-modified glass ionomer cement restoration could serve in restoring class II preparations in the primary dentition. Our pediatric patients could potentially benefit from restoring posterior teeth with resin-modified glass ionomer by reducing the amount of recurrent caries, potentially due to fluoride release, that could lead to the premature failure of class II restorations.
Specialty/Discipline (General Dentistry) (Pediatric Dentistry)
Keywords resin-modified glass ionomer cement and amalgam
ID# 2644
Date of submission: 02/28/2014spacer
E-mail cereceres@livemail.uthscsa.edu
Author Rodolfo Cereceres
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Joseph A. Bartoloni, DMD
Faculty mentor/Co-author e-mail Bartoloni@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?)
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None available
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