ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Limited Evidence to Support the Use of Tooth-Colored Bonded Restorative Materials as Replacements for Stainless Steel Crowns (SSCs) After Pulpotomies on Primary Molars
Clinical Question In children requiring a pulpotomy on a primary molar, are tooth-colored, bonded restorative materials as effective as stainless steel crowns for definitive restoration of a tooth?
Clinical Bottom Line The literature shows limited support for the use of tooth-colored bonded restorations over SSCs for restoration of primary molars following pulpotomy. Although results seem positive, there still remains research to be done in order to definitely support the effectiveness of tooth-colored, bonded restorations over SSCs.
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) 23265162Hutchenson/2012n= 31 @12 mo. follow-up appointment; ages 2 ½ to 8 Randomized Controlled Trial
Key resultsThis RCT compared multi-surface composite restorations versus SSC restorations using a split-mouth approach where a tooth on one side of the mouth was restored using one technique and the other side with the other technique. 40 patients were selected at the start of the trial; however, at 6 months, 37 patients were evaluated and at 12 months, only 31 of the original 40 were evaluated. The only significant difference when comparing these two treatments was that at each follow-up, more teeth with the composite restoration showed marginal changes than the teeth with SSCs (P < .001); all other categories of comparison, such as gingival inflammation, parulis, food impaction and margins were similar in value.
#2) 18328050Atieh/2008n = 160 primary molars in 87 children ranging in age from 4 to 7 years.Randomized Controlled Trial
Key resultsIn this RCT comparing SSC restorations vs. modified open-sandwich technique using resin-modified glass ionomer cement/composite resin restoration (RMGIC/CRR), 160 patients were randomly assigned to receive one of the two restoration types and followed at 6-,12-,18- and 24-month recalls. The clinical survival rate, after 24 months, was 95% (SSC) and 92.5% (RMGIC/CRR) (no significant difference). There were also no significant differences in the following categories: marginal integrity, proximal contact, secondary caries, and occlusion. The only difference of statistical significance (P = .014) was that only 69.1% of SSCs were in sound gingival health (no gingival bleeding) at the 24 month checkup, compared to 83.1% of the RMGIC/CRRs.
Evidence Search ("dental clinics"[MeSH Terms] OR ("dental"[All Fields] AND "clinics"[All Fields]) OR "dental clinics"[All Fields] OR "dental"[All Fields]) AND restoration[All Fields] AND ("stainless steel"[MeSH Terms] OR ("stainless"[All Fields] AND "steel"[All Fields]) OR "stainless steel"[All Fields]) AND ("pulpotomy"[MeSH Terms] OR "pulpotomy"[All Fields])
Comments on
The Evidence
Atieh's study was an RCT in which a computer randomized the treatment groups; they were similar at the start of the study. Both groups had follow-up appointments every 6 months, up to 24 months. The follow-up was not adequate because it consisted of a clinical examination only; no radiographic evaluation of the pulpal treatment or restorations were made. All restorations and evaluations were made by the author, and no report of calibration was made. Hutchenson et. al., reported on an RCT in which each side of the patient's mouth was randomly assigned to either the test or control technique. Both groups started out the same; however, the number of patients evaluated decreased over the period of the trial (77.5% of original patients were evaluated at 12 months). Two blinded, calibrated examiners evaluated the radiographs. There were no competing interests for either of these papers.
Applicability Esthetic demands have increased in the pediatric population, prompting a desire for alternatives to the use of stainless steel crowns as the gold standard of care for definitive restoration after a pulpal treatment. However, there is limited evidence to support the use of tooth-colored, bonded restorations after a pulpotomy; they are recommended only if the tooth is not expected to remain in the mouth for long, because no long-term data is available.
Specialty/Discipline (General Dentistry) (Pediatric Dentistry)
Keywords Pediatric dentistry, esthetic restoration, stainless steel crown, pulpotomy
ID# 2694
Date of submission: 04/03/2014spacer
E-mail patela11@livemail.uthscsa.edu
Author Atish K. Patel
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Maria Cervantes Mendez, DDS
Faculty mentor/Co-author e-mail CervantesMen@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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