ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title The Use of Resin Modified Glass Ionomer Liners Does Not Significantly Reduce Dentinal Hypersensitivity
Clinical Question Do patients with Resin Modified Glass Ionomer liners have less dental hypersensitivity compared to patients with resin based composites?
Clinical Bottom Line While RMGI’s can reduce dentinal hypersensitivity, studies have shown that the difference is not statistically significant.
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) 23627487Blanchard/2013613 adult patients with a total of 670 teeth.Prospective Cohort Study
Key resultsOf the 670 teeth analyzed, 491 were submitted for questionnaires 4 weeks later. This study viewed various aspects of operative procedures (i.e., dental bonding agents, use of desensitizing agents, etc.) and not just the use of GI/RMGIs which were used as liners. The results yielded no statistical significant change in post-operative dental hypersensitivity when using GI/RMGI liners. However CaOH, the other liner that was used in the study, was found to signifigantly reduce dental hypersensitivity (p=.018). The study states that there is a possiblity that these findings are questionable because the restorations were not very deep. This could however not be an issue because in Wegehaupt (2009) it states that dentinal thickness might not be influenced by the depth of the preparation.
#2) 23904575Strober/2013341 patients who have history of hypersensitivity.Randomized Comparative Effectiveness Study
Key results341 participants were used in the study, 171 were randomly assigned to the DBA group while the other 168 were assigned to the RMGI liner group. The patients were revisited 1 week and 4 weeks later, and were asked to rate their hypersensitivity pain on a scale of 1 to 10 at all three visits. The values show a marked decrease in hypersensitivity over time with the experimental (2.5 decrease for cold/2.6 for air) and control groups (2.4 decrease for cold/2.5 decrease for air) with statistically little to no difference between them (p>.05).
Evidence Search ("resins, plant"[MeSH Terms] OR ("resins"[All Fields] AND "plant"[All Fields]) OR "plant resins"[All Fields] OR "resin"[All Fields]) AND modified[All Fields] AND ("glass ionomer"[Supplementary Concept] OR "glass ionomer"[All Fields]) AND ("hypersensitivity"[MeSH Terms] OR "hypersensitivity"[All Fields]). From this search 2 articles were picked from a pool of 7 results.
Comments on
The Evidence
Validity: The validity of the Blanchard study does not seem to be very strong. It must be noted that 27% of all of the participants dropped out of the study. Also, there was supposed to be a 13 week follow up which was not documented and could have had dramatic effects on the results. It is also important to note that this study focused on many aspects and treatments for various dental procedures. Because of this there are a plethora of different treatment combinations that can cross over and clutter the results. However, it should be noted that the p-value (p=.018) is very high and can contributes to this study's validity in reference to the use of CaOH liners. The Strober article has a much higher validity than the Blanchard study. Here, only 2 participants (less than 1%) were dropped from the study. It also had much less ‘clutter’ and had more direction by focusing primarily on RMGIs. The study was also double-blind and followed a Randomized control trial format. It is however important to note that Strober et. al., acknowledge the technical limitations of the study. They state that most of the restorations were not very close to the pulp and the limitations of the restorations to the posterior teeth. However, dental hypersensitivity is something that affects many restorations regardless of their depth and coverage. Both of these articles came to the same conclusion that the use of RMGI liners does not prevent/stop dental hypersensitivity. While both have their setbacks it can be seen, especially in the Strober article, that it has been demonstrated with high validity that RMGI liners do not prevent/stop dental hypersensitivity within a statistically significant realm. However, it must be duely noted that the Blanchard study found a signifigant reduction in dental hypersensitivity when using CaOH as a liner. Perspective: An RCT combining the efforts of both of these studies would create a better scenario to answer this clinical question. For instance, instead of a control and experimental group, a study that contained four groups would yield better results. This could be done by splitting the participants into a group that currently is experiencing dental pain and another group that is not. From here the patients from both of these groups could be further split into a RBC group and a RMGI group. The results from a study such as this could further help to resolve the question at hand.
Applicability Dental pain is very common, sometimes after treatment patients will undergo treatment on a lesion in which they experience no pain and leave from the appointment with pain. It can be said with high confidence that if dental hypersensitivity is a problem, RMGI liners will probably not display a significant drop in pain.
Specialty/Discipline (General Dentistry) (Restorative Dentistry)
Keywords Resin modified glass ionomers, Hypersensitivity, iatrogenic pain, dental bonding agents
ID# 2727
Date of submission: 05/13/2014spacer
E-mail beruvides@livemail.uthscsa.edu
Author Daniel Beruvides
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Niraj Patel, DDS
Faculty mentor/Co-author e-mail patelnk@livemail.uthscsa.edu
Basic Science Rationale
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