UTCAT591, Found CAT view, CRITICALLY APPRAISED TOPICs

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Title

Amalgam and Resin Composite Fillings Show Equal Failure Rates in Small Posterior Restorations while Amalgam Shows Better Survival than Composite if used for large posterior restorations.

Clinical Question

In patients with small caries in posterior teeth, do amalgam restorations have lower failure rates than resin composite restorations?

Clinical Bottom Line

When comparing the failure rates of amalgam and resin composite in small restorations in posterior teeth, composites and amalgams were statistically no different if the restoration is small and not restoring an interproximal area. Composite has a higher failure rate due to secondary caries if the restoration was larger. (See Comments on the CAT below)

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) 11763918	Hickel/2000	Patients with posterior restorations	Meta Analysis
Key results	Annual failure rates in posterior stress-bearing cavities were determined to be 0-9% for direct resin-based composite restorations and 0-7% for amalgam restorations. The median annual failure rate of longitudinal studies for amalgam was calculated at 1.1% and at 2.1% for resin-based composite.
#2) 11317384	Hickel/2001	Patients with posterior restorations	Meta Analysis
Key results	Longevity of dental restorations is dependent upon many different factors that are related to materials, the patient and the dentist. The principal reasons for failure were secondary caries, fracture, marginal deficiencies, wear and sensitivity.
#3) 17625635	Levin/2007	650 restored interproximal spaces in 459 young adults.	Retrospective case series.
Key results	86(13%) restored interproximal surfaces showed secondary caries and 22(3%) had overhanging restorations. Considering 557 amalgam restorations, secondary caries occurred in 46(8%) while in composite restorations, secondary caries developed in 40(43%).
#4) 20660797	Opdam/2010	Patient in a private practice	Retrospective case series
Key results	Survival of 3, 4/5 surface restorations (1202 amalgams and 747 composite) was studied taking caries risk into account. After 12 years, 293 amalgam and 114 failed. In the high risk caries group, large amalgam restorations showed better survival while in the low risk caries group, large composites demonstrated better survival.

Evidence Search

"Composite Resins"[Mesh] AND "Dental Amalgam"[Mesh] AND "Dental Restoration, Permanent"[Mesh]

Comments on
The Evidence

The evidence from the two Hickel studies was the highest level of evidence being two meta-analyses. The Levin and Opdam papers were lower level evidence being retrospective case studies.

Applicability

The patient group included in these three studies is representative of a very common clinical diagnosis and treatment encountered by clinicians on a daily basis.

Specialty/Discipline

(General Dentistry) (Restorative Dentistry)

Keywords

Posterior restorations, Amalgam, Resin Composite

ID#

591

Date of submission:

04/30/2010

Revised: 11/15/2012

E-mail

willhitel@livemail.uthscsa.edu

Author

Lourdes Willhite

Co-author(s)

Co-author(s) e-mail

Faculty mentor/Co-author

Rita Renee Parma, DDS

Faculty mentor/Co-author e-mail

PARMA@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?)	post a rationale
None available

Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs)

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