UTCAT606, Found CAT view, CRITICALLY APPRAISED TOPICs

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Title

Similar Success of Bonded Amalgam vs. Pin-Retained Restorations for Complex Amalgams Restorations

Clinical Question

In comparison, which of the following is the most successful when restoring complex dental amalgam: bonded or pin-retained restorative techniques?

Clinical Bottom Line

There is no difference in effectiveness of either technique in many aspects, but if both techniques are used, there is a higher success rate in terms of retention. (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) 11480646	Summitt/2001	Amalgam Restoration replacing at least one cusp	Randomized Controlled Clinical Trial
Key results	At four years, six restorations had failed. At five years, of the 40 restorations available for evaluation, three had failed, for a total of nine failed restorations; seven of those were pin-retained and two were bonded. Using the Fisher exact test to compare the groups at five years, the authors found no significant difference in failure rate, marginal adaptation, marginal discoloration, secondary caries, tooth sensitivity or tooth vitality.
#2) 19821423	Fedorowicz/2009	31 patients receiving over 113 amalgam restorations	Systematic Review
Key results	One trial with 31 patients who received 113 restorations was included. At 2 years only 3 out of 53 restorations in the non-bonded group were lost, which was attributed to a lack of retention, and 55 of 60 bonded restorations survived with five unaccounted for at follow-up. Post-insertion sensitivity was not significantly different (P > 0.05) at baseline or 2-year follow-up. No fractures of tooth tissue were reported and there was no significant difference between the groups or matched pairs of restorations in their marginal adaptation (P > 0.05).
#3) 12011862	Sen/2002	45 extracted molars flattened approx. 2mm coronal to CEJ	In vitro comparative study
Key results	Significant differences were found among all groups. The highest bond strength (181.86 kg/cm(2)) was obtained for group 2 specimens, which were restored with 2 dentin pins and the bonding system tested.

Evidence Search

Amalgambond "[Substance Name] AND "Dental Pins"[Mesh] AND Randomized Controlled Trial[ptyp]

Comments on
The Evidence

Based on the 5 year clinical study of JB Summit, there was no significant difference in the success rate of pin-retained restorations and 4-META-based bonding resin restorations (Amalgambond Plus with HPA powder). This was based on failure rate, marginal adaptation, marginal discoloration, secondary caries, tooth sensitivity or tooth vitality. However this study proved that the Amalgambond method is a very satisfactory method to use when repairing complex tooth fractures with at least one fractured cusp. In addition, a study was performed by the prosthodontics department at Istanbul University on 45 extracted molar teeth when comparing Shear bond strengths of bonded amalgams, pin-retained amalgams and a combination of both methods. This study proved that a combination of bonding (Panavia-Ex) and dental pins significantly improved amalgam retention. According to a systematic review by the Ministry of Health in Bahrain, they had compiled randomized controlled trials comparing adhesively bonded and traditional non-bonded amalgam restorations. The author had concluded that there was no significant difference in terms of their survival rate and marginal integrity of moderately sized restorations. There were 31 patients who received 113 restorations. Unfortunately, this study was limited to adult patients with only Class I and II restorations and was limited to only a 2 year follow up. I feel the duration for the study should have been longer to make more of a comparison.

Applicability

These studies have a very significant relevance in dental practice. Many people experience tooth trauma at some point in their life from a variety of ways like chewing on hard objects or a para-functional habit. Tooth fractures can be as simple as chipping of the enamel or as severe as vertical, diagonal, or horizontal fractures of the root. The clinician must be able to decide which method (simple amalgam, bonded amalgam, or pin-retained amalgam) is most effective for the longest duration.

Specialty/Discipline

(General Dentistry) (Prosthodontics) (Restorative Dentistry)

Keywords

Dental pins, Amalgambond

ID#

606

Date of submission:

04/07/2010

E-mail

khanma@livemail.uthscsa.edu

Author

Mohammad Arsalan Khan

Co-author(s)

Co-author(s) e-mail

Faculty mentor/Co-author

Karen Troendle, DDS

Faculty mentor/Co-author e-mail

TROENDLE@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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