ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Composite Restorations Have a Higher Frequency of Repair Compared to Amalgam Restorations When Placed in Posterior Permanent Teeth in Pediatric Patients
Clinical Question In pediatric patients, do composites have a higher frequency of repair compared to amalgam when placed in posterior permanent teeth?
Clinical Bottom Line Compomer/composite restorations on posterior tooth surfaces in children may require replacement or repair at higher frequency than amalgam restorations, even within five years of placement. (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) 17545265Soncini/20076-10 yr old childrenRandomized Controlled Trial
Key resultsThe average ± standard deviation follow-up was 2.8 ± 1.4 years for primary tooth restorations and 3.4 ± 1.9 years for permanent tooth restorations. In primary teeth, the replacement rate was 5.8 percent of compomers versus 4.0 percent of amalgams (P = .10), with 3.0 percent versus 0.5 percent (P = .002), respectively, due to recurrent caries. In permanent teeth, the replacement rate was 14.9 percent of composites versus 10.8 percent of amalgams (P = .45), and the repair rate was 2.8 percent of composites versus 0.4 percent of amalgams (P = .02).
#2) 17545266Bernardo/2007472 subjects; 8-12 yrs oldRandomized Controlled Trial
Key resultsSubjects received a total of 1,748 restorations at baseline, which the authors followed for up to seven years. Overall, 10.1 percent of the baseline restorations failed. The survival rate of the amalgam restorations was 94.4 percent; that of composite restorations was 85.5 percent. Annual failure rates ranged from 0.16 to 2.83 percent for amalgam restorations and from 0.94 to 9.43 percent for composite restorations. Secondary caries was the main reason for failure in both materials. Risk of secondary caries was 3.5 times greater in the composite group
Evidence Search #9 Search (#1) AND #2 Limits: Comparative Study, All Child: 0-18 years 85#8 Search (#1) AND #2 Limits: Randomized Controlled Trial, All Child: 0-18 years 37#7 Search (#1) AND #2 1424#6 Search (#1) AND #2 Limits: Systematic Reviews, All Child: 0-18 years 5#5 Search (#1) AND #2 Limits: Meta-Analysis, All Child: 0-18 years 0#4 Search (#1) AND #2 Limits: All Child: 0-18 years 214#3 Search (#1) AND #2 1424#2 Search "Composite Resins"[Mesh] 18220#1 Search "Dental Amalgam"[Mesh] 7679
Comments on
The Evidence
Soncini: Study design was RCT; Groups were similar at start with more than 80% completion rate. Groups were treated the same with adequate follow-up. This was not a double-blind study. The compliance was adequate and recall bias was highly unlikely with no competing interests. Clinical variability was minimized by centralized training of all dental personnel and the use of standard pediatric dental procedures, specified in the NECAT protocol and procedures manual. NECAT provided clinics with dentists and materials; any remaining costs were billed to third-party payers. The dentists used the same technique when placing all restorations. The study excluded from all analyses any restorations placed with no subsequent follow-up (placed at the last dental visit before withdrawal from the study, before tooth exfoliation or at the end of the trial). Bernardo: Study design was a RCT. Groups were similar at start with >80% completion rate. Groups treated the same with adequate follow-up. The restorative procedures were standardized, and because of the group assignment, clinical decisions were limited. This meant that dentists could not decide which material to use in each specific case. Fourteen dentists with varying levels of practice experience placed the restorations. One dentist (M.B.) was involved in the treatment planning and assessment of all the subject which might have recall bias but unlikely. All dental care was provided at the University of Lisbon Faculty of Dental Medicine, using existing standards of care common to both the United States and Portugal.
Applicability The subjects in these studies are representative of pediatric patients appropriate to the clinical question. This treatment is feasible in a general dental practice and/or a pediatric dental setting. Pediatric patients may be able to benefit more from amalgam restorations on posterior permanent teeth rather than composite as the studies show. Pediatric patients should expect less frequency in repair with posterior amalgam restorations when compared to posterior composite restorations on permanent dentition.
Specialty/Discipline (Public Health) (General Dentistry) (Pediatric Dentistry) (Restorative Dentistry)
Keywords repair; dental restorations; amalgam restorations; composite restorations; survival
ID# 768
Date of submission: 03/30/2011spacer
E-mail cacho@livemail.uthscsa.edu
Author Mary Ruth Cacho
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
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Li Hsing Loh, Oanh Pham Hutson, Catherine Garza (San Antonio, TX) on 01/06/2014
Pubmed and Trip database search on 6 Jan 2014 did not return more recent researches or researches of a higher level of evidence. Amalgam still remains the material of choice for posterior restorations in pediatric patients.
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