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Title Glass Ionomer Restorations Of Root Surface caries Are More Resistant To Recurrent caries Than Amalgam In Fluoride Users
Clinical Question In a patient with root surface caries that is to be treated with a restoration, would an amalgam restoration or a glass ionomer restoration be more effective in preventing recurrent caries?
Clinical Bottom Line Glass ionomer restorations had a greater potential than amalgam for remineralization of root surface lesions, and therefore less development of recurrent caries at the cavosurface margins. (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) 12636121Haveman/2003111 restorations with the gingival cavosurface margin on the root in 9 xerostomic patients. Randomized Controlled Trial
Key results95 (86%) of the 111 restorations were evaluated at the 2-year recall appointment. They analyzed 2-year data using an analysis of variance for repeated measures and Fisher’s post hoc test. There was no significant difference between glass ionomer vs. amalgam restorations in regards to caries at the cavo-surface margin (CSM) among fluoride users. All of the restorations with caries at the CSM developed in the 3 patients who were less than 50% compliant with regards to daily use of fluoride gel. These 3 patients with glass ionomer restorations had a significantly lower rate of caries at the CSM than did patients with amalgam restorations (p < 0.05).
#2) 9699447Creanor/199828 extracted human premolar teeth with artificially placed root surface lesions.In vitro Research
Key resultsResults showed that varying degrees of subsurface demineralization and remineralization were evident, with a laminated appearance in lesions adjacent to the glass ionomer. There was higher remineralization in the glass ionomer-filled cavities than with the amalgam-filled cavities. In the water-cycled group, glass ionomer showed an increase in mineral content on tooth structure adjacent to the restoration (p < 0.05), while no changes were observed on tooth structure adjacent to the amalgam-filled cavities.
Evidence Search "Root Caries"[Mesh] OR “Class V”[All Fields] AND "Dental Amalgam"[Mesh] AND "Glass Ionomer Cements"[Mesh] ...view in PubMed
Comments on
The Evidence
The in vitro study type represents the lowest level of evidence available in regards to study design. These results are only from extracted premolar teeth with artificially placed lesions. The study assumes that remineralization is the main factor in the prevention of recurrent caries and that an in vitro study is comparable to the actual environment of the oral cavity without the factors of salivary flow or the oral hygiene status of a patient. However, in the randomized clinical trial where salivary flow and oral hygiene were accounted for, tooth structure adjacent to glass ionomer restorations in non-fluoride compliant patients had a lower caries rate than tooth structure adjacent to amalgam restorations.
Applicability Caries high-risk patients with root surface caries who do not routinely use topical fluoride.
Specialty/Discipline (General Dentistry) (Restorative Dentistry)
Keywords Class V, root surface caries, glass ionomer, amalgam
ID# 770
Date of submission: 03/15/2011spacer Revised: 01/09/2012
E-mail suhj@livemail.uthscsa.edu
Author Judy Suh
Co-author(s) e-mail
Faculty mentor/Co-author James B. Summitt, DDS, MS
Faculty mentor/Co-author e-mail SUMMITT@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
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by Liporoni, Priscila; Moncrief, Dionte' (San Antonio, TX) on 08/18/2013
A PubMed search produced a more pertinent article to the clinical question. DeMoor et. al., 2011 (PMID 19997859 ),also found that glass ionomers provided clinical caries inhibition. This study was conducted over a 24 month period on patients with cervical caries and xerostomia.

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