Title In A Xerostomic Patient, Fluoride-Releasing Restorative Materials Are More Successful At Preventing Future Secondary Caries Than Amalgam, Unless The Patient Has Good Oral Hygiene That Includes Daily Fluoride Gel Application, Making Both Fluoride-Releasing and Non-Fluoride-Releasing Materials Comparable
Clinical Question In a patient with high caries risk and a buccal surface caries lesion, would a resin-modified glass ionomer restoration be more successful than an amalgam restoration in relation to future secondary caries?
Clinical Bottom Line In a xerostomic patient, fluoride- releasing restorative materials are more successful at preventing future secondary caries than amalgam restorative materials, unless the patient has good oral hygiene that includes daily fluoride gel application, making both fluoride-releasing and non-fluoride-releasing materials comparable. This is supported by a randomized controlled clinical trial including 9 patients and 111 restorations, demonstrating the success of both fluoride-releasing and non-fluoride-releasing materials among the patients who used daily fluoride gel.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
12636121Haveman/2004111 restorations in 9 xerostomic patients Randomized Controlled Trial
Key resultsThe study tested the effectiveness of 3 different restorative materials: two fluoride releasing materials (Ketac-Fil Plus Aplicap and Vitremer Core Buildup/ Restoration) and Tytin amalgam. Other than the placement of amalgam restorations only in posterior teeth, the restoration material was decided based on a coin flip. The patients were all given at-home oral hygiene instructions along with topical fluoride gel to apply every day, and were later assessed for compliance. After the trial was completed, the researchers “divided the patients into two groups: fluoride users (that is, those who were compliant at least 50 percent of the time) and fluoride nonusers (that is, those who were compliant less than 50 percent of the time).” The researchers assessed the restorations to detect caries on the cavosurface margins (CSM). Among the groups, 85% of those restored with Ketac-Fil, 88% of those restored with Vitremer, and 56% of those restored with Tytin amalgam had no recurrent caries. When looking at the compliance of daily fluoride gel use, the results showed that “none of the patients who complied with the daily use of fluoride gel had restorations with caries at the CSM”. Of the three patients with caries at the cavosurface margins, who were also fluoride nonusers, the researchers compared the occurrence of caries on the CSM in the three different restorative materials: 36% with Ketac- Fil, 27 % with Vitremer restorations, and 68 % with Tytin amalgam restorations. Among the fluoride nonusers, the researchers performed a two-year analysis to determine if there was a significant difference among the occurrence of caries at the CSM of the different restorative materials. They found a lower rate of caries at the CSM on glass ionomer restorations than in restorations with amalgam (p < .05). In one patient, the researchers also found that although there were no recurrent caries lesions noted, 86% of the glass ionomer restorations “exhibited surfaces that rapidly became severely eroded and partially dissolved”, which required replacement between six months and 2 years. They also noted that, among the three restorative materials used, the marginal integrity and anatomy of the restorations did not demonstrate any significant difference after two years.
Evidence Search ("dental caries"[MeSH Terms] OR ("dental"[All Fields] AND "caries"[All Fields]) OR "dental caries"[All Fields]) AND restorative[All Fields] AND clinical[All Fields] AND comparison[All Fields]
Comments on
The Evidence
Validity: Although this RCT used a small number of patients (9), they placed 111 restorations and were able to evaluate 86% of these at the two-year recall. Perspective: Based on this randomized control trial, daily fluoride use can make a significant difference in the long-term clinical success of a restoration with respect to the occurrence of recurrent caries on the cavosurface margins.
Applicability This study demonstrated that in xerostomic patients, those that are therefore at a higher risk for developing caries, a fluoride-releasing restoration may be indicated. However, if the patient complies with a daily at-home fluoride application routine, either a fluoride-releasing restoration or a non-fluoride releasing material, like amalgam, will perform well in regard to resisting recurrent caries.
Specialty (General Dentistry)
Keywords Cavosurface margin caries, restoration, fluoride gel, oral hygiene
ID# 3032
Date of submission 03/22/2016
E-mail keatona@livemail.uthscsa.edu
Author Alexis Keaton
Co-author(s) e-mail
Faculty mentor James Summitt, DDS, MS
Faculty mentor 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?)
None available
Comments and Evidence-Based Updates on the CAT
None available