Title	Posterior Composite Restoration Longevity not Affected by Isolation Method
Clinical Question	In adult patients requiring posterior resin composite restorations does rubber dam isolation offer an advantage compared to cotton roll/saliva ejector isolation for restoration longevity?
Clinical Bottom Line	Although rubber dam isolation undoubtedly provides a myriad of benefits unrelated to restoration longevity, the data shows no statistically significant improvement in longevity over competent cotton roll / saliva ejector isolation when placing posterior resin composite restorations. (See Comments on the CAT below)
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 11000319 Raskin/2000 100 in vivo posterior resin composites Randomized Controlled Trial Key results Of the 100 restorations placed, 42 were Class I restorations and 58 were Class II. The restorations were examined at 0, 6, 12, 24, 36, 48, 60, 72, and 120 months after placement for signs of degradation in five clinical categories: occlusal anatomic form, proximal anatomic form, occlusal marginal adaptation, proximal marginal adaptation and cavomarginal discoloration. No statistically significant differences in rates of restoration degradation were noted in any of the clinical categories assessed with the single exception of the restorations placed with cotton roll isolation performing better in terms of proximal marginal adaptation at the 24 month mark than those placed with rubber dam isolation. This difference, however, was no longer statistically significant by the 36 month mark.
Evidence Search	PubMed search using the following MeSH term search string: "Composite Resins"[Mesh] AND "Rubber Dams"[Mesh]
Comments on The Evidence	This was the highest level of evidence found. Although it is from several years ago, the length and detail of this study point to the information as clinically relevant.
Applicability	This finding is applicable for clinical decision-making regarding the necessary factors for achieving maximal restoration performance over time. Proper control of the operative site is essential for achieving success with composite restorations and clinical judgment must be used in determining which form of isolation is necessary given clinician and assistant skill-level as well as the level of cooperativeness of the individual patient.
Specialty	(General Dentistry) (Restorative Dentistry)
Keywords	rubber dam; posterior resin composite; isolation; restoration longevity; resin composite;
ID#	490
Date of submission	01/07/2010
E-mail	naomiseverdds@gmail.com
Author	Mason Konkle
Co-author(s)	Naomi Sever
Co-author(s) e-mail
Faculty mentor	Kevin M. Gureckis, DMD
Faculty mentor e-mail	gureckis@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 (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) by Tara Eisenrich (San Antonio, TX) on 04/10/2012 In April 2012, I conducted a PubMed search on this topic and found a review of 24 trials that was published in 2003. (PMID: 12768463. This review supports the findings published in this CAT and provides additional evidence.