Evidence-based Assessment of Tooth-colored Restorations in Proximal Lesions of Primary Molars

Meghan Sullivan Walsh November 2, 2010

Literature Review - St. Joseph/LMC Pediatric Dentistry

Evidence-based Assessment of Tooth-colored Restorations in Proximal Lesions of Primary Molars

Resident: Meghan Sullivan Walsh

Program: Lutheran Medical Center- Providence

Article Title: Evidence-based Assessment of Tooth-colored Restorations in Proximal Lesions of Primary Molars

Authors: Siew Luan Toh, BDS, Grad DipclinDent, DCD; Louise Brearley Messer, BDSc, LDS, MDSc, PhD

Journal: Pediatric Dentistry

Volume (number), Year, Page #’s; 29:1, 2007, pages 8-15

Major Topic: Success rates of Glass Ionomer cement, composite resin and poly acid-modified composite resin used in Class II preparations for primary teeth.

Overview of Method of Research: Electronic databases were used to locate studies performed on Class II tooth colored restoration on primary molars. Of these finding, the data was sieved and 21 of the 256 studies remained that met the authors criteria. Meta-analyses was used to compare the data and success of these restorations.

Findings: Meta-analyses using the direct technique:

The first study compared Glass II GIC and RmGIC over three years in 40 pediatric patients. The RmGIC had a success rate of 96% and GIC a success rate of 82%

Another study compared Class II amalgam, CR and GIC over three years in 50 pediatric patients. The success rates were CR - 84% and GIC - 40% making composite restorations significantly more successful that GIC. In a German study comparing Class II composites the success rates were PAMCR 85% and CR 89%.

Meta-analyses using the indirect technique:

The overall and mean success rates of the four materials and studies were combined and compared.

The success rates were as follows GIC - 75%, RmGIC - 89%, CR -83% and PAMCR -87%.

Key Points: Summary: The meta-analyses used in these studies used both randomized and nonrandomized clinical trials. The authors discusses how normally a meta-analyses ideally uses only RCT, however due to lack of research in this topic both RCT and nonRCT were used. In addition, composite material has significantly changed over time and the comparison and combinations of these studies do no account for the varying composites.

The RmGIC and CIR were significantly more successful than GIC. No difference was noted comparing PAMCR and CR restorations. RmGIC showed the best success rates when compared to all other options. (As a side note, there were the least studies on RmGIC and all of these studies used the same material called Vitremer.)

GIC cement may have low success due to it’s low fracture toughness and flexural strength. RmGIC, however, are noted as having complete hardening due to dual setting mechanisms, higher fracture toughness, higher flexural strength and low modulus of elasticity.

Assessment of the Article: As composite is becoming more popular and often requested by our patients, it is necessary for us to have a good understanding of this material, it’s limitations and physical properties. I thought this was a good article comparing the different materials of choice. It reinforced the fact that RmGIC is the best material for interproximal lesions in primary Class II lesions. CR or PAMCR would be a good second option. I am aware that composites have improved dramatically however, I despise this material particularly in pediatrics as well as class II lesions. I don’t feel that composite is the best material we can offer our patients particularly when considering posterior restorations as well as primary teeth. Amalgam is still my gold standard and I miss it!!!