Evidence-based Assessment of Tooth Coloured Restorations in Primary Molars

Objectives: To use the principles of evidence-based dentistry (EBD) to compare successes of glass-ionomer cement (GIC), resin-modified GIC (RmGIC), composite resin (CR) and compomer (CmP) restorations in primary molars. Methods: The PICOT-question was: P: in human primary molars with proximal cavities; I: does the use of one restorative material (GIC, RmGIC, CR or CmP); C: compared to remaining materials; O: result in higher clinical success rates; T: over followup periods of at least one year? Relevant articles (n=256) were identified from databases using search strategies, sieved for relevance by examining titles (n=193), then by abstracts (n=138); and finally by full texts (n=69). After applying exclusion criteria, 26 articles remained. These prospective clinical trials (CTs) were ranked on strength of evidence: 17 randomised CTs; 1 non-randomised controlled CT; 8 uncontrolled CTs. Data were extracted for meta-analyses; odds ratios (ORs) were calculated, directly comparing success rates of four restoration types. Overall and mean success rates were calculated from pooled data from relevant study arms. Results: GIC restorations had significantly (p<0.05) lower likelihood for success than other restorations; ORs for success were: RmGIC: 5.50, CR: 7.88, CmP: 4.82. CmP restorations were less likely (not significantly, p>0.05), to be more successful than CR. Insufficient data precluded comparisons of RmGIC with CR and CmP. Overall success rates were: GIC (n=689 restorations), 71.8%; RmGIC (n=316), 86.7%; CR (n=607), 74.8%; CmP (n=592), 86.5%. Mean (±SD) success rates did not differ significantly: GIC (n=8 studies), 66.1±28.0%; RmGIC (n=4), 84.9±13.9%; CR (n=7), 79.8±18.7%; CmP (n=7), 88.4±10.3%. Conclusions: An EBD study of clinical trials exceeding one year in human primary molars with proximal cavities found GIC had a lower likelihood of success than RmGIC, CR or CmP; but the four materials were similar in mean success rates. (Support: Research Committee, School of Dental Science, University of Melbourne).