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Compomers may be an Alternative Material for Class II Restorations in the Primary Dentition
REVIEW ANALYSIS & EVALUATION ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION Literature review: Restorations of Class II cavities in the primary dentition with compomers. Marks LAM, Faict N, Welbury RR. Eur Arch Paediatr Dent 2010;11(3):109-14.
REVIEWER S.M. Hashim Nainar, BDS, MDSc
PURPOSE/QUESTION To conduct a review of clinical studies on the use of compomers for restoration of Class II cavities in the primary dentition.
Compomers may be an Alternative Material for Class II Restorations in the Primary Dentition SUMMARY Selection Criteria This systematic review searched the PubMed database using multiple keywords to identify relevant articles. The following 4 selection criteria were then applied. The 2 exclusion criteria were in vitro and animal studies. The 2 inclusion criteria were studies with Class II cavities and clinical follow-up period of minimum 12 months’ duration. The final selection consisted of 24 articles for assessment.
Key Study Factor The restoration of Class II cavities in the primary dentition with compomers (poly-acid modified composite resins).
Main Outcome Measure
SOURCE OF FUNDING
The clinical success of compomers as compared with other restorative materials for Class II cavities in the primary dentition.
Information not available
Main Results
TYPE OF STUDY DESIGN Systematic review
LEVEL OF EVIDENCE Level 2: Limited-quality patientoriented evidence
STRENGTH OF RECOMMENDATION GRADE Grade B: Inconsistent or limitedquality patient-oriented evidence
The authors assessed the 24 selected articles using 23 evaluation criteria as described by Kilpatrick and Neumann.1 The 24 articles were then considered in four different groups based on the restorative materials compared: (1) Compomers alone; (2) compomers and amalgams; (3) compomers and glass ionomer cements; and (4) compomers and hybrid composites. The authors subjectively summarized the findings for each group and found that compomers could be used for restoration of Class II cavities in primary molars and as an alternative restorative material in place of amalgams and hybrid composites. It was noted that compomers should not be used for restoration of teeth following pulpectomies.
Conclusions The authors concluded that compomers can be recommended for Class II restorations in the primary dentition.
COMMENTARY AND ANALYSIS This systematic review assessed the suitability of compomers (poly-acid modified composite resins) for the restoration of Class II cavities in the primary dentition. A qualitative synthesis of 24 selected articles was undertaken to compare the clinical outcomes of compomers with other restorative materials.
Strengths
J Evid Base Dent Pract 2011;11:29-30 1532-3382/$36.00 Ó 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.jebdp.2010.11.013
Restoring Class II cavities in the primary dentition has traditionally been done using amalgams in most cases and stainless steel crowns for the remaining few. It has, however, been observed that with the advent of tooth colored restorative materials, children and their parents preferred tooth-colored restorations as compared to amalgam restorations.2 There exists considerable interest, therefore, to determine the most suitable alternative tooth-colored
JOURNAL OF EVIDENCE-BASED DENTAL PRACTICE
restorative material. This systematic review was conducted to determine the suitability of compomers for the restoration of Class II cavities in the primary dentition.
Weaknesses (or Challenges to Interpretation) The following concerns exist with regard to this systematic review as pertains to its search methodology: There was no mention as to when the PubMed search was conducted and whether any chronologic limitations were used in the search. (The year of publication for the 24 articles included for evaluation ranged from 1997 to 2009.) It was not mentioned how many records were initially identified by the PubMed search before the application of the 4 selection criteria. The authors did not seek out additional references from other sources and based their search solely upon the PubMed database. Based on the studies included for evaluation, it appears that the language of publication was confined to the English language, although the authors do not explicitly state this criterion. Based on the above 4 points, the search strategy used appears inadequate. There were 2 other concerns with the articles included for evaluation. First, the authors in their selection criteria did not specifically mention the type of clinical studies to be reviewed, such as being limited to randomized controlled trials. (One of the 23 evaluation criteria was ‘‘prospective study’’ and one of the studies included was scored as not being a prospective study. Another evaluation criterion was ‘‘assignment of subjects by an acceptable system, randomization detailed,’’ and not even one of the studies included scored positive on this criterion.) Second, the authors did not exclude duplicative articles and allowed inclusion of multiple publications from the same clinical study as discrete articles, albeit describing results at different follow-up time intervals. The use of tooth-colored restorations has engendered interest in modest tooth preparations to conserve tooth structure. It has, however, been observed that ‘‘conservative operative strategies in the primary dentition have not been uniformly successful.’’3 The review under present consideration did not report the type of tooth preparation as an evaluation factor for the studies included. One of the studies evaluated was by Louw et al,4 who studied atraumatic restorative treatment and minimal intervention techniques on primary teeth. Another study evaluated was by Marks et al,5 who studied conservative interproximal box-only restorations in primary molars. The apparent lack of similar tooth preparations between the studies evaluated potentially detracts upon the validity of the comparison between the different studies. In their Results section, the authors listed the performance of compomers and their comparison with other restorative materials, as described in the articles included in 30
their study. They did not, however, mention any details for their qualitative data synthesis and simply reported their conclusions. The authors have listed 23 evaluation criteria for assessing the studies included in their review and have assigned a final score for each article. In their Discussion section, the authors mostly discussed the various evaluation criteria and how the various articles considered in their study tallied up. It is not clear how this numerical score helped in the evidence synthesis process.
Opportunity Based on the material presented, this study provides a good bibliographic assessment of the articles included for evaluation. This detailed evaluation of compomer studies provides a framework for investigators contemplating clinical studies using compomers and would help in protocol development and reporting of results. Such detailed and consistent data would help future systematic assessments on the use of compomers for the restoration of Class II cavities in the primary dentition.
Threats The conclusions from this study need to be interpreted with caution. Meta-analysis, statistical pooling of data from the articles reviewed in this systematic review, was not done. There are also concerns with the methodology undertaken in this qualitative synthesis of evidence. The findings from this study should be used with prudence for decisionmaking regarding selection of restorative material for a Class II cavity preparation in the primary dentition.
REFERENCES 1. Kilpatrick NM, Neumann A. Durability of amalgam in the restoration of Class II cavities in primary molars: a systematic review of the literature. Eur Arch Paediatr Dent 2007;8(1):5-13. 2. Peretz B, Ram D. Restorative material for children’s teeth: preferences of parents and children. ASDC J Dent Child 2002;69:243-8. 3. McComb D. Systematic review of conservative operative caries management strategies. J Dent Educ 2001;65:1154-61. 4. Louw AJ, Sarvan I, Chikte UM, Honkala E. One-year evaluation of atraumatic restorative treatment and minimum intervention techniques on primary teeth. SADJ 2002;57:366-71. 5. Marks LA, van Amerongen WE, Kreulen CM, Weerheijm KM, Martens LC. Conservative interproximal box-only polyacid modified composite restorations in primary molars, twelve-month clinical results. ASDC J Dent Child 1999;66:23-9.
REVIEWER S.M. Hashim Nainar, BDS, MDSc Division of Pediatric Dentistry Faculty of Dentistry, University of Toronto 124 Edward Street Toronto Ontario M5G 1G6, Canada Tel: (416) 979-4926 X4314 Fax: (416) 979-4753 [email protected] March 2011
REVIEWER S.M. Hashim Nainar, BDS, MDSc
PURPOSE/QUESTION To conduct a review of clinical studies on the use of compomers for restoration of Class II cavities in the primary dentition.
Compomers may be an Alternative Material for Class II Restorations in the Primary Dentition SUMMARY Selection Criteria This systematic review searched the PubMed database using multiple keywords to identify relevant articles. The following 4 selection criteria were then applied. The 2 exclusion criteria were in vitro and animal studies. The 2 inclusion criteria were studies with Class II cavities and clinical follow-up period of minimum 12 months’ duration. The final selection consisted of 24 articles for assessment.
Key Study Factor The restoration of Class II cavities in the primary dentition with compomers (poly-acid modified composite resins).
Main Outcome Measure
SOURCE OF FUNDING
The clinical success of compomers as compared with other restorative materials for Class II cavities in the primary dentition.
Information not available
Main Results
TYPE OF STUDY DESIGN Systematic review
LEVEL OF EVIDENCE Level 2: Limited-quality patientoriented evidence
STRENGTH OF RECOMMENDATION GRADE Grade B: Inconsistent or limitedquality patient-oriented evidence
The authors assessed the 24 selected articles using 23 evaluation criteria as described by Kilpatrick and Neumann.1 The 24 articles were then considered in four different groups based on the restorative materials compared: (1) Compomers alone; (2) compomers and amalgams; (3) compomers and glass ionomer cements; and (4) compomers and hybrid composites. The authors subjectively summarized the findings for each group and found that compomers could be used for restoration of Class II cavities in primary molars and as an alternative restorative material in place of amalgams and hybrid composites. It was noted that compomers should not be used for restoration of teeth following pulpectomies.
Conclusions The authors concluded that compomers can be recommended for Class II restorations in the primary dentition.
COMMENTARY AND ANALYSIS This systematic review assessed the suitability of compomers (poly-acid modified composite resins) for the restoration of Class II cavities in the primary dentition. A qualitative synthesis of 24 selected articles was undertaken to compare the clinical outcomes of compomers with other restorative materials.
Strengths
J Evid Base Dent Pract 2011;11:29-30 1532-3382/$36.00 Ó 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.jebdp.2010.11.013
Restoring Class II cavities in the primary dentition has traditionally been done using amalgams in most cases and stainless steel crowns for the remaining few. It has, however, been observed that with the advent of tooth colored restorative materials, children and their parents preferred tooth-colored restorations as compared to amalgam restorations.2 There exists considerable interest, therefore, to determine the most suitable alternative tooth-colored
JOURNAL OF EVIDENCE-BASED DENTAL PRACTICE
restorative material. This systematic review was conducted to determine the suitability of compomers for the restoration of Class II cavities in the primary dentition.
Weaknesses (or Challenges to Interpretation) The following concerns exist with regard to this systematic review as pertains to its search methodology: There was no mention as to when the PubMed search was conducted and whether any chronologic limitations were used in the search. (The year of publication for the 24 articles included for evaluation ranged from 1997 to 2009.) It was not mentioned how many records were initially identified by the PubMed search before the application of the 4 selection criteria. The authors did not seek out additional references from other sources and based their search solely upon the PubMed database. Based on the studies included for evaluation, it appears that the language of publication was confined to the English language, although the authors do not explicitly state this criterion. Based on the above 4 points, the search strategy used appears inadequate. There were 2 other concerns with the articles included for evaluation. First, the authors in their selection criteria did not specifically mention the type of clinical studies to be reviewed, such as being limited to randomized controlled trials. (One of the 23 evaluation criteria was ‘‘prospective study’’ and one of the studies included was scored as not being a prospective study. Another evaluation criterion was ‘‘assignment of subjects by an acceptable system, randomization detailed,’’ and not even one of the studies included scored positive on this criterion.) Second, the authors did not exclude duplicative articles and allowed inclusion of multiple publications from the same clinical study as discrete articles, albeit describing results at different follow-up time intervals. The use of tooth-colored restorations has engendered interest in modest tooth preparations to conserve tooth structure. It has, however, been observed that ‘‘conservative operative strategies in the primary dentition have not been uniformly successful.’’3 The review under present consideration did not report the type of tooth preparation as an evaluation factor for the studies included. One of the studies evaluated was by Louw et al,4 who studied atraumatic restorative treatment and minimal intervention techniques on primary teeth. Another study evaluated was by Marks et al,5 who studied conservative interproximal box-only restorations in primary molars. The apparent lack of similar tooth preparations between the studies evaluated potentially detracts upon the validity of the comparison between the different studies. In their Results section, the authors listed the performance of compomers and their comparison with other restorative materials, as described in the articles included in 30
their study. They did not, however, mention any details for their qualitative data synthesis and simply reported their conclusions. The authors have listed 23 evaluation criteria for assessing the studies included in their review and have assigned a final score for each article. In their Discussion section, the authors mostly discussed the various evaluation criteria and how the various articles considered in their study tallied up. It is not clear how this numerical score helped in the evidence synthesis process.
Opportunity Based on the material presented, this study provides a good bibliographic assessment of the articles included for evaluation. This detailed evaluation of compomer studies provides a framework for investigators contemplating clinical studies using compomers and would help in protocol development and reporting of results. Such detailed and consistent data would help future systematic assessments on the use of compomers for the restoration of Class II cavities in the primary dentition.
Threats The conclusions from this study need to be interpreted with caution. Meta-analysis, statistical pooling of data from the articles reviewed in this systematic review, was not done. There are also concerns with the methodology undertaken in this qualitative synthesis of evidence. The findings from this study should be used with prudence for decisionmaking regarding selection of restorative material for a Class II cavity preparation in the primary dentition.
REFERENCES 1. Kilpatrick NM, Neumann A. Durability of amalgam in the restoration of Class II cavities in primary molars: a systematic review of the literature. Eur Arch Paediatr Dent 2007;8(1):5-13. 2. Peretz B, Ram D. Restorative material for children’s teeth: preferences of parents and children. ASDC J Dent Child 2002;69:243-8. 3. McComb D. Systematic review of conservative operative caries management strategies. J Dent Educ 2001;65:1154-61. 4. Louw AJ, Sarvan I, Chikte UM, Honkala E. One-year evaluation of atraumatic restorative treatment and minimum intervention techniques on primary teeth. SADJ 2002;57:366-71. 5. Marks LA, van Amerongen WE, Kreulen CM, Weerheijm KM, Martens LC. Conservative interproximal box-only polyacid modified composite restorations in primary molars, twelve-month clinical results. ASDC J Dent Child 1999;66:23-9.
REVIEWER S.M. Hashim Nainar, BDS, MDSc Division of Pediatric Dentistry Faculty of Dentistry, University of Toronto 124 Edward Street Toronto Ontario M5G 1G6, Canada Tel: (416) 979-4926 X4314 Fax: (416) 979-4753 [email protected] March 2011