Failure rate of atraumatic restorative treatment using high-viscosity glass-ionomer cement - a systematic review update - II

BACKGROUND: This further systematic review update includes evidence from Chinese trials that were initially still under translation, as well as corrections of all identified errata. Atraumatic Restorative Treatment (ART) is a minimally invasive procedure that involves removing markedly softened carious enamel and dentine, using only hand instruments, and then restoring the resulting cavity with an adhesive restorative material. Although developed for use in the less industrialized parts of the world ART has now been accepted as part of the minimum intervention (MI) dentistry philosophy in developed countries. Currently the restorative material of choice for ART is high-viscosity glass ionomer cement (GIC). GIC is ideally suited to managing dental caries according to the principles of MI dentistry, as it can be applied in the very early stages of caries development or in the larger cavity. Additionally, it simplifies the restorative process and enables the dentine-pulp complex to react against the carious process.

REVIEW OBJECTIVE: This systematic review update seeks to answer the question as to whether, in patients with carious cavities of any class in primary and permanent teeth, ART restorations with high-viscosity GIC have a higher failure rate than amalgam restorations placed with conventional rotary instruments, in tooth cavities of the same size, type of dentition and follow-up period after one or more years.

SEARCH STRATEGY: The following databases were searched for relevant trials up to January 2012: MEDLINE accessed via PubMed; CENTRAL accessed via Cochrane Library; Open access sources: Biomed Central, Database of Open Access Journals (DOAJ), OpenJ-Gate; Regional databases: Bibliografia Brasileira de Odontologia (BBO), Literatura Latino-Americana e do Caribean Ciências da Saúde (LILACS), IndMed, Sabinet, Scielo; Grey-Literature sources: Scirus (Medicine), OpenSIGLE, Google Scholar. Hand searching was performed for journals not indexed in the databases. References of included trials were checked.

SELECTION CRITERIA: Prospective, clinical controlled trials, with focus relevant to review objective and reporting on computable data with a follow-up period of at least one year were selected without language restrictions. Data collection and analysis: Two review authors independently screened and extracted data from, and assessed the risk of bias in, the selected trial reports. Individual datasets were extracted from the trial results and analyzed regarding in- between-dataset heterogeneity and effect size estimates. The investigated outcome was restoration failure. Meta-analysis was conducted on condition of between-dataset homogeneity. Internal trial validity was assessed in terms of selection-, performance-, detection-, attrition-, publication- and reporting bias. Research gaps in the precision and consistency of the results were evaluated.

MAIN RESULTS: Eighteen trials were accepted for review. Of these 49 individual dichotomous datasets could be extracted and analyzed. The majority of the results show no differences between both types of intervention. High risk of selection-, performance-, detection- and attrition bias was established. Existing research gaps are mainly due to lack of trials and small sample size.

CONCLUSION: The current evidence indicates that the failure rate of high-viscosity GIC/ART restorations is not higher than, but similar to that of conventional amalgam fillings after periods longer than one year. These results are in line with the conclusions drawn during the original systematic review. There is a high risk that these results are affected by bias, and thus confirmation by further trials with suitably high number of participants is needed.