Abstract
Subjects or Study Selection
The study is a systematic review and meta-analysis comparing the clinical performance of glass ionomer cements to composite restoration in CL II restorations of primary molars. MeSH terms (glass ionomer cement, resin modified glass ionomer, composite resin child, tooth deciduous) and related words were used to search Pubmed, Scopus, Web of Science, Virtual health library, Cochrane library, OpenGrey, and clinical trials. Hand search for articles was not available electronically. The search yielded 2937 articles, out of which 25 articles were potentially eligible. Of the 25 articles, 15 were excluded for various reasons resulting in only 10 articles being included in the systematic review and meta-analysis. The articles included in the systematic review and meta-analysis were all randomized clinical trials. The follow-up time in the selected articles was between 18 months to 48 months. The studies with longer follow-up time studies (36 and 48 months) had the least number of samples. Ten of the selected articles were used for quantitative analysis and 9 articles for the qualitative analysis. The systematic review was carried out by 2 of the authors independently. When disagreements occurred, discussion between the 2 reviewers was done with the help of a third reviewer to reach a consensus. Eleven meta-analyses were carried out to measure the primary and secondary objectives of the study.
Key Study Factor
The main objective of the study was to compare the clinical performance of conventional glass ionomer cement and composite restorations. The secondary outcome was to compare the influence of type of glass ionomer cement (conventional and resin modified) restorations and the type of isolation used on the clinical performance of the restoration.
To determine the primary and secondary outcomes of the study, the authors conducted 11 meta-analyses to evaluate the following:
1. The percentage of failure of restorations in all selected studies
2. The percentage of failure of restorations in studies with follow-up period equal to or greater than 24 months
3. The percentage of failure of restorations, subgrouping by type of GIC: subgroup 1: C-GIC 3 CR; subgroup 2: RM-GIC 3 CR
4. The percentage of failure of restorations, subgrouping by type of isolation: subgroup 1: rubber dam isolation; subgroup 2: cotton roll isolation
5. The clinical performance of the main parameters (marginal adaptation [MA], marginal discoloration [MD], anatomical form [AF], and secondary carious lesions [SCLs]) considering all selected studies
6. The clinical performance of the main parameters (MA, MD, AF, and SCL) considering studies with follow-up period equal to or greater than 24 months
7. The clinical performance of the main parameters (MA, MD, AF, and SCL) including only studies using RM-GIC
8. The clinical performance of the main parameters (MA, MD, AF, and SCL) including only studies using C-GIC
9. The clinical performance of the main parameters (MA, MD, AF, and SCL) including only studies using rubber dam isolation
10. The clinical performance of the main parameters (MA, MD, AF, and SCL) including only studies using cotton roll isolation
11. The percentage of failure of restorations, subgrouping by type of evaluation criteria applied: subgroup 1: USPHS criteria; subgroup 2: FDI criteria, subgroup 3: Serpa et al., 2017 criteria.
Main Outcome Measure
The main outcomes measured to determine the clinical performance were MA, MD, AF, and secondary carious lesions. The secondary aim was to measure the clinical performance of conventional GIC and resin modifies GIC in CL II restoration of primary molars. The meta-analysis also looked at the type of isolation and its influence on the clinical performance of the conventional and resin-modified GIC.
Main Results
The follow-up period varied from 6 to 48 months. None of RCTs had blinding, 6 of these papers were rated as having low risk of bias, and 4 articles were unclear when assessed by the Cochrane collaboration tool for qualitative assessment. It is worth mentioning that one article scored high bias in the selective report of outcome due to drop-out exceeding 50%. In 6 meta-analyses, no significant difference was found between GIC and CRs.
Individual analysis of both types of GIC versus CR did not show any significant difference in failure rates between conventional GIC and resin-modified GIC when compared to CRs.
In 4 of the 6 meta-analyses evaluating clinical performance of GIC (conventional and resin modified), GIC performed significantly better than CR with respect to the prevalence of secondary caries outcome. When conventional GIC was considered separately, it was similar to CRs in all parameters, including presence of secondary caries.
In the studies' final analysis at a confidence interval of 95%, the overall effect in clinical performance was RD 0.03 (P = .06) between resin-modified GIC and CR restorations and was RD 0.02 (P = .56) between conventional GIC and CR restorations.
When rubber dam isolation was used, GIC performed better than CRs in all parameters. When cotton roll was used, no significant difference was seen between the 2 materials.
Conclusions
The authors concluded that GIC had similar clinical performance to composite resins with respect to the percentage of failures, marginal adaptation, marginal discoloration, and anatomical form in class II restorations of primary molar teeth. Resin-modified GIC performed better than composite restorations in the secondary carious lesion parameter when rubber dam isolation was used.