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Study flow diagram.
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Figure 1

Study flow diagram.

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
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Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Comparison 1 Liner versus no liner, Outcome 1 Postoperative hypersensitivity (POH) by patient report (Y/N).
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Analysis 1.1

Comparison 1 Liner versus no liner, Outcome 1 Postoperative hypersensitivity (POH) by patient report (Y/N).

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Comparison 1 Liner versus no liner, Outcome 2 Postoperative hypersensitivity (POH) by patient report (VAS).
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Analysis 1.2

Comparison 1 Liner versus no liner, Outcome 2 Postoperative hypersensitivity (POH) by patient report (VAS).

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Comparison 1 Liner versus no liner, Outcome 3 Cold response measurement (CRM) (time it took in seconds for patient to feel cold sensation).
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Analysis 1.3

Comparison 1 Liner versus no liner, Outcome 3 Cold response measurement (CRM) (time it took in seconds for patient to feel cold sensation).

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Comparison 1 Liner versus no liner, Outcome 4 Cold response measurement (CRM) (VAS).
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Analysis 1.4

Comparison 1 Liner versus no liner, Outcome 4 Cold response measurement (CRM) (VAS).

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Comparison 1 Liner versus no liner, Outcome 5 Cold response measurement (CRM) (Y/N).
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Analysis 1.5

Comparison 1 Liner versus no liner, Outcome 5 Cold response measurement (CRM) (Y/N).

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Comparison 1 Liner versus no liner, Outcome 6 Restoration failure at 1 year follow‐up.
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Analysis 1.6

Comparison 1 Liner versus no liner, Outcome 6 Restoration failure at 1 year follow‐up.

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Liner versus no liner for Class I and Class II resin‐based composite restorations

Patient or population: Patients requiring Class I or Class II resin‐based composite restorations

Settings: General practice

Intervention: Liner

Comparison: No liner

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of restorations
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk*

Corresponding risk

No liner

Liner

Postoperative hypersensitivity (POH) (Patient‐reported Y/N)

Follow‐up: 1 week

100 per 1000

56 per 1000
(26 to 117)

RR 0.56
(0.26 to 1.17)

299
(3 studies)

⊕⊕⊝⊝1
low

POH was also measured at 24 hours (1 trial at high risk of bias) and 1 month (3 trials at high/unclear risk of bias). A benefit in favour of liners was shown at 24 hours; this difference was not maintained at any other time point

1 additional high risk of bias study measured patient‐reported POH using VAS. A benefit was shown in favour of liners at 1 week and 1 month follow‐up

Postoperative cold response measurement (CRM) (time it took in seconds for patient to feel cold sensation)

Follow‐up: 1 week

The mean postoperative CRM at 1 week (time it took in seconds for patient to feel cold sensation) was 16 seconds

MD 6 seconds more
(1.36 more to 10.64 more)

88
(1 study)

⊕⊕⊝⊝2
low

CRM was also measured at 24 hours (1 trial at high risk of bias) and 1 month (1 trial at high risk of bias). No difference was shown between the use of liners and no liners at either time point

Other methods of measuring CRM (using VAS or Y/N response) showed no difference between liners and no liners at any time point

Restoration failure

Follow‐up: 1 year

7 per 1000

7 per 1000
(0 to 104)

RR 1.00
(0.07 to 15.00)

281
(4 studies)3

⊕⊕⊝⊝1
low

Restoration failure at 2‐year follow‐up also showed no difference between the use of liners or not

Adverse events

None reported

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)
CI: confidence interval; MD: mean difference; RR: risk ratio; VAS: visual analog scale

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate
Very low quality: We are very uncertain about the estimate

*Assumed risk based on control group risk.
1Downgraded due to high risk of bias and imprecision.
2Downgraded due to single study at high risk of bias.
34 studies reported on restoration failure at 1 year. However, no failures were reported in either group for 3 of the 4 studies; these studies do not inform the RR presented.

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Comparison 1. Liner versus no liner

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Postoperative hypersensitivity (POH) by patient report (Y/N) Show forest plot

4

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

1.1 24 hours follow‐up

1

88

Risk Ratio (M‐H, Random, 95% CI)

0.26 [0.11, 0.64]

1.2 1 week follow‐up

3

299

Risk Ratio (M‐H, Random, 95% CI)

0.56 [0.26, 1.17]

1.3 1 month follow‐up

3

253

Risk Ratio (M‐H, Random, 95% CI)

0.44 [0.15, 1.34]

2 Postoperative hypersensitivity (POH) by patient report (VAS) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

2.1 1 week follow‐up

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

2.2 1 month follow‐up

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

3 Cold response measurement (CRM) (time it took in seconds for patient to feel cold sensation) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

3.1 24 hours follow‐up

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

3.2 1 week follow‐up

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

3.3 1 month follow‐up

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

4 Cold response measurement (CRM) (VAS) Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Subtotals only

4.1 1 week follow‐up

2

447

Mean Difference (IV, Random, 95% CI)

‐0.20 [‐0.67, 0.26]

4.2 1 month follow‐up

2

444

Mean Difference (IV, Random, 95% CI)

‐0.33 [‐0.76, 0.11]

5 Cold response measurement (CRM) (Y/N) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

5.1 1 week follow‐up

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5.2 1 month follow‐up

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6 Restoration failure at 1 year follow‐up Show forest plot

4

281

Risk Ratio (M‐H, Random, 95% CI)

1.0 [0.07, 15.00]
Figures and Tables -
Comparison 1. Liner versus no liner
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