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Temas

A: an infected tooth. The inner space of the tooth is the root canal system, where the pulp is located. The pulp of this tooth is irreversibly inflamed from bacterial infection due to decay.B and C: the process of root canal therapy. B: a hole has been drilled from the top of the crown of the tooth. The dentist could then remove the infected tissues and toxic irritants by a combination of mechanical cleaning and irrigation in the root canal system through the hole. C: after cleaning and irrigation, the dentist fills the space with an inert packing material and seals the opening.D and E: the process of retrograde filling. D: when retrograde filling is indicated, the dentist needs to cut a flap in the gum and creates a hole in the bone to get access to the bottom tip of the root. E: after cutting off the tip, then thorough preparation, the apex is sealed (the apical seal) and the hole made by the dentist filled with a dental material.
Figuras y tablas -
Figure 1

A: an infected tooth. The inner space of the tooth is the root canal system, where the pulp is located. The pulp of this tooth is irreversibly inflamed from bacterial infection due to decay.

B and C: the process of root canal therapy. B: a hole has been drilled from the top of the crown of the tooth. The dentist could then remove the infected tissues and toxic irritants by a combination of mechanical cleaning and irrigation in the root canal system through the hole. C: after cleaning and irrigation, the dentist fills the space with an inert packing material and seals the opening.

D and E: the process of retrograde filling. D: when retrograde filling is indicated, the dentist needs to cut a flap in the gum and creates a hole in the bone to get access to the bottom tip of the root. E: after cutting off the tip, then thorough preparation, the apex is sealed (the apical seal) and the hole made by the dentist filled with a dental material.

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Study flow diagram.

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Figure 2

Study flow diagram.

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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Figure 3

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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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 4

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

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Comparison 1: MTA versus IRM, Outcome 1: Success rate ‐ 1‐year outcome (tooth as unit of analysis)

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Analysis 1.1

Comparison 1: MTA versus IRM, Outcome 1: Success rate ‐ 1‐year outcome (tooth as unit of analysis)

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Comparison 1: MTA versus IRM, Outcome 2: Success rate ‐ 2‐year outcome (tooth as unit of analysis)

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Analysis 1.2

Comparison 1: MTA versus IRM, Outcome 2: Success rate ‐ 2‐year outcome (tooth as unit of analysis)

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Comparison 2: MTA versus Super‐EBA, Outcome 1: Success rate ‐ 1‐year outcome (tooth as unit of analysis)

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Analysis 2.1

Comparison 2: MTA versus Super‐EBA, Outcome 1: Success rate ‐ 1‐year outcome (tooth as unit of analysis)

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Comparison 2: MTA versus Super‐EBA, Outcome 2: Success rate ‐ 4‐year outcome (tooth as unit of analysis)

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Analysis 2.2

Comparison 2: MTA versus Super‐EBA, Outcome 2: Success rate ‐ 4‐year outcome (tooth as unit of analysis)

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Comparison 3: Super‐EBA versus IRM, Outcome 1: Success rate ‐ 1‐year outcome (tooth as unit of analysis)

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Analysis 3.1

Comparison 3: Super‐EBA versus IRM, Outcome 1: Success rate ‐ 1‐year outcome (tooth as unit of analysis)

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Comparison 4: Dentine‐bonded resin composite versus glass ionomer cement, Outcome 1: Success rate ‐ 1‐year outcome PP analysis (tooth as unit of analysis)

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Analysis 4.1

Comparison 4: Dentine‐bonded resin composite versus glass ionomer cement, Outcome 1: Success rate ‐ 1‐year outcome PP analysis (tooth as unit of analysis)

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Comparison 4: Dentine‐bonded resin composite versus glass ionomer cement, Outcome 2: Success rate ‐ 1‐year outcome ITT analysis (tooth as unit of analysis)

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Analysis 4.2

Comparison 4: Dentine‐bonded resin composite versus glass ionomer cement, Outcome 2: Success rate ‐ 1‐year outcome ITT analysis (tooth as unit of analysis)

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Comparison 4: Dentine‐bonded resin composite versus glass ionomer cement, Outcome 3: Success rate ‐ 1‐year outcome PP analysis (root as unit of analysis)

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Analysis 4.3

Comparison 4: Dentine‐bonded resin composite versus glass ionomer cement, Outcome 3: Success rate ‐ 1‐year outcome PP analysis (root as unit of analysis)

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Comparison 4: Dentine‐bonded resin composite versus glass ionomer cement, Outcome 4: Success rate ‐ 1‐year outcome ITT analysis (root as unit of analysis)

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Analysis 4.4

Comparison 4: Dentine‐bonded resin composite versus glass ionomer cement, Outcome 4: Success rate ‐ 1‐year outcome ITT analysis (root as unit of analysis)

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Comparison 5: Glass ionomer cement versus amalgam, Outcome 1: Success rate ‐ 1‐year outcome (tooth as unit of analysis)

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Analysis 5.1

Comparison 5: Glass ionomer cement versus amalgam, Outcome 1: Success rate ‐ 1‐year outcome (tooth as unit of analysis)

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Comparison 5: Glass ionomer cement versus amalgam, Outcome 2: Success rate ‐ 5‐year outcome (tooth as unit of analysis)

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Analysis 5.2

Comparison 5: Glass ionomer cement versus amalgam, Outcome 2: Success rate ‐ 5‐year outcome (tooth as unit of analysis)

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Comparison 6: MTA versus RRM, Outcome 1: Success rate ‐ 1‐year outcome (tooth as unit of analysis)

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Analysis 6.1

Comparison 6: MTA versus RRM, Outcome 1: Success rate ‐ 1‐year outcome (tooth as unit of analysis)

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Summary of findings 1. MTA versus IRM for retrograde filling in root canal therapy

MTA versus IRM for retrograde filling in root canal therapy

Patient or population: patients needing retrograde filling in root canal therapy
Settings: UK and the Netherlands
Intervention: MTA versus IRM

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of teeth
(studies)

Certainty of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

IRM

MTA

Success rate ‐ 1‐year outcome (tooth as unit of analysis)
Assessed by combination of clinical and radiological methods
Follow‐up: mean 1 year

806 per 1000

879 per 1000
(782 to 983)

RR 1.09
(0.97 to 1.22)

222
(2 studies)

⊕⊝⊝⊝
verylowa

There may be little to no effect of MTA compared to IRM on success rate at 1 year but the evidence is very uncertain

Adverse events

Outcome was not assessed by the included studies

*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; IRM: intermediate restorative material; MTA: mineral trioxide aggregate; RR: risk ratio

GRADE Working Group grades of evidence

High certainty: we are very confident that the true effect lies close to that of the estimate of the effect

Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different

Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect

Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect

aDowngraded by 3 levels due to high risk of bias (downgraded by 1 level; both studies had the personnel unblinded due to the nature of the study design, and Chong 2003 had incomplete outcome data reported) and imprecision (downgraded by 2 levels; small number of participants and wide confidence intervals including both benefit and no benefit).
 

Figuras y tablas -
Summary of findings 1. MTA versus IRM for retrograde filling in root canal therapy
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Summary of findings 2. MTA versus Super‐EBA for retrograde filling in root canal therapy

MTA versus Super‐EBA for retrograde filling in root canal therapy

Patient or population: patients needing retrograde filling in root canal therapy
Settings: South Korea
Intervention: MTA versus Super‐EBA

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of teeth
(studies)

Certainty of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Super‐EBA

MTA

Success rate ‐ 1‐year outcome (tooth as unit of analysis)
Assessed by combination of clinical and radiological methods
Follow‐up: mean 1 year

931 per 1000

959 per 1000
(894 to 1000)

RR 1.03
(0.96 to 1.10)

192
(1 study)

⊕⊝⊝⊝
very lowa

There may be little to no effect of MTA compared to Super‐EBA on success rate at 1 year but the evidence is very uncertain

Adverse events

Outcome was not assessed by the included studies

*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; MTA: mineral trioxide aggregate; RR: risk ratio; Super‐EBA: super ethoxybenzoic acid

GRADE Working Group grades of evidence

High certainty: we are very confident that the true effect lies close to that of the estimate of the effect

Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different

Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect

Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect

aDowngraded by 3 levels due to high risk of bias (downgraded by 1 level; the included study (Kim 2016) had high risk of bias regarding incomplete data reporting and personnel blinding) and imprecision (downgraded by 2 levels; small population might cause serious imprecision).

Figuras y tablas -
Summary of findings 2. MTA versus Super‐EBA for retrograde filling in root canal therapy
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Summary of findings 3. Super‐EBA versus IRM for retrograde filling in root canal therapy

Super‐EBA versus IRM for retrograde filling in root canal therapy

Patient or population: patients needing retrograde filling in root canal therapy
Settings: Sweden
Intervention: Super‐EBA versus IRM

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of teeth
(studies)

Certainty of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

IRM

Super‐EBA

Success rate ‐ 1‐year outcome (tooth as unit of analysis)
Assessed by combination of clinical and radiological methods
Follow‐up: mean 1 year

906 per 1000

815 per 1000
(725 to 915)

RR 0.90
(0.80 to 1.01)

194
(1 study)

⊕⊝⊝⊝
very lowa

The evidence is very uncertain about the effect of Super‐EBA compared with IRM on success rate at 1 year, with results indicating Super‐EBA may reduce or have no effect on success rate

Adverse events

Outcome was not assessed by the included studies

*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; IRM: intermediate restorative material; RR: risk ratio; Super‐EBA: super ethoxybenzoic acid

GRADE Working Group grades of evidence

High certainty: we are very confident that the true effect lies close to that of the estimate of the effect

Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different

Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect

Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect

aDowngraded by 3 levels due to high risk of bias (downgraded by 1 level; high risk of bias existed in the only included study (Wälivaara 2011) on allocation concealment and personnel blinding) and imprecision (downgraded by 2 levels; small number of participants and wide confidence intervals including both benefit and no benefit).

Figuras y tablas -
Summary of findings 3. Super‐EBA versus IRM for retrograde filling in root canal therapy
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Summary of findings 4. Dentine‐bonded resin composite versus glass ionomer cement for retrograde filling in root canal therapy

Dentine‐bonded resin composite versus glass ionomer cement for retrograde filling in root canal therapy

Patient or population: patients needing retrograde filling in root canal therapy
Settings: Denmark
Intervention: dentine‐bonded resin composite versus glass ionomer cement

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of teeth/roots
(studies)

Certainty of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Glass ionomer cement

Dentine‐bonded resin composite

Success rate ‐ 1‐year outcome PP analysis (tooth as unit of analysis)
Assessed by combination of clinical and radiological methods
Follow‐up: mean 1 year

306 per 1000

731 per 1000
(490 to 1000)

RR 2.39
(1.60 to 3.59)

122 teeth
(1 study)

⊕⊝⊝⊝
very lowa

Compared to glass ionomer cement, dentine‐bonded resin composite may increase the success rate of the treatment at 1 year but the evidence is very uncertain

Success rate ‐ 1‐year outcome PP analysis (root as unit of analysis)
Assessed by radiological methods
Follow‐up: mean 1 year

519 per 1000

825 per 1000
(623 to 1000)

RR 1.59
(1.20 to 2.09)

127 roots
(1 study)

⊕⊝⊝⊝
very lowa

Compared to glass ionomer cement, dentine‐bonded resin composite may increase the success rate of the treatment at 1 year but the evidence is very uncertain

Adverse events

Outcome was not assessed by the included studies

*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; PP: per‐protocol; RR: risk ratio

GRADE Working Group grades of evidence

High certainty: we are very confident that the true effect lies close to that of the estimate of the effect

Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different

Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect

Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect

aDowngraded by 3 levels due to high risk of bias (downgraded by 1 level; the included study (Jensen 2002) did not have participants, personnel, or outcome assessors blinded) and imprecision (downgraded by 2 levels; small population might cause serious imprecision).

Figuras y tablas -
Summary of findings 4. Dentine‐bonded resin composite versus glass ionomer cement for retrograde filling in root canal therapy
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Summary of findings 5. Glass ionomer cement versus amalgam for retrograde filling in root canal therapy

Glass ionomer cement versus amalgam for retrograde filling in root canal therapy

Patient or population: patients needing retrograde filling in root canal therapy
Settings: Sweden
Intervention: glass ionomer cement versus amalgam

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of teeth
(studies)

Certainty of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Amalgam

Glass ionomer cement

Success rate ‐ 1‐year outcome (tooth as unit of analysis)
Assessed by combination of clinical and radiological methods
Follow‐up: mean 1 year

904 per 1000

886 per 1000
(777 to 1000)

RR 0.98
(0.86 to 1.12)

105
(1 study)

⊕⊝⊝⊝
very lowa

The evidence is very uncertain about the effect of glass ionomer cement compared with amalgam on success rate at 1 year, with results indicating glass ionomer cement may reduce or have no effect on success rate

Adverse events

Outcome was not assessed by the included studies

*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; RR: risk ratio

GRADE Working Group grades of evidence

High certainty: we are very confident that the true effect lies close to that of the estimate of the effect

Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different

Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect

Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect

aDowngraded by 3 levels due to high risk of bias (downgraded by 1 level; the included study (Jesslen 1995) had the personnel unblinded due to the nature of the study design) and imprecision (downgraded by 2 levels; small number of participants and wide confidence intervals including both benefit and no benefit).

Figuras y tablas -
Summary of findings 5. Glass ionomer cement versus amalgam for retrograde filling in root canal therapy
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Summary of findings 6. MTA versus RRM for retrograde filling in root canal therapy

MTA versus RRM for retrograde filling in root canal therapy

Patient or population: patients needing retrograde filling in root canal therapy

Settings: China

Intervention: MTA versus RRM

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of teeth
(studies)

Certainty of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

RRM

MTA

Success rate ‐ 1‐year outcome (tooth as unit of analysis)

Assessed by combination of clinical and radiological methods

Follow‐up: 1 year

933 per 1000

896 per 1000
(840 to 970)

RR 1.00
(0.94 to 1.07)

278
(2 studies)

⊕⊝⊝⊝
very lowa

There may be little to no effect of MTA compared to RRM on success rate at 1 year but the evidence is very uncertain

Adverse events

Outcome was not assessed by the included studies

*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% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)

CI: confidence interval; MTA: mineral trioxide aggregate; RR: risk ratio; RRM: root repair material

GRADE Working Group grades of evidence

High certainty: we are very confident that the true effect lies close to that of the estimate of the effect

Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different

Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect

Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect

aDowngraded by 3 levels due to high risk of bias (downgraded by 1 level; the included studies (Safi 2019; Zhou 2017) had high risk of bias regarding personnel blinding) and imprecision (downgraded by 2 levels; small number of participants and wide confidence intervals including both benefit and no benefit).

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Summary of findings 6. MTA versus RRM for retrograde filling in root canal therapy
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Comparison 1. MTA versus IRM

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1.1 Success rate ‐ 1‐year outcome (tooth as unit of analysis) Show forest plot

2

222

Risk Ratio (M‐H, Fixed, 95% CI)

1.09 [0.97, 1.22]

1.2 Success rate ‐ 2‐year outcome (tooth as unit of analysis) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 1. MTA versus IRM
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Comparison 2. MTA versus Super‐EBA

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

2.1 Success rate ‐ 1‐year outcome (tooth as unit of analysis) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2.2 Success rate ‐ 4‐year outcome (tooth as unit of analysis) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected
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Comparison 2. MTA versus Super‐EBA
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Comparison 3. Super‐EBA versus IRM

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

3.1 Success rate ‐ 1‐year outcome (tooth as unit of analysis) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected
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Comparison 3. Super‐EBA versus IRM
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Comparison 4. Dentine‐bonded resin composite versus glass ionomer cement

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

4.1 Success rate ‐ 1‐year outcome PP analysis (tooth as unit of analysis) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

4.2 Success rate ‐ 1‐year outcome ITT analysis (tooth as unit of analysis) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

4.3 Success rate ‐ 1‐year outcome PP analysis (root as unit of analysis) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

4.4 Success rate ‐ 1‐year outcome ITT analysis (root as unit of analysis) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 4. Dentine‐bonded resin composite versus glass ionomer cement
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Comparison 5. Glass ionomer cement versus amalgam

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

5.1 Success rate ‐ 1‐year outcome (tooth as unit of analysis) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

5.2 Success rate ‐ 5‐year outcome (tooth as unit of analysis) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected
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Comparison 5. Glass ionomer cement versus amalgam
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Comparison 6. MTA versus RRM

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

6.1 Success rate ‐ 1‐year outcome (tooth as unit of analysis) Show forest plot

2

278

Risk Ratio (M‐H, Fixed, 95% CI)

1.00 [0.94, 1.07]
Figuras y tablas -
Comparison 6. MTA versus RRM
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