Tratamiento restaurativo no traumático versus tratamiento restaurativo convencional para la caries dental
Información
- DOI:
- https://doi.org/10.1002/14651858.CD008072.pub2Copiar DOI
- Base de datos:
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- Cochrane Database of Systematic Reviews
- Versión publicada:
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- 28 diciembre 2017see what's new
- Tipo:
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- Intervention
- Etapa:
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- Review
- Grupo Editorial Cochrane:
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Grupo Cochrane de Salud oral
- Copyright:
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- Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cifras del artículo
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Autores
Contributions of authors
Mojtaba Dorri (MD) ‐ drafting of the protocol, designing a search strategy, screening search results, selection of studies, writing to authors of papers for additional information, quality assessment, data extraction, drafting the final review, updating the review.
María José Martinez‐Zapata ‐ selection of studies, quality assessment, data extraction, carrying out the analysis, drafting the final review, updating the review.
Tanya Walsh ‐ data extraction, carrying out the analysis, interpreting the analysis, drafting the final review, updating the review.
Valeria Marinho (VM) ‐ drafting of the protocol, selection of studies, interpreting the analysis, drafting the final review, updating the review.
Aubrey Sheiham (AS) ‐ drafted the protocol, designed a search strategy, and selected studies. Aubrey made a very important contribution to this review. He passed away in 2015.
Carlos Zaror (CZ) ‐ screening search results, selection of studies, writing to authors of papers for additional information, quality assessment, data extraction, carrying out the analysis, drafting the final review, updating the review.
Sources of support
Internal sources
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The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), UK NIHR Manchester Biomedical Research Centre, UK.
External sources
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CONICYT Higher educational program. Government of Chile, Chile.
Project number 80140042
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Instituto de Salud Carlos III, Spain.
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Dr. Mª José Martinez Zapata is funded by a Miguel Servet research contract from the Instituto de Salud Carlos III and European Social Fund (Investing in Your Future) (CP15/00116)
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Naitonal Institute for Health Research (NIHR), UK.
This project was supported by the NIHR, via Cochrane Infrastructure funding to Cochrane Oral Health. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health
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Cochrane Oral Health Global Alliance, Other.
The production of Cochrane Oral Health reviews has been supported financially by our Global Alliance since 2011 (Cochrane Oral Health Global Alliance partners). Contributors over the past year have been: British Association for the Study of Community Dentistry, UK; British Society of Paediatric Dentistry, UK; the Canadian Dental Hygienists Association, Canada; Centre for Dental Education and Research at All India Institute of Medical Sciences, India; National Center for Dental Hygiene Research & Practice, USA; New York University College of Dentistry, USA; NHS Education for Scotland, UK; Swiss Society for Endondontology, Switzerland
Declarations of interest
Mojtaba Dorri: none known.
Maria José Martinez‐Zapata: none known.
Tanya Walsh: none known. Dr Walsh is an Editor with Cochrane Oral Health.
Valeria CC Marinho: none known.
Aubrey Sheiham: deceased. Declaration of interest from protocol: 'none known'.
Carlos Zaror: none known.
Acknowledgements
The review authors would like to thank Cochrane Oral Health and the referees for their comments, support and assistance with conducting this review. We would like to acknowledge Liyuan Ma, Professor Zongdao Shi, Professor Chengge Hua, Dr Fatemeh Mokhtarpour, Professor Bo Su and Frans Banki for their help with translating Chinese and Dutch articles. Thanks are also due to Jo Frecken for providing further details of his study; Anne Littlewood (Cochrane Oral Health) for searching different databases; Marta Roqué‐Figuls (Iberoamerican Cochrane Center) for their contribution in resolving methodological issues; and Dominic Hurst for his contribution in the early stages of this review. We acknowledge those who provided feedback on the review: Helen Worthington, Jan Clarkson, Liz Bickerdike and Ruth Floate; external referees Ivor G. Chestnutt and Margherita Fontana; and Denise Mitchell for copy editing. Last but not least, we would like to thank Laura MacDonald (Cochrane Oral Health) for her generous and continued support throughout this review and, in particular, for facilitating the communication between the review team and Cochrane Oral Health.
Carlos Zaror is a PhD candidate in Methodology of Biomedical Research and Public Health program, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
Version history
| Published | Title | Stage | Authors | Version |
| 2017 Dec 28 | Atraumatic restorative treatment versus conventional restorative treatment for managing dental caries | Review | Mojtaba Dorri, Maria José Martinez‐Zapata, Tanya Walsh, Valeria CC Marinho, Aubrey Sheiham (deceased), Carlos Zaror | |
| 2009 Oct 07 | Atraumatic restorative treatment versus conventional restorative treatment for the management of dental caries | Protocol | Mojtaba Dorri, Aubrey Sheiham, Valeria CC Marinho | |
Differences between protocol and review
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The 'Objectives' section was expanded to better describe the objectives of this review for the readers.
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We had planned to include both RCTs and quasi‐RCTs in this review. However, we decided to exclude quasi‐RCTs to improve the internal validity of findings.
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In the protocol it was not clear whether we would include studies using different restorative materials in study arms. We clarified in the 'Types of interventions section' that studies using the same and different materials in study arms would be included in the review, but only studies using the same restorative material in both arms would be pooled in the meta‐analysis.
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We had planned to search IndMED (India), Chinese BiomedicalLiterature Database (CBM) (in Chinese), Grey literature databases such as SIGLE (1980 to present). In the full review, Cochrane Oral Health amended the list of databases and added the following: Meta Register of Controlled Trials (to 6 July 2015), ClinicalTrials.gov (to 22 February 2017), WHO International Clinical Trials Registry Platform (to 22 February 2017).
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Following consultation with Cochrane Oral Health, we decided to reduce the large list of secondary outcomes and to prioritise only the clinically relevant outcomes.
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To pool parallel and split‐mouth data, we used the generic inverse variance method (GIV) and therefore, we calculated the OR rather than RR.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
Medical Subject Headings Check Words
Adult; Child; Female; Humans; Male;
PICO
Study flow diagram
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
Risk of bias summary: review authors' judgements about each risk of bias item for each included study
Forest plot of comparison 1. Atraumatic restorative treatment using high‐viscosity glass ionomer cement (H‐GIC) versus conventional treatment using H‐GIC, outcome: 1.1 restoration failure (primary teeth) ‐ longest follow‐up
Comparison 1 Atraumatic restorative treatment using high‐viscosity glass ionomer cement (H‐GIC) versus conventional treatment using H‐GIC, Outcome 1 Restoration failure ‐ primary teeth ‐ longest follow‐up.
Comparison 1 Atraumatic restorative treatment using high‐viscosity glass ionomer cement (H‐GIC) versus conventional treatment using H‐GIC, Outcome 2 Pain ‐ primary teeth.
Comparison 1 Atraumatic restorative treatment using high‐viscosity glass ionomer cement (H‐GIC) versus conventional treatment using H‐GIC, Outcome 3 Participant experience ‐ discomfort.
Comparison 2 Atraumatic restorative treatment using composite versus conventional treatment using composite, Outcome 1 Restoration failure ‐ primary teeth ‐ longest follow‐up.
Comparison 2 Atraumatic restorative treatment using composite versus conventional treatment using composite, Outcome 2 Participant experience ‐ dental anxiety.
Comparison 3 Atraumatic restorative treatment using resin‐modified glass ionomer cement (RM‐GIC) versus conventional treatment using RM‐GIC, Outcome 1 Restoration failure ‐ permanent teeth ‐ longest follow‐up.
Comparison 3 Atraumatic restorative treatment using resin‐modified glass ionomer cement (RM‐GIC) versus conventional treatment using RM‐GIC, Outcome 2 Secondary caries.
| Atraumatic restorative treatment (ART) using high‐viscosity glass ionomer cement (H‐GIC) compared with conventional restorative treatment using H‐GIC for dental caries | |||||
| Patient or population: people with dental caries Settings: community settings and dental clinics Intervention: ART using H‐GIC Comparison: conventional treatment using H‐GIC | |||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | Number of participants | Quality of the evidence | |
| Assumed risk | Corresponding risk | ||||
| Conventional treatment with H‐GIC | ART with H‐GIC | ||||
| Restoration failure (primary dentition) at 12 to 24 months | 471 per 1000 | 588 per 1000 | OR 1.60 | 643 participants/846 teeth | ⊕⊕⊝⊝ |
| Pain | Mean pain (primary teeth) was 1.38 (SD 1.21) | Mean pain (primary teeth) was 0.73 (SD 1.14) | MD 0.65 lower (1.38 lower to 0.07 higher) | 40 participants | ⊕⊕⊝⊝ |
| Adverse events | ‐ | ‐ | ‐ | ‐ | Not measured |
| *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). | |||||
| GRADE Working Group grades of evidence | |||||
| 1We downgraded the evidence by two levels because of very serious concerns regarding risk of bias: we judged all five studies as high risk of performance bias, three studies as high risk of attrition bias, and two studies as high risk of reporting bias. | |||||
| Atraumatic restorative treatment (ART) using composite resins compared with conventional restorative treatment using composite resins for dental caries | |||||
| Patient or population: people with dental caries Settings: community settings and dental clinics Intervention: ART using composite Comparison: conventional treatment using composite | |||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Quality of the evidence | |
| Assumed risk | Corresponding risk | ||||
| Conventional treatment | ART | ||||
| Restoration failure (primary dentition) | 362 per 1000 | 387 per 1000 | OR 1.11 | 57 participants/100 teeth | ⊕⊝⊝⊝ |
| Pain | ‐ | ‐ | ‐ | ‐ | Not measured |
| Adverse events | ‐ | ‐ | ‐ | ‐ | Not measured |
| *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). | |||||
| GRADE Working Group grades of evidence | |||||
| 1We downgraded the evidence by three levels: one level because it is a single study (indirectness) and two levels because of very serious concern regarding the risk of bias (high risk of performance bias and high risk of attrition bias). The result was also very imprecise. | |||||
| Atraumatic restorative treatment (ART) using resin‐modified glass ionomer cement (RM‐GIC) compared with conventional restorative treatment using RM‐GIC for dental caries | |||||
| Patient or population: people with dental caries Settings: community settings and dental clinics Intervention: ART using RM‐GIC Comparison: conventional treatment using RM‐GIC | |||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect | No of participants | Quality of the evidence | |
| Assumed risk | Corresponding risk | ||||
| Conventional treatment | ART | ||||
| Restoration failure (primary dentition) | ‐ | ‐ | ‐ | 0 studies | No studies included |
| Restoration failure (permanent teeth) | 75 per 1000 | 180 per 1000 | OR 2.71 | 64 participants/141 teeth | ⊕⊝⊝⊝ |
| Pain | ‐ | ‐ | ‐ | ‐ | Not measured |
| Adverse events | ‐ | ‐ | ‐ | ‐ | Not measured |
| *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). | |||||
| GRADE Working Group grades of evidence | |||||
| 1We downgraded the evidence by one level because it is a single study (indirectness), one level because of concern regarding high risk of performance bias, and one level because the result was imprecise. | |||||
| ART with one material versus conventional treatment with another material | |||
| ART material | Conventional treatment material | Outcomes | Effect estimate OR (95% CI) |
| H‐GIC | Amalgam | Restoration failure ‐primary teeth – 2 studies (Miranda 2005; Yu 2004). Studies reporting on single + multiple lesions | 2.15 (0.73 to 6.35); I2 = 0% |
| Pain (primary dentition) – 1 study (Miranda 2005). Studies reporting on single + multiple lesions | 1.44 (0.45 to 4.60) | ||
| GIC | Amalgam | Restoration failure ‐ primary teeth – 1 study (Ling 2003). Studies reporting on lesion type: not reported | 0.78 (0.30 to 2.02) |
| Restoration failure ‐ permanent, immature teeth – 1 study (Estupiñan‐Day 2006). Studies reporting on lesion type: not reported | 1.71 (1.32 to 2.22) | ||
| Pain ‐ permanent, immature teeth (Estupiñan‐Day 2006) | 0.41 (0.35 to 0.47) | ||
| H‐GIC | Composite and local anaesthetic | Restoration failure ‐ primary teeth – 1 study (Luz 2012). Studies reporting on multiple lesions | 8.00 (1.24 to 51.48) |
| Pain (primary dentition) – 1 study (Luz 2012) | 2.22 (0.51 to 9.61) | ||
| H‐GIC | RM‐GIC and local anaesthetic | Restoration failure ‐ permanent, mature teeth – 2 studies (Da Mata 2015; Lo 2006). Studies reporting on coronal/root caries | 1.46 (0.74 to 2.88); I2 = 0% |
| CI: confidence interval; OR: odds ratio | |||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Restoration failure ‐ primary teeth ‐ longest follow‐up Show forest plot | 5 | Odds Ratio (Random, 95% CI) | 1.60 [1.13, 2.27] | |
| 1.1 Single and multiple cavity surfaces | 1 | Odds Ratio (Random, 95% CI) | 2.75 [0.50, 15.16] | |
| 1.2 Multiple cavity surfaces | 3 | Odds Ratio (Random, 95% CI) | 1.62 [1.03, 2.55] | |
| 1.3 Type of cavity surfaces not reported | 1 | Odds Ratio (Random, 95% CI) | 0.79 [0.12, 5.45] | |
| 2 Pain ‐ primary teeth Show forest plot | 1 | 40 | Mean Difference (IV, Fixed, 95% CI) | ‐0.65 [‐1.38, 0.07] |
| 3 Participant experience ‐ discomfort Show forest plot | 1 | Odds Ratio (M‐H, Fixed, 95% CI) | Totals not selected | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Restoration failure ‐ primary teeth ‐ longest follow‐up Show forest plot | 1 | Odds Ratio (Random, 95% CI) | Totals not selected | |
| 2 Participant experience ‐ dental anxiety Show forest plot | 1 | Mean Difference (IV, Fixed, 95% CI) | Totals not selected | |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Restoration failure ‐ permanent teeth ‐ longest follow‐up Show forest plot | 1 | Odds Ratio (M‐H, Random, 95% CI) | Totals not selected | |
| 2 Secondary caries Show forest plot | 1 | Odds Ratio (M‐H, Fixed, 95% CI) | Subtotals only | |
