Quick action may help save the tooth and avoid the need for a more expensive crown. This is a common misconception, one that could lead to a lifetime of problems. As the oldest and most trusted filling material, amalgam is made of a variety of metals, including silver, copper, zinc and mercury.
The presence of mercury scares some parents, but Colgate. Advantages: Amalgam is very strong and durable, making it a great choice for molars exposed to extreme bite pressures. The material also takes less time to apply than other types of fillings, meaning the process can usually be completed in a single visit. Disadvantages: Amalgam is metallic colored and can corrode or tarnish over time, causing discoloration where the tooth meets the filling. Options in this category include composite resins, glass ionomers and a combination type called resin-modified glass ionomers.
The process involves first removing the decay and cleaning the remaining tooth surface. Then the white filling is applied one layer at a time, each of which is exposed to intense light to harden the material.
The tooth and filling are then shaped and polished so the end result looks and feels as natural as possible. Therefore, dental fillings are still routinely placed in daily pediatric dental clinics.
Restorative therapy has many benefits such as restoring the tooth structure and, thus, preventing teeth from shifting and protecting the dental pulp. American Academy of Pediatric Dentistry.
Guideline on restorative dentistry. Pediatr Dent. Evidence-based update of pediatric dental restorative procedures: dental materials. J Clin Pediatr Dent. Although amalgam has been considered the gold standard in restorative dentistry 4 4. Atraumatic restorative treatment versus amalgam restoration longevity: a systematic review. Clin Oral Investig. Fuks AB. The use of amalgam in pediatric dentistry: new insights and reappraising the tradition. However, there is still inconsistency regarding the choice of the best conventional restorative material for restoring carious primary teeth.
Dental fillings for the treatment of caries in the primary dentition. Cochrane Database Syst Rev. Direct evidence from high quality randomized clinical trials should be used when possible. Otherwise, indirect comparisons from randomized clinical trials might be necessary. Indirect comparisons of competing interventions [iii-iv.
Health Technol Assess. Therefore, the aim of this systematic review and network meta-analysis was to evaluate the clinical performance of different conventional restorative materials placed in posterior primary teeth.
The hypothesis tested was that there would be no difference in longevity of restorative materials in primary dentition. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations.
Ann Intern Med. The following research question was formulated to address the literature and outline the search strategy: Is there a best conventional material for restoring posterior primary teeth?
Comparison: Amalgam, compomer, composite resin, conventional glass ionomer cement, resin-modified glass ionomer cement, high-viscosity glass ionomer cement or reinforced glass ionomer cement;. To reduce publication bias, unpublished documents through the ClinicalTrials. The results of searches of various databases were cross-checked to locate and eliminate duplicates using Review Manager Software 5.
Titles and abstracts were reviewed independently by two authors CWP and DP and selected for further review if they met the inclusion criteria: clinical trials that compared the longevity of at least two different conventional restorative materials placed in posterior primary teeth. Any disagreement was firstly solved by discussion between the two reviewers.
If disagreements remained, a third author TLL was consulted. To retrieve all relevant articles, the reviewers screened the reference lists of the included articles. The longevity of the materials was recorded as the number of failed restorations. Higgins JP, Sally G. Cochrane handbook for systematic reviews of interventions Version 5. The Cochrane Collaboration The criteria were divided into seven domains as follows: selection bias sequence generation, allocation concealment , performance and detection bias blinding of participants, personnel, and outcome assessment , attrition bias incomplete outcome data , and reporting bias selective outcome reporting.
If needed, authors were contacted via e-mail at least two attempts were made for missing or unclear information. The data were analyzed using traditional pairwise meta-analysis followed by network meta-analysis.
Bayesian meta-analysis of multiple treatment comparisons: an introduction to mixed treatment comparisons. Value Health. The network meta-analysis was based on a binomial model with log link function. Lu G, Ades AE. Combination of direct and indirect evidence in mixed treatment comparisons. Stat Med. Therefore, the effect-size measure estimated was relative risk.
The GIC was considered the baseline treatment. Both fixed effect and homogeneous variance random effects models were considered. Models were adjusted using Markov Chain Monte Carlo methods with non-informative priors. Convergence was assessed by trace plots and inconsistency by split node method.
Checking consistency in mixed treatment comparison metaanalysis. The search strategy identified 1, potentially relevant records, excluding duplicates. Two ongoing trials were identified. After screening titles and abstracts, 48 studies were retrieved to obtain detailed information. Another 10 studies were identified in reference lists of related reviews. From the 58 full-text articles, 2 studies presented the same sample 13 A randomized trial of resin-based restorations in class I and class II beveled preparations in primary molars: month results.
J Am Dent Assoc. Randomised trial of resin-based restorations in Class I and Class II beveled preparations in primary molars: month results. J Dent. Finally, 17 randomized controlled trials RCTs met the eligibility criteria and were included in the systematic review. The flow chart in Figure 1 summarizes the process of study selection and the reasons for exclusions.
The main characteristics of the included papers are presented in the Table 1. There were six RCTs using parallel groups, 15 Sengul F, Gurbuz T.
Clinical evaluation of restorative materials in primary teeth class II lesions. Clinical evaluation of compomer in primary teeth: 1-year results. Conservative interproximal box-only polyacid modified composite restorations in primary molars, twelve-month clinical results. Silver amalgam versus resin modified GIC class-II restorations in primary molars: twelve month clinical evaluation.
Flowable resin composite as a class II restorative in primary molars: A two-year clinical evaluation. Acta Odontol Scand. The third study recruited 30 patients age range, years with one pair of primary molars that required a Class II restoration. The materials tested were a compomer and amalgam.
This meant that only the month data were usable. For all of the outcomes compared in all three studies, there were no significant differences in clinical performance between the materials tested. No studies were found that compared restorations with extractions or with no treatment as an intervention in children with childhood caries. Conclusions: It was disappointing that only three trials that compared three different types of materials were suitable for inclusion into this review.
There were no significant differences found in all three trials for all of the outcomes assessed. Well-designed RCT comparing the different types of filling materials for similar outcomes are urgently needed in dentistry. There was insufficient evidence from the three included trials to make any recommendations about which filling material to use.
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