Cochrane · intervention · CD008072
Atraumatic restorative treatment versus conventional restorative treatment for managing dental caries
Dorri, M, Martinez‐Zapata, MJ, Walsh, T, et al. · Cochrane Database of Systematic Reviews · 2017 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
30
current version
GRADE rated
4
No studies
13
Included studies
15
as reported
No studies 13 · 43.3%Ungraded 13 · 43.3%Very low 2 · 6.7%Low 2 · 6.7%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Dentate participants, regardless of age and sex, with a history of dental (coronal or root) primary caries lesions extended into enamel and dentine (but not the pulp); primary and permanent teeth with single or multiple surface lesions | 3760 participants; 9944 teeth (6347 ART, 3204 conventional); mean age 25.42 years (range 3 to 101); 48% male; 11 studies primary teeth, 4 permanent teeth |
| Intervention | Adhesive restorative materials (e.g. GICs of different viscosities or resins) placed with the 'true' ART approach, including ITR with hand instruments | ART using H-GIC (n=7 same-material studies; also in 3 different-material comparisons); ART using composite (n=1); ART using RM-GIC (n=1); ART using GIC (n=2) |
| Comparison | The same or different restorative materials (e.g. GIC) placed with conventional cavity preparation methods | Conventional using H-GIC (n=7); composite (n=1); RM-GIC (n=1); amalgam (n=3) |
| Outcomes | Primary: Restoration failure (primary dentition; permanent immature dentition; permanent mature dentition); Pain (during and immediately after treatment). Secondary: Adverse events; Secondary caries; Participant experience (satisfaction or quality of life; discomfort, anxiety or stress); Costs (direct: treatment); Costs (indirect: time off school or work) | Restoration failure (n=13); Pain (n=4); Secondary caries (n=4); Participant experience (n=4); Cost-effectiveness (n=2); Adverse events (n=0) |
| Study designs | Randomised controlled trials (RCTs) with at least six months' follow-up; parallel-group, split-mouth and cluster designs eligible | 15 RCTs (11 parallel-group, of which 6 cluster-randomised; 4 split-mouth) |
| Timing | At least six months' follow-up | Follow-up 6 to 36 months |
Search date: 2017-02. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid (1946 to 2017); Embase Ovid (1980 to 2017); LILACS BIREME Virtual Health Library (1982 to 2017); BBO BIREME Virtual Health Library (1986 to 2017); ClinicalTrials.gov; WHO International…
Questions and results
Show all 2 versionsART using high-viscosity glass ionomer cement (H-GIC), hand instruments vs Conventional treatment using H-GIC (rotary instruments)
Population: People with dental caries in primary teeth (mainly children)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Participant experience (discomfort during procedure) Multiple lesions, children 6 to 8 years | OR 0.95 [0.51, 1.79] | 1 study · 220 participants | Ungraded |
Costs (direct and indirect) | No studies reported on costs for this comparison. | 0 studies | No studies |
Pain (during procedure, primary dentition) During procedure | MD -0.65 [-1.38, 0.07] | 1 study · 40 participants | Low Downgraded: risk of bias, imprecision |
Secondary caries | Two studies reported on secondary caries, but this outcome was not reported by trial arm (Yu 2004; Roeleveld 2006). | 2 studies | Ungraded |
Adverse events | Adverse events: Not measured. | 0 studies | No studies |
Restoration failure (permanent dentition) | No studies reported on restoration failure in permanent dentition for this comparison. | 0 studies | No studies |
Restoration failure (primary dentition) 12 to 24 months | OR 1.60 [1.13, 2.27] 471 vs 588 | 5 studies · 643 participants | Low Downgraded: risk of bias |
ART using composite resin vs Conventional treatment using composite resin
Population: Children with dental caries in primary teeth (mean age 7 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain | Pain: Not measured. | 0 studies | No studies |
Adverse events | Adverse events: Not measured. | 0 studies | No studies |
Restoration failure (permanent dentition) | No studies reported on restoration failure in the permanent dentition for this comparison. | 0 studies | No studies |
Participant experience (dental anxiety) | MD 0.00 [-0.52, 0.52] | 1 study · 57 participants | Ungraded |
Restoration failure (primary dentition) 24 months · Multiple surface lesions | OR 1.11 [0.54, 2.29] 362 vs 387 | 1 study · 57 participants | Very low Downgraded: risk of bias, indirectness |
Secondary caries | No studies reported on secondary caries for this comparison. | 0 studies | No studies |
Costs (direct and indirect) | No studies reported on costs for this comparison. | 0 studies | No studies |
ART using resin-modified glass ionomer cement (RM-GIC) vs Conventional treatment using RM-GIC
Population: Older adults with root caries in permanent (mature) teeth (mean age 75 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Participant experience | No studies reported on participant experience for this comparison. | 0 studies | No studies |
Secondary caries 6 months | One study reported data on secondary caries for this comparison (Cruz 2016). The odds of secondary caries at six months were greater with ART than with conventional treatment. | 1 study | Ungraded |
Pain | Pain: Not measured. | 0 studies | No studies |
Costs (direct and indirect) | No studies reported on costs for this comparison. | 0 studies | No studies |
Restoration failure (primary dentition) | Restoration failure (primary dentition): 0 studies; No studies included. | 0 studies | No studies |
Adverse events | Adverse events: Not measured. | 0 studies | No studies |
Restoration failure (permanent, mature dentition; root surfaces) 6 months · Root caries | OR 2.71 [0.94, 7.81] 75 vs 180 | 1 study · 64 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
ART using H-GIC vs Conventional treatment using amalgam
Population: Children with dental caries in primary teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Restoration failure (primary teeth) Single and multiple lesions | OR 2.15 [0.73, 6.35] | 2 studies | Ungraded |
Pain (primary dentition) Single and multiple lesions | OR 1.44 [0.45, 4.60] | 1 study | Ungraded |
ART using glass ionomer cement (GIC) vs Conventional treatment using amalgam
Population: Children and adolescents with dental caries (primary teeth and permanent immature teeth)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Restoration failure (permanent, immature teeth) Lesion type not reported | OR 1.71 [1.32, 2.22] | 1 study · 1629 participants | Ungraded |
Restoration failure (primary teeth) Lesion type not reported | OR 0.78 [0.30, 2.02] | 1 study · 80 participants | Ungraded |
Pain (permanent, immature teeth) | OR 0.41 [0.35, 0.47] | 1 study | Ungraded |
Participant experience (co-operation during procedure) | Ling 2003 assessed participant co-operation during procedures, showing a co-operation rate in the ART group significantly higher than in the control group (no summary statistic reported). | 1 study | Ungraded |
ART using H-GIC vs Conventional treatment using composite (with local anaesthetic)
Population: Children with dental caries in primary teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Restoration failure (primary teeth) Multiple lesions | OR 8.00 [1.24, 51.48] | 1 study · 30 participants | Ungraded |
Pain (primary dentition) | OR 2.22 [0.51, 9.61] | 1 study | Ungraded |
ART using H-GIC vs Conventional treatment using RM-GIC (with local anaesthetic)
Population: Adults with root caries in permanent (mature) teeth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Restoration failure (permanent, mature teeth) Coronal and root caries | OR 1.46 [0.74, 2.88] | 2 studies · 210 participants | Ungraded |