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
Current version onlyART 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 |
Adhesive restorative materials (e.g. glass ionomer cements of different viscosities) placed with the 'true' ART approach, including ITR with hand instruments vs Conventional cavity preparation with restorative materials such as amalgam
Population: Dentate participants, regardless of age and sex, with a history of dental (coronal or root) caries treated with conventional restorative or ART approaches
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Patient discomfort during the procedure | no estimate extracted | NR | No studies |
Surface changes (changes in texture) | no estimate extracted | NR | No studies |
Secondary caries | no estimate extracted | NR | No studies |
Restoration failure (e.g. replaced restorations) | no estimate extracted | NR | No studies |
Marginal integrity of restoration | no estimate extracted | NR | No studies |
Costs (direct cost of treatment; indirect: time off school or work) | no estimate extracted | NR | No studies |
Sleep habits following intervention | no estimate extracted | NR | No studies |
Pain relief (freedom from symptoms of pain and sensitivity) | no estimate extracted | NR | No studies |
Aesthetics | no estimate extracted | NR | No studies |
Need for monitoring and after-care of restorative treatment | no estimate extracted | NR | No studies |
Operator effect | no estimate extracted | NR | No studies |
Durability of restoration (survival time in months) | no estimate extracted | NR | No studies |
Patient's anxiety and stress after treatment | no estimate extracted | NR | No studies |
Fatigue in operator | no estimate extracted | NR | No studies |
Adverse events | no estimate extracted | NR | No studies |
Weight gain/loss after intervention | no estimate extracted | NR | No studies |
Defects of restorative materials (wear, fracture, staining) | no estimate extracted | NR | No studies |