Repositorio
Institucional

Dorri, Mojtaba

Jose Martinez-Zapata, Maria#Walsh, Tanya#Marinho, Valeria C. C.#Sheiham, Aubrey#Zaror, Carlos

Atraumatic restorative treatment versus conventional restorative treatment for managing dental caries

WILEY

COCHRANE DATABASE OF SYSTEMATIC REVIEWS

en

Background Dental caries is a sugar-dependent disease that damages tooth structure and, due to loss of mineral components, may eventually lead to cavitation. Dental caries is the most prevalent disease worldwide and is considered the most important burden of oral health. Conventional treatment methods (drill and fill) involve the use of rotary burs under local anaesthesia. The need for an electricity supply, expensive handpieces and highly trained dental health personnel may limit access to dental treatment, especially in underdeveloped regions. To overcome the limitations of conventional restorative treatment, the Atraumatic Restorative Treatment (ART) was developed, mainly for treating caries in children living in under-served areas of the world where resources and facilities such as electricity and trained manpower are limited. ART is a minimally invasive approach which involves removal of decayed tissue using hand instruments alone, usually without use of anaesthesia and electrically driven equipment, and restoration of the dental cavity with an adhesive material (glass ionomer cement (GIC), composite resins, resin-modified glass-ionomer cement (RM-GICs) and compomers). Objectives To assess the effects of Atraumatic Restorative Treatment (ART) compared with conventional treatment for managing dental caries lesions in the primary and permanent teeth of children and adults. Search methods Cochrane Oral Health's Information Specialist searched the following databases: Cochrane OralHealth's Trials Register (to 22 February 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 1), MEDLINE Ovid (1946 to 22 February 2017), Embase Ovid (1980 to 22 February 2017), LILACS BIREME Virtual Health Library (Latin American and Caribbean Health Science Information database, 1982 to 22 February 2017) and BBO BIREME Virtual Health Library (Bibliografia Brasileira de Odontologia, 1986 to 22 February 2017). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. Selection criteria We included randomised controlled trials (RCTs) with at least six months' follow-up that compared the effects of ART with a conventional restorative approach using the same or different restorative dental materials to treat caries lesions. Data collection and analysis Two review authors independently screened search results, extracted data from included studies and assessed the risk of bias in those studies. We used standard methodological procedures expected by Cochrane to evaluate risk of bias and synthesise data. Where pooling was appropriate we conducted meta-analyses using the random-effects model. We assessed the quality of the evidence using GRADE criteria. Main results We included a total of 15 eligible studies randomising 3760 participants in this review. The age of participants across the studies ranged from 3 to 101 years, with a mean of 25.42 years. 48% of participants were male. All included studies were published between 2002 and 2016. Two of the 15 studies declared that the financial support was from companies that manufacture restorative material. Five studies were individually randomised parallel-group studies, six were cluster-randomised parallel-group studies, and four were randomised studies that used a split-mouth design. Eleven studies evaluated the effects of ART on primary teeth only, and four on permanent teeth. The follow-up period of the included studies ranged from 6 months to 36 months. We judged all studies to be at high risk of bias. For the main comparison of ART compared to conventional treatment using the same material: all but two studies used high-viscosity glass ionomer (H-GIC) as the restorative material, one study used a composite material, and one study used resin-modified glass ionomer cement (RM-GIC)). Compared to conventional treatment using H-GIC, ART may increase the risk of restoration failure in the primary dentition, over a follow-up period from 12 to 24 months (OR 1.60, 95% CI 1.13 to 2.27, five studies, 643 participants analysed, low-quality evidence). Our confidence in this effect estimate is limited due to serious concerns over risk of performance and attrition bias. For this comparison, ART may reduce pain during procedure compared with conventional treatment (MD -0.65, 95% CI -1.38 to 0.07, 40 participants analysed, low-quality evidence) Comparisons of ART to conventional treatment using composite or RM-GIC were downgraded to very low quality due to indirectness, imprecision and high risk of performance and attrition bias. Given the very low quality of the evidence from single studies, we are uncertain about the restoration failure of ART compared with conventional treatment using composite over a 24-month follow-up period (OR 1.11, 95% CI 0.54 to 2.29, one study, 57 participants) and ART using RM-GIC in the permanent teeth of older adults with root caries lesions over a six-month follow-up period (OR 2.71, 95% CI 0.94 to 7.81, one study, 64 participants). No studies reported on adverse events or costs. Authors' conclusions Low-quality evidence suggests that ART using H-GIC may have a higher risk of restoration failure than conventional treatment for caries lesions in primary teeth. The effects of ART using composite and RM-GIC are uncertain due to the very low quality of the evidence and we cannot rely on the findings. Most studies evaluated the effects of ART on the primary dentition. Well-designed RCTs are required that report on restoration failure at clinically meaningful time points, as well as participant-reported outcomes such as pain and discomfort. Due to the potential confounding effects from the use of different dental materials, a robust body of evidence on the effects of ART compared with conventional treatment using the same restoration material is necessary. We identified four ongoing trials that could provide further insights into this area.

Artículo de revisión

The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), UK NIHR Manchester Biomedical Research Centre, UK.r CONICYT Higher educational program. Government of Chile, Chile.r Project number 80140042r Instituto de Salud Carlos III, Spain.r Dr. Ma Jose 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)r Naitonal Institute for Health Research (NIHR), UK.r 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 Healthr Cochrane Oral Health Global Alliance, Other.r 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

La Universidad de Manchester, Manchester Academic Health Sciences Centre (MAHSC), Reino Unido NIHR Manchester Biomedical Research Centre, Reino Unido.r Programa de educación superior de CONICYT. Gobierno de Chile, Chile.r Número de proyecto 80140042r Instituto de Salud Carlos III, España.r El Dr. Ma José Martínez Zapata está financiado por un contrato de investigación Miguel Servet del Instituto de Salud Carlos III y el Fondo Social Europeo (Invirtiendo en tu futuro) (CP15/00116)r National Institute for Health Research (NIHR), Reino Unido.r Este proyecto fue apoyado por el NIHR, a través de la financiación de Infraestructura Cochrane para Cochrane Oral Health. Las opiniones y puntos de vista expresados ​​en el mismo son los de los autores y no reflejan necesariamente los del Programa de Revisiones Sistemáticas, NIHR, NHS o el Departamento de Saludr Cochrane Oral Health Global Alliance, Otros.r La producción de revisiones de Cochrane Oral Health ha sido apoyada financieramente por nuestra Alianza Global desde 2011 (socios de Cochrane Oral Health Global Alliance). Los colaboradores durante el último año han sido: Asociación Británica para el Estudio de la Odontología Comunitaria (RU), Sociedad Británica de Odontología Pediátrica (RU), Asociación Canadiense de Higienistas Dentales (Canadá), Centro de Educación e Investigación Dental del Instituto de Ciencias Médicas de la India (India), Centro Nacional de Investigación y Práctica de Higiene Dental (EE. UU.), Facultad de Odontología de la Universidad de Nueva York (EE. UU.), NHS Education for Scotland (RU), Sociedad Suiza de Endondontología (Suiza).

10.1002/14651858.CD008072.pub2

pdf

http://dx.doi.org/10.1002/14651858.CD008072.pub2

Medicine, General & Internal

Odontología, Cirugía y Medicina Oral

Medicina General e Interna

Servicios y Cuidados en Ciencias de la Salud (Administración de Hospitales, financiamiento de la atención hospitalaria)

version publicada

hibrida

acceso abierto

acceso abierto

WOS:000419102200006

Atraumatic restorative treatment versus conventional restorative treatment for managing dental caries

Artículo de revisión

WILEY

COCHRANE DATABASE OF SYSTEMATIC REVIEWS

Medicina general e interna

1469-493X

en

MAHSC#UK NIHR Manchester Biomedical Research Centre#ANID CONICYT 80140042#ISCIII European Social Fund CP15/00116#NIHR#Cochrane Oral Health Global Alliance#British Association for the Study of Community Dentistry#British Society of Paediatric Dentistry#Canadian Dental Hygienists Association#Centre for Dental Education and Research#India Institute of Medical Sciences#National Center for Dental Hygiene Research & Practice#New York University College of Dentistry#NHS Education for Scotland#Swiss Society for Endondontology

MAHSC UK NIHR

ANID CONICYT 80140042

ISCIII

EU CP15/00116]

Cochrane Oral Health Global Alliance

British Association for the Study of Community Dentistry, UK

British Society of Paediatric Dentistry, UK

Canadian Dental Hygienists Association, Canada

Centre for Dental Education and Research at All India Institute of Medical Sciences

National Center for Dental Hygiene Research Practice

New York University College of Dentistry

NHS Education for Scotland, UK

Swiss Society for Endondontology

The University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), UK NIHR Manchester Biomedical Research Centre, UK.r CONICYT Higher educational program. Government of Chile, Chile.r Project number 80140042r Instituto de Salud Carlos III, Spain.r Dr. Ma Jose 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)r Naitonal Institute for Health Research (NIHR), UK.r 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 Healthr Cochrane Oral Health Global Alliance, Other.r 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

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