Reports of uncontrolled clinical trials for directly placed restorations in vital teeth

Abstract Uncontrolled trials are criticized as unreliable. This study aimed to establish how the number of published reports from uncontrolled clinical trials compares to that of controlled trials for directly placed restorations in vital teeth and whether their annual number is increasing, stable or decreasing. PubMed was searched and suitable citations of uncontrolled and controlled trial reports published between 1990-2016 were included. Reference check and hand searching were conducted. The median annual report number with 25 and 75% percentile was calculated for both types of trials. 695 reports were found. The median number of reports per year was 4 (3-7) and 22 (15-26) from uncontrolled and controlled trials, respectively. A statistically significant decreasing ratio of uncontrolled to controlled trial reports was observed (p = 0.01) by linear regression analysis. The number of reports of uncontrolled clinical trials listed in PubMed over the last 27 years appears at least five times smaller than that of controlled clinical trials and its number in relation to that of controlled trials seems to decrease over time.

The modified Ottawa method to establish the update need of a systematic review: glass-ionomer versus resin sealants for caries prevention

OBJECTIVE: To demonstrate the application of the modified Ottawa method by establishing the update need of a systematic review with focus on the caries preventive effect of GIC versus resin pit and fissure sealants; to answer the question as to whether the existing conclusions of this systematic review are still current; to establish whether a new update of this systematic review was needed. METHODS: Application of the Modified Ottawa method. Application date: April/May 2012. RESULTS: Four signals aligned with the criteria of the modified Ottawa method were identified. The content of these signals suggest that higher precision of the current systematic review results might be achieved if an update of the current review were conducted at this point in time. However, these signals further indicate that such systematic review update, despite its higher precision, would only confirm the existing review conclusion that no statistically significant difference exists in the caries-preventive effect of GIC and resin-based fissure sealants. CONCLUSION: In conclusion, this study demonstrated the modified Ottawa method as an effective tool in establishing the update need of the systematic review. In addition, it was established that the conclusions of the systematic review in relation to the caries preventive effect of GIC versus resin based fissure sealants are still current, and that no update of this systematic review was warranted at date of application. .

Sugar-free chewing gum and dental caries: a systematic review

OBJECTIVE: To appraise existing evidence for a therapeutic / anti-cariogenic effect of sugar-free chewing gum for patients. METHOD: 9 English and 2 Portuguese databases were searched using English and Portuguese keywords. Relevant articles in English, German, Portuguese and Spanish were included for review. Trials were excluded on lack of randomisation, control group, blinding and baseline data, drop out rate >33 percent, no statistical adjustment of baseline differences and no assessment of clinically important outcomes. Reviews were excluded on lack of information, article selection criteria, search strategy followed, search keywords, searched databases or lack of study-by-study critique tables. In cases of multiple reports from the same study, the report covering the longest period was included. Two reviewers independently reviewed and assessed the quality of accepted articles. RESULTS: Thirty-nine articles were included for review. Thirty were excluded and 9 accepted. Of the 9 accepted, 2 trials of reasonable and good evidence value did not demonstrate any anti-cariogenic effect of sugar-free chewing gum. However, 7 articles, with 1 of strong, and 6 of good evidence value, demonstrated anti-cariogenic effects of chewing Sorbitol, Xylitol or Sorbitol/Xylitol gum. This effect can be ascribed to saliva stimulation through the chewing process, particularly when gum is used immediately after meals; the lack of sucrose and the inability of bacteria to metabolize polyols into acids. Conclusion: The evidence suggests that sugar-free chewing gum has a caries-reducing effect. Further well-designed randomised trials are needed to confirm these findings.

Factors inhibiting the implementation of the Atraumatic Restorative Treatment approach in public oral health services in Gauteng province, South Africa

OBJECTIVE: To investigate potential barriers to the utilisation of the ART approach in a South African public oral health service. METHOD: 7 barriers were identified: patient load/work load, operator opinion, patient opinion, service management, material supply, clinical ART skill, chair-side assistance. Operators were asked to answer a questionnaire one year after completing the ART training. Responses ranged from 1 = no barrier to 5 = highest barrier. Treatment data per operator were collected during 1 year after training, for both dentitions, including: number of extracted teeth, placed traditional restorations, ART restorations. The restoration/extraction (REX) ratio and the proportion of ART restorations (ART percent) of the total number of restorations were calculated and correlated with the barrier variables. Pearson correlation, ANOVA and 2-tailed t-tests were used in the statistical analyses. RESULTS: Patient load/work load (mean = 2.80: SE = 0.16) was the strongest barrier (p<0.001) and clinical ART skill was the weakest barrier (p<0.001). A significant correlation between material supply and mean REX score was observed in both dentitions. In primary teeth, the ART percent correlated significantly with clinical ART skill (r= -0.63; p<0.01). In permanent teeth, statistically significant correlations were observed between ART percent and patient load/work load (r = -0.54; p<0.05), patient opinion (r = -0.76; p<0.01), operator opinion (r = -0.53; p<0.05), chair-side assistance (r = -0.57; p<0.05), oral health service management (r = -0.46; p<0.05). CONCLUSIONS: 1 year after ART training completion high patient load/work load, followed by insufficient provision of materials/instruments, were the two most inhibiting barriers to the use of ART in the public oral health services. Dentists' perceptions of low clinical skill levels in performing ART confidently inhibited the use of ART in primary teeth in children.

Atraumatic Restorative Treatment (ART): factors affecting success

The success of tooth restorations rendered according to principles of the Atraumatic Restorative Treatment (ART) approach is dependant on various clinical factors. The most common failures, due to these factors, are partial material loss; complete material loss; caries related to restoration margin and material wear > 0.5mm. The main reason for clinical ART failures are related to operator skills and performance. The prevention and management of ART failures includes emphasis on correct clinical indication and the repair of failed restorations. A new caries classification may provide guidance for clinical indication. The classification combines site and size of a lesion, which is reflected in a dual coding system. In addition, ART training and diligence during ART application are important for clinical success.

O sucesso de restaurações dentais resultante dos princípios do Tratamento Restaurador Atraumático (ART) é dependente de vários fatores clínicos. A falhas mais comuns decorrentes desses fatores estão relacionadas com o desgaste do material (>0,5 mm); perda parcial do material; perda completa do material e cárie associada à margem da restauração. A principal razão para as falhas clínicas do ART está relacionada com a habilidade e performance do operador. A prevenção e controle das falhas do ART incluem ênfase na correta indicação e no reparo de restaurações falhas. Uma nova classificação de cáries pode servir de guia para a indicação clínica. A classificação combina localização e extensão da lesão, a qual é expressa em um sistema de código duplo. Adicionalmente, o treinamento e domínio durante a aplicação do ART são fatores importantes para o sucesso clínico.