Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Cork University Dental School and Hospital, University College Cork, Cork, Ireland.
Gerodontology. 2019 Sep;36(3):285-293. doi: 10.1111/ger.12409. Epub 2019 May 24.
We aimed to appraise the comparative clinical efficacy of atraumatic restorative treatment (ART) versus conventional restorative treatment (CT) using a meta-analysis, and assessed the robustness of evidence by trial sequential analysis (TSA).
Due to its simplified clinical approach, ART may be advantageous over CT for restoration of root caries lesions in institutionalised older patients.
Three electronic databases (PubMed, Embase and Cochrane CENTRAL) were screened, and hand searches and cross-referencing performed to identify randomised controlled trials reporting on survival of ART vs CT for restoration of root caries in older patients. Trial selection, data extraction and risk of bias assessment were performed by two independent reviewers. ART and CT were compared using fixed- or random-effects pairwise meta-analysis for per-protocol (PP), intention-to-treat (ITT) and best-case scenarios. TSA was used to control for risk of random errors.
A total of 235 studies were identified, and three trials involving 130 patients (463 restorations) were included. Risk of bias was high or moderate in all but one trial. ART was associated with a significantly increased risk of failure (OR [95% CI] 2.06 [1.06/4.00]) in PP- but not in ITT analysis (1.36 [0.92/2.02]). Analyses for best-case scenarios found great uncertainty introduced by attrition. No firm evidence was reached according to TSA.
For restoration of root caries, there is insufficient data to clearly rule out whether differences between ART and CT exist. Limited available data indicate there might be an increased risk of failure for ART.
本研究旨在通过荟萃分析评估非创伤性修复治疗（ART）与常规修复治疗（CT）的临床疗效比较，并通过试验序贯分析（TSA）评估证据的稳健性。
由于简化了临床操作，ART 可能比 CT 更有利于机构化老年患者根面龋的修复。
我们对三个电子数据库（PubMed、Embase 和 Cochrane CENTRAL）进行了筛选，并进行了手工检索和交叉引用，以确定报告 ART 与 CT 用于修复老年患者根面龋的生存情况的随机对照试验。两名独立的评审员进行了试验选择、数据提取和偏倚风险评估。使用固定或随机效应的成对荟萃分析比较了意向治疗（ITT）和最佳情况的意向治疗（PP）和 ITT 分析。TSA 用于控制随机错误的风险。
共确定了 235 项研究，其中包括 3 项涉及 130 名患者（463 个修复体）的试验。除一项试验外，所有试验的偏倚风险均较高或中度。在 PP 分析中，ART 与失败风险显著增加相关（OR [95%CI] 2.06 [1.06/4.00]），但在 ITT 分析中则无此相关性（1.36 [0.92/2.02]）。最佳情况分析发现，失访带来了很大的不确定性。根据 TSA，未得出确凿的证据。
对于根面龋的修复，尚无明确的数据可以排除 ART 和 CT 之间是否存在差异。有限的现有数据表明，ART 的失败风险可能增加。
