Panetta Alessandro, Lopes Pedro, Novaes Tatiane Fernandes, Rio Rute, Fernandes Gustavo Vicentis Oliveira, Mello-Moura Anna Carolina Volpi
Faculty of Dental Medicine, Universidade Católica Portuguesa, 3504-505 Viseu, Portugal.
Center for Interdisciplinary Research in Health, Faculty of Dental Medicine, Universidade Católica Portuguesa, 3504-505 Viseu, Portugal.
J Funct Biomater. 2024 Feb 19;15(2):48. doi: 10.3390/jfb15020048.
The aim of this umbrella review was to evaluate the longevity of glass ionomer cement (GIC) as a restorative material for primary and permanent teeth. Research in the literature was conducted in three databases (MedLine/PubMed, Web of Science, and Scopus). The inclusion criteria were: (1) to be a systematic review of clinical trials that (2) evaluated the clinical longevity of GICs as a restorative material in primary and/or permanent teeth; the exclusion criteria were: (1) not being a systematic review of clinical trials; (2) not evaluating longevity/clinical performance of GICs as a restorative material; and (3) studies of dental restorative materials in teeth with enamel alterations, root caries, and non-carious cervical lesions. Twenty-four eligible articles were identified, and 13 were included. The follow-up periods ranged from 6 months to 6 years. Different types of GICs were evaluated in the included studies: resin-modified glass ionomer cement (RMGIC), compomers, and low- and high-viscosity glass ionomer cement. Some studies compared amalgam and composite resins to GICs regarding longevity/clinical performance. Analyzing the AMSTAR-2 results, none of the articles had positive criteria in all the evaluated requisites, and none of the articles had an a priori design. The criteria considered for the analysis of the risk of bias of the included studies were evaluated through the ROBIS tool, and the results of this analysis showed that seven studies had a low risk of bias; three studies had positive results in all criteria except for one criterion of unclear risk; and two studies showed a high risk of bias. GRADE tool was used to determine the quality of evidence; for the degree of recommendations, all studies were classified as Class II, meaning there was still conflicting evidence on the clinical performance/longevity of GICs and their recommendations compared to other materials. The level of evidence was classified as Level B, meaning that the data were obtained from less robust meta-analyses and single randomized clinical trials. To the best of our knowledge, this is the first umbrella review approaching GIC in permanent teeth. GICs are a good choice in both dentitions, but primary dentition presents more evidence, especially regarding the atraumatic restorative treatment (ART) technique. Within the limitation of this study, it is still questionable if GIC is a good restorative material in the medium/long term for permanent and primary dentition. Many of the included studies presented a high risk of bias and low quality. The techniques, type of GIC, type of cavity, and operator experience highly influence clinical performance. Thus, clinical decision-making should be based on the dental practitioner's ability, each case analysis, and the patient's wishes. More evidence is needed to determine which is the best material for definitive restorations in permanent and primary dentition.
本伞状综述的目的是评估玻璃离子水门汀(GIC)作为乳牙和恒牙修复材料的使用寿命。在三个数据库(MedLine/PubMed、科学网和Scopus)中进行了文献研究。纳入标准为:(1)为对临床试验的系统评价,且(2)评估了GIC作为乳牙和/或恒牙修复材料的临床使用寿命;排除标准为:(1)不是对临床试验的系统评价;(2)未评估GIC作为修复材料的使用寿命/临床性能;以及(3)关于牙釉质改变、根龋和非龋性颈部病变牙齿的牙科修复材料研究。共识别出24篇符合条件的文章,其中13篇被纳入。随访期从6个月到6年不等。纳入研究中评估了不同类型的GIC:树脂改性玻璃离子水门汀(RMGIC)、复合体以及低粘度和高粘度玻璃离子水门汀。一些研究在使用寿命/临床性能方面将汞合金和复合树脂与GIC进行了比较。分析AMSTAR - 2结果,所有文章在所有评估要求中均无积极标准,且没有文章采用预先设计。通过ROBIS工具评估纳入研究偏倚风险分析所考虑的标准,该分析结果表明七项研究偏倚风险较低;三项研究除一项风险不明确的标准外,在所有标准中均有积极结果;两项研究显示偏倚风险较高。使用GRADE工具确定证据质量;对于推荐等级,所有研究均归类为II类,这意味着与其他材料相比,关于GIC的临床性能/使用寿命及其推荐仍存在相互矛盾的证据。证据水平归类为B级,这意味着数据来自可靠性较低的荟萃分析和单项随机临床试验。据我们所知,这是第一项针对恒牙中GIC的伞状综述。GIC在两种牙列中都是一个不错的选择,但乳牙列有更多证据支持,特别是关于非创伤性修复治疗(ART)技术。在本研究的局限性内,GIC在恒牙和乳牙列的中长期是否为良好的修复材料仍存在疑问。许多纳入研究存在较高的偏倚风险和低质量。技术、GIC类型、窝洞类型和操作者经验对临床性能有很大影响。因此,临床决策应基于牙科医生的能力、对每个病例的分析以及患者的意愿。需要更多证据来确定哪种材料是恒牙和乳牙列确定性修复的最佳材料。