n Journal of Minimum Intervention in Dentistry - Failure rate of atraumatic restorative treatment using high-viscosity glass-ionomer cement compared to conventional amalgam restorative treatment in primary and permanent teeth : a systematic review of Chinese trials

Volume 5, Issue 8
  • ISSN : 1998-801X


The last update of this systematic review was assumed to be at risk of language bias, as it did not include the search of major Chinese medical databases.

This systematic review addition with focus on the Chinese dental literature aimed to answer the question as to whether, in patients with carious cavities of any class in primary and permanent teeth, ART restorations have a higher failure rate than amalgam restorations placed using conventional rotary instruments in tooth cavities of the same size, type of dentition and follow-up period?
Databases: Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI, formerly China Academic Journals), VIP Information and WanFang Data; reference lists of included articles were searched; Strings of search terms were constructed in simplified Chinese. In addition, the English search term "ART" was used for database search;
Prospective, clinical controlled trials, with focus relevant to review objective and reporting on computable data with a follow-up period of at least one year were selected from the Chinese dental literature.
Two review authors independently screened and extracted data from, and assessed the risk of bias in, the selected trial reports. Individual datasets were extracted from the trial results and analyzed regarding in-between-dataset heterogeneity and effect size estimates. The investigated outcome was restoration failure. Internal trial validity was assessed in terms of selection-, performance-, detection-, attrition-, publication- and reporting bias. Research gaps in the precision and consistency of the results were evaluated.
Eighteen trials were accepted for review. Of these 36 individual dichotomous datasets could be extracted and analyzed. The majority of the results showed no differences between both types of intervention. High risk of selection-, performance-, detection- and attrition bias was established. Existing research gaps were mainly due to lack of trials and small sample size.
The current evidence from the Chinese dental literature indicates that the failure rate of high-viscosity GIC/ART restorations is not higher than, but similar to that of conventional amalgam fillings after periods longer than one year. These results appear to corroborate the conclusions drawn during the previous systematic review update. There is a high risk that these results are affected by bias, and thus confirmation by further trials with suitably high number of participants is needed.

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