COMPOSITE VS.

GLASS IONOMER FOR NON-CARIOUS CLASS V LESIONS

Presented By
BLAIRE HYDE CRYSTAL STINSON LESLEY LATHAM ANNE LINDLEY

"In patients with non-carious Class V lesions, does restoring the tooth with glass ionomer, as opposed to composite, result in a decreased occurrence of secondary decay?"
Is glass ionomer or composite resin the most retentive and which will have better clinical performance when restoring non-carious class V lesions.

Search terms: class V lesion, composite vs. glass ionomer Search Limits: clinical trial, meta-analysis, RCT, comparative study, journal article Articles Found: 4 Highest Level of Evidence: Systematic Review of RCTs Number of Articles Selected:4 General Criteria for selection:
*hierarchy of the study type *reputable journal *statistical significance of findings *age of the study

Complete reference: Demineralization of hard tooth tissue adjacent to resin-modified glassionomers and composite resins: a quantitative systematic review. Mickennautsch, S. and Yengopal, V. Journal of Oral Science, Vol. 52, No. 3, 347-357, 2010.
Why did you select this article? It is a quantitative, systematic review of 5 database searches on clinical trials regarding demineralization of tooth structure adjacent to glass ionomer vs. composite. Level of Evidence: 1- Systematic review of RCTs

Key Findings: Evidence suggests that demineralization of tooth structure is reduced more significantly when adjacent to a glass ionomer restoration as compared to composite without fluoride under caries challenge.

ARTICLE ONE

Critical Appraisal of the article:

A quantitative, systematic review of 13 randomized trials; 9 laboratory, 3 in situ, and 1 control, analyzing the degree of demineralization adjacent to glass ionomer vs. composite restorations.

Summary of Evidence Related to PICO:

The quantitative evidence suggests that a glass ionomer restoration is associated with a higher reduction of demineralization in adjacent tooth structure under caries challenge than a non-fluoride containing composite restoration. Because of ethical challenges for designing a randomized clinical trial for answering this question, the authors realized that only a few RCTs would be found and an in situ study was accepted as an alternative.

ARTICLE ONE

Complete reference:
Two-year clinical evaluation of four polyacid-modified resin composites and a resin-modified glass-ionomer cement in Class V lesions. Ermis, R.B. Quintessence Int, Vol. 33, 542-548, 2002

Why did you select this article?

This study compares the clinical performance of resin composites and resin modified glass ionomer in class V non-carious cervical lesions. It was an acceptable level of evidence without any conflicts of interest

Level of Evidence: Randomized Controlled Trial 1c

Key Findings: Evidence suggests that polyacid-modified resin composite and

resin-modified glass-ionomer cement restorations showed acceptable clinical performance after 2 years. No statistically significant differences were found among the materials after 2 years for any evaluation category.

ARTICLE TWO

Critical Appraisal of the article:

The journal of the published article has an impact factor of 1.137. The statistics provided were P <.05 and statistically significant however the sample size is small and power may be a concern. Although patients were assigned a restoration type randomly, the conditions may not satisfy the requirements for a randomized controlled trial, double blinded.

Summary of Evidence Related to PICO:

After placement of the restoration in non-carious cervical lesions evaluations were performed at baseline and 6 months, 1 year, and 2 years after placement for retention, color match, cavosurface marginal discoloration, anatomic form, marginal adaptation, secondary caries, and post-operative sensitivity by 2 dentists unaware of the type of restoration. Vitremer restorations were most retentive at 95%. No statistically significant differences were found among the materials after 2 years for any evaluation category. Polyacid-modified resin composite and resin-modified glass-ionomer cement restorations showed acceptable clinical performance after 2 years.

ARTICLE TWO

Complete reference:
Five-year Double-blind Randomized Clinical Evaluation of a Resin-modified Glass Ionomer and a Polyacid-modified Resin in Noncarious Cervical Lesions. Loguercio, A., Reis, A., Barbosa, A., Roulet, J. Journal of Adhesive Dentistry, 5:323-332, 2003.

Why did you select this article? The level of evidence for this article is high. It directly answers the PICO question regarding materials used and the lesion type restored. Level of Evidence:2 -Randomized Clinical Trial- double-blind with method of randomization unclear. Key Findings: The restorations are judge on criteria inferring secondary decay. Marginal adaption is significantly greater with Resin-modified glass ionomer than polyacidmodified resin.

ARTICLE THREE

Critical Appraisal of the article:

A double-blind randomized clinical evaluation in situ in twelve patients over five years comparing resin-modified glass ionomer cements with polyacid-modified resin composites.

Summary of Evidence Related to PICO:

The evidence suggests resin-modified glass ionomer cements have better marginal adaptation-therefore less chance of secondary caries- and less marginal discoloration than polyacidmodified resin composites. However, the article highlights the importance of proper acid etching technique, suggesting the manufacturers instructions did not allow the composite restorations to adapt fully. There are no other significant findings.

ARTICLE THREE

Complete reference:
A clinical evaluation of a resin composite and a compomer in noncarious Class V lesions. A 3-year follow-up. Pollington, S. and Van Noort, R. Am J Dent, Vol. 21, No.1, 49-52, 2008

Why did you select this article?

It is a randomized clinic trial that evaluates the marginal adaptation and secondary caries in resin composite vs. compomer.

Level of Evidence: 2 Randomized Clinical trial

Key Findings:
Evidence suggests that there is no significant difference in marginal adaptation, secondary caries, and marginal discoloration between the two materials over a 3 year period.

ARTICLE FOUR

Critical Appraisal of the article:

Thirty patients with comparable sized no carious cervical lesions were selected from one practice. Each patient received on composite and one compomer randomly placed by the same dentist. The mean age of the patients was 54 years and a self-etch adhesive was used to place the restorations. Parameters were evaluated over a three year period by the same dentist using the United States Public Health Service criteria.

Summary of Evidence Related to PICO:

Marginal discoloration is generally associated with polymerization shrinkage, which can lead to gap formation. The compomer showed inferior staining and less resistance to staining than composite, but this was not statistically significant. Laboratory studies have shown that the bond strength of the selfetched adhesive was higher when combined with a compomer. This clinical trial shows that bond strength does not necessarily reflect a better clinical performance. The author realizes the age of the patient must be examined. Clinical studies have found greater restorative failure in older teeth, due to increase flexure and sclerosis of tooth structure that is resistant to priming.

ARTICLE FOUR

Based on the 4 articles reviewed, there is no overwhelming evidence that glass ionomer lessens the incidence of secondary caries when compared to composite. Two articles showed a significant difference between the two materials and two other articles showed no difference at all. Due to this inconclusive evidence, each individual patient's situation should be taken into consideration when deciding upon the material to use. The patient's preferences should play an important role in the decision making process clinically. Also, because of this conflicting evidence, many authors advocate the use of the "sandwich" method (a glass ionomer increment covered with composite). The practitioner would be able to justify the use of either glass ionomer, or composite, or both to restore class V lesions.

The data found has good clinical applicability. By combining the results with standing information on selection of restoration materials for class V lesions you are able to come to a good scientific conclusion on the best choice for this patient.