Glass ionomer cements compared with composite resin in restoration of noncarious cervical lesions: A systematic review and meta-analysis

Abstract

Objective: Restoring noncarious cervical lesions are challenging to clinical practice. This study aimed to compare the clinical performance/longevity of glass ionomer cements (GIC) and composite resins (CR) used for noncarious cervical lesions (NCCL) through a systematic review and meta-analysis (MA).

Data: Randomized and controlled clinical trials and nonrandomized clinical trials, which compared the clinical performance/longevity of CR and GIC (conventional and/or resin-modified) in the treatment of NCCL, were included.

Source: The methodological quality and risk of bias were evaluated using the Cochrane Collaboration tool. Seven MAs were performed considering (1) the clinical performance of the parameters in common: retention, marginal discoloration, marginal adaptation, secondary caries, color, anatomic form, surface texture and (2) a follow-up time of 12, 24 and 36 months. The prevalence of successful restorations and the total number of restorations per clinical parameter/follow-up time were used to calculate the relative risk (95% CI).

Study selection: After screening of the studies, 13 studies were used for quantitative synthesis. The risk difference (CI 95%, α, I²) between GIC and CR for anatomic form was 0.00 (-0.02, 0.02; p = 0.83; 0%); for color was -0.02 (-0.08, 0.04; p = 0.48; 80%); for surface texture was -0.02 (-0.06, 0.02; p = 0.31; 63%); for secondary caries was -0.00 (-0.01, 0.01; p = 0.87; 0%); for marginal discoloration was 0.01 (-0.01, 0.03; p = 0.23; 3%); for marginal adaptation was 0.01 (-0.01, 0.04; p = 0.34; 32%) and for retention was 0.07 (0.02, 0.12; p = 0.003; 76%).

Conclusion: GIC showed a clinical performance significantly higher than CR in regard to retention, whereas for the other parameters, GIC was similar to CR.

Clinical significance: NCCLs is increasingly prevalent among the population and this type of lesion causing defects in the tooth that affect not only aesthetics but also everyday habits, such as drinking, eating and teeth brushing, due to the sensitivity these lesions cause.

Keywords: Clinical research; Composite resin; Dental materials; Dentistry; Evidence-based medicine; Glass ionomer cements; Root caries.

Figure 1

Flow diagram of literature searches according to the PRISMA statement.

Figure 2

Forest plot of the criterion anatomic form of the NCCL restorations performed with glass ionomer cement and composite resin, subgrouped by the follow-up time at 12, 24 and 36 months. The blue squares indicate the mean of each study, and the error bars are the respective 95% confidence intervals. Black diamonds indicate the results of the subgrouped studies for a period of time, and the last diamond indicates the unified results of the three subgroups evaluated.

Figure 3

Forest plot of the criterion color of the NCCL restorations performed with glass ionomer cement and composite resin, subgrouped by the follow-up time at 12, 24 and 36 months. The blue squares indicate the mean of each study, and the error bars are the respective 95% confidence intervals. Black diamonds indicate the results of the subgrouped studies for a period of time, and the last diamond indicates the unified results of the three subgroups evaluated.

Figure 4

Forest plot of the criterion surface texture of the NCCL restorations performed with glass ionomer cement and composite resin, subgrouped by the follow-up time at 12, 24 and 36 months. The blue squares indicate the mean of each study, and the error bars are the respective 95% confidence intervals. Black diamonds indicate the results of the subgrouped studies for a period of time, and the last diamond indicates the unified results of the three subgroups evaluated.

Figure 5

Forest plot of the criterion secondary caries of the NCCL restorations performed with glass ionomer cement and composite resin, subgrouped by the follow-up time at 12, 24 and 36 months. The blue squares indicate the mean of each study, and the error bars are the respective 95% confidence intervals. Black diamonds indicate the results of the subgrouped studies for a period of time, and the last diamond indicates the unified results of the three subgroups evaluated.

Figure 6

Forest plot of the marginal discoloration form of the NCCL restorations performed with glass ionomer cement and composite resin, subgrouped by the follow-up time at 12, 24 and 36 months. The blue squares indicate the mean of each study, and the error bars are the respective 95% confidence intervals. Black diamonds indicate the results of the subgrouped studies for a period of time, and the last diamond indicates the unified results of the three subgroups evaluated.

Figure 7

Forest plot of the criterion marginal adaptation of the NCCL restorations performed with glass ionomer cement and composite resin, subgrouped by the follow-up time at 12, 24 and 36 months. The blue squares indicate the mean of each study, and the error bars are the respective 95% confidence intervals. Black diamonds indicate the results of the subgrouped studies for a period of time, and the last diamond indicates the unified results of the three subgroups evaluated.

Figure 8

Forest plot of the criterion retention of the NCCL restorations performed with glass ionomer cement and composite resin, subgrouped by the follow-up time at 12, 24 and 36 months. The blue squares indicate the mean of each study, and the error bars are the respective 95% confidence intervals. Black diamonds indicate the results of the subgrouped studies for a period of time, and the last diamond indicates the unified results of the three subgroups evaluated.