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. 2023 Jun 15;23(1):394.
doi: 10.1186/s12903-023-03110-y.

Clinical efficacy of bioactive restorative materials in controlling secondary caries: a systematic review and network meta-analysis

Noeleni Souza Pinto  1 , Gabriela Rebouças Jorge  1 , Jader Vasconcelos  2 , Livia Fernandes Probst  3 , Alessandro Diogo De-Carli  1 , Andrea Freire  4
Affiliations

Clinical efficacy of bioactive restorative materials in controlling secondary caries: a systematic review and network meta-analysis

Noeleni Souza Pinto et al. BMC Oral Health. .

Abstract

Background: This systematic review and network meta-analysis aimed to compare the clinical efficacy of bioactive and conventional restorative materials in controlling secondary caries (SC) and to provide a classification of these materials according to their effectiveness.

Methods: A search was performed in Pubmed, Web of Science, Embase, BBO, Lilacs, Cochrane Library, Scopus, IBECS and gray literature. Clinical trials were included, with no language or publication date limitations. Paired and network meta-analyses were performed with random-effects models, comparing treatments of interest and classifying them according to effectiveness in the permanent and deciduous dentition and at 1-year or 2/more years of follow-up. The risk of bias and certainty of evidence were evaluated.

Results: Sixty-two studies were included in the qualitative syntheses and 39 in the quantitative ones. In permanent teeth, resin composite (RC) (RR = 2.00; 95%CI = 1.10, 3.64) and amalgam (AAG) (RR = 1.79; 95%CI = 1.04, 3.09) showed a higher risk of SC than Glass Ionomer Cement (GIC). In the deciduous teeth, however, a higher risk of SC was observed with RC than with AAG (RR = 2.46; 95%CI = 1.42, 4.27) and in GIC when compared to Resin-Modified Glass Ionomer Cement (RMGIC = 1.79; 95%CI = 1.04, 3.09). Most randomized clinical trials studies showed low or moderate risk of bias.

Conclusion: There is a difference between bioactive restorative materials for SC control, with GIC being more effective in the permanent teeth and the RMGIC in the deciduous teeth. Bioactive restorative materials can be adjuvants in the control of SC in patients at high risk for caries.

Keywords: Amalgam; Bioactive materials; Dental caries; Resin composite; Secondary caries.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
PRISMA flowchart of study selection
Fig. 2
Fig. 2
Analysis of restorative materials for the SC outcome in permanent teeth for 1 year and 2 or more years of follow-up: a Network diagram for 1 year of follow-up; b Network diagram for a follow-up of 2 years or more. Abbreviations: AAG: Amalgam; GIC: Glass Ionomer Cement; RMGIC: Resin Modified Glass Ionomer Cement; FAAG: Fluoride-containing Amalgam; RC: Resin Composite
Fig. 3
Fig. 3
Network meta-analysis estimates of interventions versus GIC for the SC outcome in deciduous teeth with a follow-up of 02/more years. Abbreviations: AAG: Amalgam; GIC: Glass Ionomer Cement; RMGIC: Resin Modified Glass Ionomer Cement; RC: Resin Composite
Fig. 4
Fig. 4
Risk of Bias of Randomized Clinical Trials: a Individual analysis of the articles; b Graph showing the abstracts of all articles
Fig. 5
Fig. 5
Risk of Bias of non-randomized studies assessed using the Risk of Bias in Non-randomized Studies—of Interventions (ROBINS-I) tool: a individual analysis of the articles; b graph showing the abstracts of all articles
Fig. 6
Fig. 6
Analysis of restorative materials for the SC outcome in permanent teeth for 1 year and 2 or more years of follow-up: a Ranking of interventions for a follow-up of 1 year; b Ranking of interventions for a follow-up of 02 years or more. Abbreviations: AAG: Amalgam; GIC: Glass Ionomer Cement; RMGIC: Resin Modified Glass Ionomer Cement; FAAG: Fluoride-containing Amalgam; RC: Resin Composite
Fig. 7
Fig. 7
Network meta-analysis estimates of interventions versus GIC for the outcome of secondary caries in permanent teeth with a follow-up of 01 year (a) and 02/more years (b). Abbreviations: AAG: Amalgam; GIC: Glass Ionomer Cement; RMGIC: Resin Modified Glass Ionomer Cement; FAAG: Fluoride-containing Amalgam; RC: Resin Composite
Fig. 8
Fig. 8
Analysis of restorative materials for the SC outcome in deciduous teeth: Paired meta-analysis estimates between bioactive materials and resin composite for a follow-up of 1 year. Abbreviation: CIVMR: Resin Modified Glass Ionomer Cement
Fig. 9
Fig. 9
Analysis of restorative materials for the SC outcome in deciduous teeth with a follow-up of 02/more years: a Ranking of interventions for a follow-up of 02/more years; b Network meta-analysis estimates of interventions versus RMGIC for a follow-up of 02/more years. Abbreviations: AAG: Amalgam; GIC: Glass Ionomer Cement; RMGIC: Resin Modified Glass Ionomer Cement; RC: Resin Composite
Fig. 10
Fig. 10
Funnel plots for the network meta-analysis of all primary outcomes in clinical trials – a Permanent teeth follow-up of 1 year; b Permanent teeth follow-up of 2 years/more; c Deciduous teeth follow-up of 2 years/more
Fig. 11
Fig. 11
Sensitivity analyses were performed including only RCTs with low risk of bias. Analysis of restorative materials for the SC outcome in permanent teeth for 1 year and 2 or more years of follow-up: a Ranking of interventions for a follow-up of 1 year; b Ranking of interventions for a follow-up of 02 years or more. Abbreviations: AAG: Amalgam; GIC: Glass Ionomer Cement; RMGIC: Resin Modified Glass Ionomer Cement; FAAG: Fluoride-containing Amalgam; RC: Resin Composite
Fig. 12
Fig. 12
Ranking of restorative materials for the SC outcome in deciduous teeth with a follow-up of 02/more years. Abbreviations: AAG: Amalgam; GIC: Glass Ionomer Cement; RMGIC: Resin Modified Glass Ionomer Cement; RC: Resin Composite
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