COMPOSITE RESIN OR COMPOMER FOR THE RESTORATION OF PRIMARY MOLARS: A SYSTEMATIC REVIEW

Maha Moussa Azab 1 , Dalia Mohamed Moheb 2 , Osama Ibrahim El Shahawy 2 and Mervat Rashed 3 . 1. Ass. Lecturer, Department of Pediatric Dentistry, Faculty of Dentistry, Fayoum University. 2. Ass. Professor, Department of Pediatric Dentistry, Faculty of Dentistry, Cairo University. 3. Professor, Department of Pediatric Dentistry, Faculty of Dentistry, Cairo University. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


ISSN: 2320-5407
Int. J. Adv. Res. 5 (8), 1906-1912 1907 This systematic review was carried out according to the Cochrane Collaboration methodology as described in the Cochrane Handbook for systematic reviews of interventions (10).
PICO question:-Types of participants: Patients of either or both sexes, aged less than 14 years, with carious primary posterior tooth or teeth, without pulp involvement. Interventions: Primary molars with class I or II cavities that were restored with composite resin restoration. Control: Primary molars with class I or II cavities that were restored with compomer restoration. Outcome measures: Secondary caries is the primary outcome, marginal adaptation is the secondary outcome.

Information sources and search strategy:-
To identify relevant published studies; PubMed, Cochrane Library, Scopus, and Embase databases were searched up to the 30 th of November 2016 to identify studies to be considered for this review. Reference lists of identified studies and relevant reviews were further examined in attempt to identify studies not identified during electronic search. The search strategy included appropriate keywords, and Mesh terms when applicable; combined with Boolean operators "AND", "OR" and "NOT".

Screening and selecting:-
The titles of the articles resulted from the electronic search were screened first followed by the abstracts. Articles with eligible titles and abstracts were read in full text to confirm they are meeting the eligibility criteria. Disagreements at each stage were resolved through discussion among authors.

Quality assessment (Risk of bias of individual studies):-
The Cochrane risk of bias tool was used to evaluate risk of bias of included studies (11). Discussions among authors were used to reach consensus in case of disagreements.
A study was classified as having low risk of bias if it had: no selection bias regarding random sequence generation, and allocation concealment; no performance bias regarding unawareness of participants and personnel about the type of intervention; no detection bias regarding unawareness of examiners about the type of intervention; no 1908 reporting bias regarding avoiding selective reporting; no attrition bias regarding complete outcome data regarding number of participants and follow-up period. If any of these criteria was at unclear risk, the study was considered to have unclear risk of bias. If any of these criteria was at high risk, the study was considered to have high risk of bias (10).

Type of cavities:-
Two studies were conducted exclusively on class II cavities (19,20), and 2 studies were conducted on class I and class II cavities (16)(17)(18).

Assessment criteria:-
Two experiments (16)(17)(18) used United States Public Health Service USPHS criteria while the other two (19,20) used World Dental Federation FDI criteria Study outcomes results:-Both primary and secondary outcomes were reported in all four included experiments (16)(17)(18)(19)(20). In Pascon et al., 2006 (16); for the marginal adaptation outcome, after 24 months, 41% of the composite group; developed crevice to be caught by a blunt explorer, while 31% and 27% of the 2 compomer groups had similar crevices. Statistically significant differences were found between one compomer group and composite resin group at the12-month recall for marginal adaptation (p=0.04), and between the other compomer group and composite group at 12-month recall for secondary caries (p=0.03), where compomer showed better performance in both cases.
In Dos Santos, et al., 2009 andDos Santos et al., 2010 (17,18); although results were not very clearly displayed; authors stated that in composite resin group; 11 out of 44 (25%) failed due to recurrent caries and marginal adaptation, while in compomer group (n=51); 2 class I cases failed due to recurrent caries and marginal adaptation, and 6 class II cases failed due to recurrent caries. The authors equally recommend the use of both materials.

Study
Reason for exclusion (HSE & WEI., 1997) (12) Include class V restorations with no clear data for each class (Attin et al., 1998) (20); for the composite resin group; after 12 months 7% of cases showed recurrent caries, they were repaired and remained caries free for the 18 months follow up but other 7% got recurrent caries, while the compomer group showed no cases of recurrent caries along the 18 months follow up period of the study. For the marginal adaptation outcome; the composite resin group 34.5 % showed detectable gaps after 18 months while for the compomer group; only 10 % showed detectable gaps after 18 months. the authors concluded that the clinical performance of compomer is superior to resin composite    Quality assessment:-Was based on the estimated potential risk of bias (Table:3). Three studies showed unclear risk of bias (16,19,20), and one study showed high risk of bias (17,18).

Discussion:-
Selection of esthetic restorative material for primary posterior molars presents a confusing clinical situation. The current systematic review high lightened the present evidence on the clinical performance of two of the commonly used materials; composite resin and compomer; and the effect of using each material on secondary caries and marginal adaptation.
Composite resin and compomer restorations have become commonly used for the restorations of primary and permanent, anterior and posterior teeth. They are demanded by patients and parents to provide esthetic restorations for their children, and used by dentists due to their conservative approaches in cavity preparation and more than average physical and mechanical properties. Compomer restorations also benefits from the added advantage of fluoride release and caries inhibiting property (21).
The four experiments included evaluated 180 composite restorations and 170 compomer restorations.
Similarities and variables in studies was monitored, regarding the study design (parallel or split-mouth), the follow up periods, the type of cavity (class I or class II), the number, and age of the participating patients, the number of restorations placed, the use of rubber dam, presence of bevels in preparations.
The selection of outcomes in this review was done depending on the fact that failures in adhesive restorations occurs mainly due to secondary caries, then poor marginal adaptation (17,22,23).
Taking in consideration that none of the included studies showed (low risk of bias), and the fact that meta-analysis was not feasible due to the use of different criteria in studies and the results are displayed in different ways in different experiments; the results of the present systematic review show no clear superiority of one restoration to another regarding the selected outcomes.
This finding, may be due to the fact that recurrent caries and marginal adaptation failures may occur due to issues in bonding system, cavity design and practitioner's performance (22) rather than with the restorative material itself.

Conclusion:-
Within the limitation of the available literature; the current review concluded that the clinical performance of both composite resin and compomer restorations, in class I and class II cavities, in primary molars; is acceptable. However, the limited number and quality of studies is not providing a clear-cut evidence on the superiority of either materials. Further studies are required to develop that evidence, with more attention on study methodology in terms of elimination of risk of bias, clear display of results and adequate choice of investigating criteria.

Study
Sequence generation