doi:10.1111/iej.12364

REVIEW

Endodontic complications in teeth with vital pulps restored with composite resins: a systematic review

V. S. Dawson, S. Amjad & H. Fransson Department of Endodontics, Faculty of Odontology, Malm€ o University, Malm€ o, Sweden

Abstract Dawson VS, Amjad S, Fransson H. Endodontic complications in teeth with vital pulps restored with composite resins: a systematic review. International Endodontic Journal.

Composite resin is used extensively for restoration of teeth with vital pulps. Although cell culture studies have disclosed harmful effects on pulpal cells, any untoward clinical effects, manifest as adverse pulpal responses, have yet to be determined. This study comprises a systematic review, designed to address the question of whether the risk of endodontic complications is greater with composite resin restorations than with other restorative materials, such as amalgam. The study methodology involved (i) formulation of the research question, (ii) construction and conduct of an extensive literature search with (iii) interpretation and assessment of the retrieved literature. A search of the medical database PubMed was complemented with a search of the Controlled Trials Register

Introduction The use of composite resin materials for direct restoration of decayed teeth has gained in popularity. Estimates show that worldwide, more than 500 million direct restorations are undertaken annually: 261 million are of composite material (Heintze & Rousson 2012). Increased use of composite resins could be

Correspondence: Helena Fransson, Department of Endodontics, Faculty of Odontology, Malm€ o University, SE-205 06 Malm€o, Sweden (Tel.: +46-40-665 83 15; fax: +46-40-665 85 77; e-mail: [email protected]).

© 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd

(CENTRAL). The initial search yielded 1043 publications, the abstracts of which were read independently by the authors. After additional searches, 10 studies were included in the review. In all the included studies, the level of evidence was assessed as low. No conclusions could therefore be drawn. The included studies reported few, if any, endodontic complications. Little or no differences emerged between teeth restored with composite resins and those restored with amalgam. To determine whether composite resin restorations of teeth with vital pulps are associated with an increased risk for development of endodontic complications such as apical periodontitis, further evidence is needed, from well-constructed studies with a large number of participants. Keywords: composite resins, dental materials, dental pulp necrosis/aetiology, endodontic inflammation, periapical periodontitis, permanent dentition. Received 5 September 2013; accepted 31 July 2014

attributed to greater demand for aesthetics and a shift towards less invasive dentistry. Composite material can be bonded to the tooth structure and retention requires less preparation and removal of tooth substance than for amalgam restorations. Another factor contributing to increased use of composite resin materials is concern that mercury in amalgam is an environmental hazard. This applies particularly in Scandinavia, where amalgam has been banned since the end of 2010. Once the use of amalgam is forbidden, composite resin becomes by default the primary choice of dental restorative material. It is therefore important to determine whether there are any

International Endodontic Journal

1

Restorative complications Dawson et al.

adverse effects associated with composite resin restoration of teeth with vital pulps. The use of composite resin restorative materials is not without concerns. Cell culture experiments have shown the material to cause toxic and local immunological effects (Lefebvre & Schuster 1994, Andersson & Dahlgren 2010, Chang et al. 2012, Sigusch et al. 2012). Allergic reactions have been observed when bare skin has been exposed to composite resin materials. This is particularly evident amongst dentists who have been sensitized to monomers in the composite: handling the composite material results in an allergic reaction, manifest as sores and blisters on the fingertips (Jacobsen et al. 1991, Munksgaard 2000). However, it is not known whether composite resin restorations have adverse effects on the dental pulp, such as pain, irreversible pulpal inflammation and subsequent necrosis of the pulp tissue or apical periodontitis. During the polymerization process, composite resins shrink approximately 2–5% by volume (Kleverlaan & Feilzer 2005), which may lead to formation of a void between the restoration and the wall of the tooth cavity (Hilton 2002, Lopes et al. 2004), allowing penetration of bacteria and/or bacterial toxins through the dentine towards the dental pulp. This might give rise to inflammatory reactions, leading to pulpal necrosis and subsequently apical periodontitis (Bergenholtz 2000). If a review of the literature disclosed that endodontic complications were frequently associated with direct composite restorations, then this would influence clinical decisions with respect to the type of restorative material recommended to the patient. This study, in the form of a systematic review of the literature, was undertaken to determine whether there are any associations between the incidence of endodontic complications in teeth with vital pulps directly restored with composite resins and those restored with other materials. The hypothesis was that there is no difference in occurrence of endodontic complications in teeth restored with direct composite resin restorations, compared with those restored with other materials.

Materials and methods To ensure a systematic basis for the literature search, the study was conducted according to the Swedish Council on Health Technology Assessment (SBU 2013), applying the PRISMA checklist (Moher

2

International Endodontic Journal

et al. 2009). The steps were as follows: (i) formulate a question in a structured way, with inclusion and exclusion criteria; (ii) construct and conduct an extensive literature search and (iii) interpret and assess the retrieved literature and then draw conclusions.

Question specification The research problem was formulated as a PICO question (Sackett et al. 1997): Is direct composite resin restoration of a tooth with a vital pulp associated with greater risk of endodontic complications than direct restoration using other materials? In which the • P (Population) is ‘vital permanent teeth’ • I (Intervention) is ‘direct composite resin restorations’ • C (Comparison) is ‘all other direct restorations’ • O (Outcome) is ‘endodontic complications such as pulpal sensitivity, apical periodontitis or root filling following coronal restoration’. Ideally, the ‘C’ (comparison) above will apply to publications comparing the pulpal condition after direct restoration with different materials, such as comparison between composite resin and amalgam or other materials.

Literature search The literature search was made of the PubMed database, using a combination of broad MeSH terms (Index Medicus: Medical Subject Headings) covering the formulated PICO question (Table 1). The time range for the database search was set at 1st July 1991 to 1st March 2013, on the basis that the composition of composite resins has altered over the years, but the current generation has been in use for the past 20 years or so (Minguez et al. 2003). The criteria for the selection of articles are presented in Table 2. The authors independently read the abstracts of articles identified by the literature search in PubMed. Where abstracts were considered relevant, the full text of the articles was retrieved. If one author favoured the abstract of an article, the full text was then retrieved without consensus. Relevant reviews were not read in detail, but the reference lists were scrutinized by the three authors, seeking publications which had not been identified by the PubMed search.

© 2014 International Endodontic Journal. Published by John Wiley & Sons Ltd

Dawson et al. Restorative complications

Table 1 The PubMed search and the number of publications retrieved at each step. The search was undertaken on 27th May 2013 MeSH or free text term, type of publication

No. of publications

Dentistry (MeSH) Dental restoration, permanent (MeSH) Dental materials (MeSH) Composite filling* (free text) Periapical diseases (MeSH) Dental pulp diseases (MeSH) Radiography, dental (MeSH) Tooth, deciduous (MeSH) Case reports (publication type) #1 AND (#2 OR #3 OR #4) AND (((#5 OR #6) AND #7) OR (#5 OR #6)) NOT #8 NOT #9

92 697 12 545 29 655 95 2497 3258 6554 3044 509 144 1043

Search #1 #2 #3 #4 #5 #6 #7 #8 #9 #10

Limits: an abstract, written in English, studies on humans and publication time between 1st July 1991 and 1st March 2013.

Additional searches The PubMed search was complemented with an additional search in The Cochrane Controlled Trials Register (CENTRAL) database. Moreover, an expert in the field was consulted to find complementary studies. Random searches were also conducted using PubMed. All the reference lists of the included articles were manually searched to disclose any additional relevant articles. The publications were retrieved in full text. The entire literature search, with the number of articles remaining at each stage, is shown in Fig. 1.

Interpretation and assessment of publications A data extraction protocol (Figure S1) was used to include or exclude the retrieved full-text publications.

The protocol was gradually modified until it reached its present form. The included publications were then evaluated through a quality assessment protocol (Figure S2) according to Guyatt et al. (1993, 1994). The authors independently assessed the quality of each of the included publications. None of the processes was blinded. Depending on the quality of the assessed publications, the evidence was rated as high, moderate or low, as shown in Table 3.

Results Literature search The systematic search in the PubMed database yielded 1043 publications within the limits and MeSH terms, as described under Material and Methods. All the abstracts were read, and 38 publications were retrieved in full text: 31 original scientific studies and seven reviews. After application of the data extraction protocol (Figure S1), 3 of the 31 original scientific studies were selected. Table 4 presents the main reasons for exclusion and the excluded articles. Only the reference list of a review article was scrutinized to identify further relevant publications. No further articles were identified from the reference lists of the seven review articles. No additional publications were found in the additional search in CENTRAL. To identify all relevant articles, an expert in the field was consulted for advice on additional publications that might be relevant to the topic of the systematic review. This measure did not disclose any additional publications. A further free search of the PubMed database identified a recently published review article by

Table 2 Criteria for the selection of articles Inclusion criteria Data on teeth restored with some sort of direct composite restoration (fillings/crown/all sizes) The teeth were judged to be vital, that is not root filled prior to restoration Evaluation of any endodontic complication such as apical periodontitis as seen on X-ray, reported pain or root canal treatment after the coronal restoration Sample size given and larger than 30 teeth

Exclusion criteria Teeth with extreme marginal periodontitis (gravis or complicate) Teeth with pulp exposures Teeth that have been subjected to trauma

Studies with attrition of more than 60% of the initial test group

Follow-up time not been

Endodontic complications in teeth with vital pulps restored with composite resins: a systematic review.

Composite resin is used extensively for restoration of teeth with vital pulps. Although cell culture studies have disclosed harmful effects on pulpal ...
164KB Sizes 0 Downloads 6 Views