Replacement versus repair of defective restorations in adults: amalgam

Sharif MO, Merry A, Catleugh M, Tickle M, Brunton P, Dunne SM, Aggarwal VR

Published Online:

February 17, 2010

The management of dental caries is a major part of clinical dentistry. Amalgam filling material is very commonly used and when amalgam restorations (fillings) become defective two treatment options exist: 1) the amalgam restoration can be replaced completely, or 2) the restoration can be repaired. Traditionally, replacement of defective amalgam restorations was the only option recommended, however, repairing the restoration would offer a more conservative approach in certain situations. Repairing restorations could save time and as certain repairs may be performed without the use of local anaesthesia they can be less distressing for the patient when compared with replacement. The review authors did not identify any randomised controlled trials suitable for inclusion that compared the effectiveness of managing defective amalgam restorations by replacing them (with amalgam) versus repairing them (with amalgam) in permanent molar and premolar teeth. Further randomised controlled trials should be conducted in a well designed manner and reported according to the Consolidated Standards of Reporting Trials (CONSORT) statement. They should also explore qualitatively the views of patients on repairing versus replacement of amalgam restorations and investigate themes around pain, distress and anxiety, time and costs which are all relevant for effective patient care and satisfaction.

Abstract (click to read)

Background:

Amalgam is a common filling material for posterior teeth, as with any restoration amalgams have a finite life-span. Traditionally replacement was the ideal approach to treat defective amalgam restorations, however, repair offers an alternative more conservative approach where restorations are only partially defective. Repairing a restoration has the potential of taking less time and may sometimes be performed without the use of local anaesthesia hence it may be less distressing for a patient when compared with replacement.

Objectives:

To evaluate the effectiveness of replacement (with amalgam) versus repair (with amalgam) in the management of defective amalgam dental restorations in permanent molar and premolar teeth.

Search strategy:

For the identification of studies relevant to this review we searched the Cochrane Oral Health Group Trials Register (to 23rd September 2009); CENTRAL (The Cochrane Library 2009, Issue 4); MEDLINE (1950 to 23rd September 2009); EMBASE (1980 to 23rd September 2009); ISI Web of Science (SCIE, SSCI) (1981 to 22nd December 2009); ISI Web of Science Conference Proceedings (1990 to 22nd December 2009); BIOSIS (1985 to 22nd December 2009); and OpenSIGLE (1980 to 2005). Researchers, experts and organisations known to be involved in this field were contacted in order to trace unpublished or ongoing studies. There were no language limitations.

Selection criteria:

Trials were selected if they met the following criteria: randomised or quasi-randomised controlled trial, involving replacement and repair of amalgam restorations.

Data collection and analysis:

Two review authors independently assessed titles and abstracts for each article identified by the searches in order to decide whether the article was likely to be relevant. Full papers were obtained for relevant articles and both review authors studied these. The Cochrane Collaboration statistical guidelines were to be followed for data synthesis.

Main results:

The search strategy retrieved 145 potentially eligible studies, after de-duplication and examination of the titles and abstracts all but three studies were deemed irrelevant. After further analysis of the full texts of the three studies identified, none of the retrieved studies met the inclusion criteria and all were excluded from this review.

Authors' conclusions:

There are no published randomised controlled clinical trials relevant to this review question. There is therefore a need for methodologically sound randomised controlled clinical trials that are reported according to the Consolidated Standards of Reporting Trials (CONSORT) statement (www.consort-statement.org/). Further research also needs to explore qualitatively the views of patients on repairing versus replacement and investigate themes around pain, distress and anxiety, time and costs.

This record should be cited as:

Sharif MO, Merry A, Catleugh M, Tickle M, Brunton P, Dunne SM, Aggarwal VR. Replacement versus repair of defective restorations in adults: amalgam. Cochrane Database of Systematic Reviews 2010, Issue 2. Art. No.: CD005970. DOI: 10.1002/14651858.CD005970.pub2

Assessed as up to date:

January 4, 2010

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Primary Review Group:

Oral Health Group

Health topics:

Dentistry & oral health > Dental caries > Treatment

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Replacement versus repair of defective restorations in adults: amalgam

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