Atraumatic vs conventional restorative treatment for root caries lesions in older patients: Meta‐ and trial sequential analysis

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Date
2019-05-24
Authors
Göstemeyer, Gerd
da Mata, Cristiane
McKenna, Gerald
Schwendicke, Falk
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John Wiley & Sons, Inc.
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Abstract
Objectives: We aimed to appraise the comparative clinical efficacy of atraumatic restorative treatment (ART) versus conventional restorative treatment (CT) using a meta-analysis, and assessed the robustness of evidence by trial sequential analysis (TSA). Background: Due to its simplified clinical approach, ART may be advantageous over CT for restoration of root caries lesions in institutionalised older patients. Methods: Three electronic databases (PubMed, Embase and Cochrane CENTRAL) were screened, and hand searches and cross-referencing performed to identify randomised controlled trials reporting on survival of ART vs CT for restoration of root caries in older patients. Trial selection, data extraction and risk of bias assessment were performed by two independent reviewers. ART and CT were compared using fixed- or random-effects pairwise meta-analysis for per-protocol (PP), intention-to-treat (ITT) and best-case scenarios. TSA was used to control for risk of random errors. Results: A total of 235 studies were identified, and three trials involving 130 patients (463 restorations) were included. Risk of bias was high or moderate in all but one trial. ART was associated with a significantly increased risk of failure (OR [95% CI] 2.06 [1.06/4.00]) in PP- but not in ITT analysis (1.36 [0.92/2.02]). Analyses for best-case scenarios found great uncertainty introduced by attrition. No firm evidence was reached according to TSA. Conclusions: For restoration of root caries, there is insufficient data to clearly rule out whether differences between ART and CT exist. Limited available data indicate there might be an increased risk of failure for ART.
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Keywords
Atraumatic restorative treatment , Evidence‐based dentistry , Geriatric dentistry , Root caries
Citation
Göstemeyer, G., da Mata, C., McKenna, G. and Schwendicke, F. (2019) 'Atraumatic vs conventional restorative treatment for root caries lesions in older patients: Meta- and trial sequential analysis', Gerodontology, 36(3), pp. 285-293. https://doi.org/10.1111/ger.12409
Copyright
© 2019, Gerodontology Association and John Wiley & Sons Ltd. This is the accepted version of the following item: Göstemeyer, G., da Mata, C., McKenna, G. and Schwendicke, F. (2019) 'Atraumatic vs conventional restorative treatment for root caries lesions in older patients: Meta- and trial sequential analysis', Gerodontology, 36(3), pp. 285-293, which has been published in final form at: https://doi.org/10.1111/ger.12409. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.