Inhibition of hybrid layer degradation by cavity pretreatment: Meta- and trial sequential analysis. (June 2016)

• Record Type: Journal Article
• Authors: Göstemeyer, Gerd; Schwendicke, Falk
• Is Part Of: Journal of dentistry. Volume 49(2016:Jun.)
• Page Start: 14
• Page End: 21
• Publication Date: 2016-06
• Subjects: Chlorhexidine -- Dentin bonding -- Ethanol-wet bonding -- Matrix metallo-proteinase -- Mdpb -- Resin restorations; Dentistry -- Periodicals; Dentistry -- Periodicals; Dentisterie -- Périodiques; Electronic journals; 617.6005
• DOI: 10.1016/j.jdent.2016.04.007
• Languages: English
• ISSNs: 0300-5712

Abstract

Abstract: Objectives: Inhibition of hybrid layer degradation, for example via inhibition of matrix-metallo-proteinases (MMP) could reduce risk of retention loss and failure of adhesively placed restorations. This systematic review investigated such inhibitory pretreatment qualitatively and via meta - and trial-sequential-analysis. Data sources: We included randomized clinical trials comparing degradation inhibitory cavity pretreatment versus no, placebo or alternative treatments prior adhesive placement of resin-based restorations. Trials reporting retention loss or failure (graded bravo-delta in USPHS or similar criteria) were included. Trial selection, data extraction, and risk of bias assessment were conducted independently by two reviewers. Fixed- or random-effects intention-to-treat, per-protocol, and scenario meta -analyses were performed, and trial-sequential-analysis used to control for risk of random errors. Electronic databases (PubMed, Embase, Cochrane CENTRAL) were systematically screened, and hand searches and cross-referencing performed. Study selection: The ten included trials involved 208 patients (695 cavities) and used chlorhexidine (seven trials), ethanol-wet-bonding (two trials), and quaternary ammonium compounds for degradation inhibition. All but one trial had high risk of bias. Follow-up ranged from 6 to 36 months. Risk of retention loss was not significantly decreased after pretreatment (per-protocol OR [95% CI] 1.37 [0.68/2.77], intention-to-treat: 1.25 [0.76/2.04]). This was found for risk of restoration failure as well (per-protocol: 0.86 [0.56/1.34], intention-to-treat: 1.22 [0.83/1.80]). Scenario analyses found great uncertainty introduced by attrition. According to trial sequential analysis, no firm evidence was reached. Conclusions: There is insufficient evidence to recommend or refute degradation inhibitory cavity pretreatment prior adhesively placing resin-based restorations. This may change if teeth are followed-up for longer. Clinical significance: Dentists can perform cavity pretreatments for inhibition of hybrid layer degradation, but a beneficial effect is not supported by sufficient evidence. The impact of further effects (e.g. disinfection, pulp-irritation) remains unclear.