Adhesively bonded versus non-bonded amalgam restorations

for dental caries (Review)

Fedorowicz Z, Nasser M, Wilson N

This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library
2009, Issue 4
http://www.thecochranelibrary.com

Adhesively bonded versus non-bonded amalgam restorations for dental caries (Review)
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
[Intervention Review]

Adhesively bonded versus non-bonded amalgam restorations

for dental caries

Zbys Fedorowicz1 , Mona Nasser2 , Nairn Wilson3

1 UKCC (Bahrain Branch), Ministry of Health, Bahrain, Awali, Bahrain. 2 Department of Health Information, Institute for Quality
and Efficiency in Health care, Cologne, Germany. 3 King’s College London Dental Institute at Guy’s, King’s College and St Thomas’
Hospitals, London, UK

Contact address: Zbys Fedorowicz, UKCC (Bahrain Branch), Ministry of Health, Bahrain, Box 25438, Awali, Bahrain.
zbysfedo@batelco.com.bh. (Editorial group: Cochrane Oral Health Group.)

Cochrane Database of Systematic Reviews, Issue 4, 2009 (Status in this issue: New)
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
DOI: 10.1002/14651858.CD007517.pub2
This version first published online: 7 October 2009 in Issue 4, 2009.
Last assessed as up-to-date: 23 July 2009. (Help document - Dates and Statuses explained)

This record should be cited as: Fedorowicz Z, Nasser M, Wilson N. Adhesively bonded versus non-bonded amalgam restorations for
dental caries. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD007517. DOI: 10.1002/14651858.CD007517.pub2.

ABSTRACT
Background
Dental caries (tooth decay) is one of the commonest diseases which afflicts mankind, and has been estimated to affect up to 80% of
people in high-income countries. Caries adversely affects and progressively destroys the tissues of the tooth, including the dental pulp
(nerve), leaving teeth unsightly, weakened and with impaired function. The treatment of lesions of dental caries, which are progressing
through dentine and have caused the formation of a cavity, involves the provision of dental restorations (fillings).
Objectives
To assess the effects of adhesive bonding on the in-service performance and longevity of restorations of dental amalgam.
Search strategy
Databases searched July 2009: the Cochrane Oral Health Group’s Trials Register; CENTRAL (The Cochrane Library 2009, Issue 3);
MEDLINE (1950 to July 2009); and EMBASE (1980 to July 2009).
Selection criteria
Randomised controlled trials comparing adhesively bonded versus traditional non-bonded amalgam restorations in conventional
preparations utilising deliberate retention, in adults with permanent molar and premolar teeth suitable for Class I and II amalgam
restorations only.
Data collection and analysis
Two review authors independently screened papers, extracted trial details and assessed the risk of bias in the included study.
Main results
One trial with 31 patients who received 113 restorations was included. At 2 years only 3 out of 53 restorations in the non-bonded group
were lost, which was attributed to a lack of retention, and 55 of 60 bonded restorations survived with five unaccounted for at follow-
up. Post-insertion sensitivity was not significantly different (P > 0.05) at baseline or 2-year follow-up. No fractures of tooth tissue were
Adhesively bonded versus non-bonded amalgam restorations for dental caries (Review)
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
reported and there was no significant difference between the groups or matched pairs of restorations in their marginal adaptation (P >
0.05).
Authors’ conclusions
There is no evidence to either claim or refute a difference in survival between bonded and non-bonded amalgam restorations. This
review only found one methodologically sound but somewhat under-reported trial. This trial did not find any significant difference in
the in-service performance of moderately sized adhesively bonded amalgam restorations, in terms of their survival rate and marginal
integrity, in comparison to non-bonded amalgam restorations over a 2-year period. In view of the lack of evidence on the additional
benefit of adhesively bonding amalgam in comparison with non-bonded amalgam, it is important that clinicians are mindful of the
additional costs that may be incurred.

PLAIN LANGUAGE SUMMARY

Adhesively or non-adhesively bonded amalgam restorations for dental caries
Tooth decay is a common problem affecting both children and adults. Cavities form in the teeth by the action of acid producing
bacteria present in dental plaque.
A number of techniques and a variety of materials can be used to restore teeth and one of the most commonly used and comparatively
cheap filling material is dental amalgam (a mixture of mercury and metal alloy particles). The review authors sought to evaluate the
added benefit of using an adhesive to bond amalgam to tooth structure to see if bonded fillings would last longer.
Only one study, which provided limited data, showed that for medium sized fillings there was no difference in sensitivity between the
bonded and non-bonded fillings after their placement and that bonding of amalgam to tooth did not have any effect on the survival
of the filling over a 2-year period and thus the time taken for the additional step in addition to the cost of bonding material cannot be
justified.

Adhesively bonded versus non-bonded amalgam restorations for dental caries (Review)
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.