Meta-analysis of the clinical behavior of posterior direct resin restorations: Low polymerization shrinkage resin in comparison to methacrylate composite resin.

Paula De Castro Kruly,Uhana Seifert Guimarães Suga,Marcelo Giannini,Laíse Midori Tokubo,Raquel Sano Suga Terada,Renata Corrêa Pascotto,Any De Castro Ruiz Marques,Denys Makarov

doi:10.1371/journal.pone.0191942

Paula De Castro Kruly, Uhana Seifert Guimarães Suga + Show 6 more

Open Access

https://doi.org/10.1371/journal.pone.0191942

Copy DOI

Abstract

Polymerization shrinkage of resin composite can compromise the longevity of restorations. To minimize this problem, the monomeric composition of composites have been modified. The objective of this study was to conduct a meta-analysis to assess the clinical behavior of restorations performed with low polymerization shrinkage resin composite in comparison with traditional methacrylates-based resin composite. This systematic review was registered at Prospero data system (CRD42015023940). Studies were searched in the electronic databases PubMed, Web of Science, Scopus, Lilacs and EMBASE according to a predefined search strategy. The inclusion criteria were as follow: (1) randomized controlled clinical trials with at least six months of follow-up; (2) studies investigating composites with monomers designed to reduce polymerization shrinkage; (3) studies conducted with class I or II restorations in the permanent dentition; and (4) studies that assessed at least one of the following criteria: marginal integrity/adaptation, marginal discoloration, recurent caries, retention of composite restorations, and postoperative sensitivity. Two independent reviewers analyzed the articles to determine inclusion and risk of bias. The search conducted in the databases resulted in a total of 14,217 studies. After reviewing the references and citations, 21 articles remained. The longest clinical follow-up time was 60 months. The meta-analysis of the data in the included studies demonstrated that only one variable (marginal adaptation after 12 months) showed statistically significant outcomes, in which methacrylates-based composites presented significantly better results than resin composites containing modified monomers. The good level of the scientific evidence as well as the overall low risk of bias of the included studies indicate that composites with silorane, ormocer or bulk-fill type modified monomers have a clinical performance similar to conventional resin composites.

Highlights

Over the past decades, resin composites came as a great promise to replace amalgam in dental restorations
Literature reviews evaluating the longevity of conventional resin composite restorations in posterior teeth have demonstrated predictable outcomes [4,5,6]
Many of the most common clinical problems presented by posterior teeth restorations such as secondary caries, restoration fractures, marginal infiltration and marginal discoloration have been related to polymerization shrinkage stress [7]

Summary

Introduction

Resin composites came as a great promise to replace amalgam in dental restorations. Besides their low cost and esthetic appearance, composite restorations do not require extensive preparations, preserving dental structure, and present good clinical behavior in posterior teeth [1,2,3]. Many of the most common clinical problems presented by posterior teeth restorations such as secondary caries, restoration fractures, marginal infiltration and marginal discoloration have been related to polymerization shrinkage stress [7] To minimize these problems, restorations with conventional resin composites are made in increments, an effective but time consuming technique. Clinical follow-up studies conducted so far seem to indicate that these composites present similar clinical performance when compared to conventional resin composites [17,18,19]

Objectives

Methods

Results

Discussion

Conclusion