Chlorhexidine to improve the survival of ART restorations: A systematic review and meta-analysis

El-Kady, Dina; Khater, Ahmad G. A.; Schwendicke, Falk

doi:10.1016/j.jdent.2020.103491

Cited by 6 publications

(7 citation statements)

References 28 publications

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“…Further research and evidence are required to understand the efficacy of ART with different materials. Interventions that combined chemical agents (e.g., chlorhexidine [ 71 ], SDF [ 72 ], fluoride varnish [ 73 ]) and restoration by ART have been introduced and studied in children, with some advanced benefits. However, there is still a lack of evidence for these combined root caries treatments.…”

Section: Discussionmentioning

confidence: 99%

Impact of direct restorative dental materials on surface root caries treatment. Evidence based and current materials development: A systematic review

Tonprasong

Inokoshi

Shimizubata

et al. 2022

Japanese Dental Science Review

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This systematic review provides an update on the development and efficacy of direct restorative dental materials for root caries interventions from in vitro and clinical studies. PubMed, Embase, and Web of Science were searched using specific MeSH keywords. Full articles from September 1990 to October 2021 were collected. Additional articles were identified by reference retrieval and manual searching. Studies not related to restorative materials for root caries treatment, case reports, non-original articles, and/or articles not written in English were excluded. Bias risk assessment was performed for the clinical studies. Forty-two articles (eleven clinical studies and thirty-one in vitro studies) were included for analysis. Most in vitro studies indicated an excellent cariostatic effect of glass ionomer cement. Resin-modified glass ionomer restorations also presented reduced recurrent caries activity but had a lower efficacy than glass ionomer cement restorations. For composite resin restorations, the main material development strategies are to strengthen the tooth structure and integrate antimicrobial activity. The clinical studies offered limited data, so the most appropriate material for surface root caries treatment is still inconclusive. However, atraumatic restorative treatment (ART) is an alternative treatment for patients with limiting conditions. Further clinical studies are required to confirm the efficacy of bioactive materials.

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Section: Discussionmentioning

confidence: 99%

Impact of direct restorative dental materials on surface root caries treatment. Evidence based and current materials development: A systematic review

Tonprasong

Inokoshi

Shimizubata

et al. 2022

Japanese Dental Science Review

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“…Sealing carious lesions and bacteria after selective removal and ART is based on the concept of changing the ecological environment by depriving the bacteria of nutrition and reducing or inhibiting bacterial proliferation and activity [ 42 , 43 ]. To increase the antibacterial effect of sealing by reducing the remaining bacteria, several studies have investigated using an antibacterial agent as a cavity disinfectant or restorative material [ 2 , 29 , 42 – 44 ].…”

Section: Discussionmentioning

confidence: 99%

Chlorhexidine gluconate enhances the remineralization effect of high viscosity glass ionomer cement on dentin carious lesions in vitro

et al. 2022

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Background To compare the mean mineral density (MMD) and examine the remineralization of carious dentin after cavity disinfection with chlorhexidine gluconate (CHX) and restoration with high viscosity glass ionomer cement (H-GIC) in vitro. Methods Selective caries removal to leathery dentin was performed in 40 extracted primary molars. The samples were scanned using micro-computed tomography (micro-CT) to determine the MMD baseline and randomly divided into 4 groups (n = 10): Equia™ group, applied dentin conditioner and restored with H-GIC (Equia Forte™), CHX-Equia™ group, disinfected the cavity with 2% CHX before applying dentin conditioner and restored with H-GIC (Equia Forte™), Ketac™ group, restored with H-GIC (Ketac Universal™) and CHX-Ketac™ group, disinfected the cavity with 2% CHX before restored with H-GIC (Ketac Universal™). The samples underwent micro-CT scanning post-restoration and post-pH-cycling to determine their respective MMDs. One sample from each group was randomly selected to analyze by scanning electron microscopy (SEM). Results The MMD gain in the 4 groups post-restoration was significantly different between the Equia™ and CHX-Ketac™ groups (oneway ANOVA with Post hoc (Tukey) test, P = 0.045). There was a significant difference in MMD gain post-restoration between the Equia™ and CHX-Equia™ groups (Independent t-test, P = 0.046). However, the Ketac™ and CHX-Ketac™ group’s MMD were similar. The SEM images revealed that the CHX-Ketac™ group had the smallest dentinal tubule orifices and the thickest intertubular dentin among the groups. However, the CHX-Equia™ group had thicker intertubular dentin than the Equia™ group. Conclusion Applying 2% CHX on demineralized dentin enhances the remineralization of the dentin beneath the restoration.

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“…At depth >3mm, the survival percentage was high for CHX modified GIC. This may be due to the enhanced antimicrobial ability of CHX modified GIC, which reduced pulpal infection in deep cavities and chances of failure [10,13]. Concerning buccolingual and mesiodistal width, the highest success was observed with a 2.1-3 mm width.…”

Section: Discussionmentioning

confidence: 99%

“…Previously, several studies [18,21,24,[26][27][28] have focused on the survival of single surface ART restorations without considering the influence of cavity size. Although it is reported that physical properties are not affected in CHX modified GIC, [11,14,15] the survival of the same has been tested by a limited number of studies [10], especially in the primary dentition [15,24]. With this background, the present randomized trial was conducted to assess the influence of cavity size on the survival of conventional and CHX modified GIC in single surface primary molar teeth ART.…”

Section: Introductionmentioning

confidence: 99%

“…The glass-ionomer used in ART has the advantage of chemical adhesion to the tooth structure, a good level of thermal biocompatibility with enamel and dentin, and remineralization of demineralized dentin [9]. To enhance the antimicrobial ability of GIC, few authors have incorporated chlorhexidine (CHX) into it [10][11][12][13][14][15]. However, the survival of conventional and or CHX modified GIC depends upon cavity size, number of surfaces involved, the experience of the operator, and isolation techniques used during the restorative procedure [16][17][18][19][20][21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

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Influence of Cavity Size on the Survival of Single Surface Atraumatic Restorative Treatment Using Glass Ionomer Cement with or without Chlorhexidine Diacetate—A Randomized Trial

et al. 2021

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The purpose of the present study was to assess the influence of cavity size on the survival of conventional and CHX modified GIC in single surface primary molars receiving Atraumatic Restorative Treatment (ART). A randomized controlled trial with a split-mouth design was conducted on 90 children with symmetrical bilateral single surface carious lesions on primary molars. The teeth were randomly allotted to the conventional GIC group (group 1, n = 90) and CHX modified GIC group (group 2, n = 90). Both groups received atraumatic restorative treatment under rubber dam isolation. The cavity size was measured in terms of depth, mesiodistal, and buccolingual dimensions. The survival of ART restorations was measured after 6, 12, 18, and 24 months. The difference in proportion was tested using the Kruskal–Wallis H test, and survival curve estimation was carried out using the Kaplan–Meier method. The overall survival of all ART restorations was 83.3% at 24 months for the total sample. The survival of conventional GIC at 24 months was 83.9%, and for CHX-modified GIC was 82.7% (p > 0.05). The collective overall success of 65.1% was seen in the cavity volume category of 10–29.9 mm3. CHX modified GIC showed high survival percentage (60%) with depth >3 mm. To conclude, no significant difference was observed in the overall survival percentage of conventional and CHX modified GIC. Survival percentage was highest for cavities with a volume of 10–19.9 mm3.

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Chlorhexidine to improve the survival of ART restorations: A systematic review and meta-analysis

Cited by 6 publications

References 28 publications

Impact of direct restorative dental materials on surface root caries treatment. Evidence based and current materials development: A systematic review

Impact of direct restorative dental materials on surface root caries treatment. Evidence based and current materials development: A systematic review

Chlorhexidine gluconate enhances the remineralization effect of high viscosity glass ionomer cement on dentin carious lesions in vitro

Influence of Cavity Size on the Survival of Single Surface Atraumatic Restorative Treatment Using Glass Ionomer Cement with or without Chlorhexidine Diacetate—A Randomized Trial

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