| Objective: The pit and fissure caries is a kind of caries which occur inenamel and/or dentin around pits and fissures on the occlusal surface of theteeth very easily. Except of food and bacterial plaque adhere, the pits andfissures of the young permanent molar are narrow, complex and lowmineralization, and they are the most risk region of caries. It was reported thatthe pits and fissures caries accounted of90percent of caries in posteriorpermanent teeth. Preventive resin restoration proposed by Simonsen in1977was considered as the most appropriate restoration skill for prevention of pitand fissure caries. With the development of oral materials and the minimallyinvasion skill, the flowable composite and flowable compomer had beenwidely used in dental clinic. Although there were a large number of researchesperformed so far. A systematic and comprehensive evaluation about theapplication of flowable composite and compomer in PRR has not been shown.This study aims to evaluate the effectiveness of flowable composite orcompomer in preventive resin restoration of pit and fissure caries in permanentteeth by Meta analysis, meanwhile to provide scientific guide for the clinicalapplication of these restorative material.Methods:1Methods of searching and studies selectionStudies about flowable composite or flowable compomer to fill the pitand fissure caries of permanent teeth were identified by a comprehensivesearching from the follows: PubMed, Cochrane library, OVID, Science Direct,CNKI, CBM and VIP databases from the beginning of these databases toDecember2012. The language of the literatures was Chinese and English. Therelated studies, gray literatures and the references of eligible studies were alsoresearched. 2The selection criteria:2.1Studies designed as: randomized controlled trial.2.2Study objects: patients diagnosed clearly as pit and fissure caries ofpermanent teeth.2.3Intervention: one group filled with flowable composite or flowablecompomer, the control group filled with composite, pit and fissure sealants,silver amalgam, glass ionimer cement or composite combind with pit andfissure sealants.2.4Clinical effectiveness standard as following: complete retention rate,success rate, and secondary caries incidence.2.5Drop-out rate was <20%. There are effective data that could be analyzed.Trials were analyzed independently by two reviewers to decide whetherto be collected in this research. Disagreement was resolved by consensus or athird party.3Qualitative assessmentsThe quality of eligible studies was evaluated by two observeresindepently with the revised Jadad’s scale. The studies were divided intohigh-quality trials (more than4scores) and low-quality trials (less than4scores). Meanwhile the useful data was extracted according to the studies.4Statistical analysesMeta-analyses were performed by Stata software11.0. The effect size ofthe binary response data was indicated using relative risk (RR) and95%confidence interval. The potential publication-bias was tested by funnel plotand Begg’s test.Results:1Researching results: there were1312references about flowable composite orflowable compomer in PRR in total. Of these,20randomized, controlled trialsmet the inclusion criteria.2The control group of the studies included flowable composite or flowablecompomer therapy versus pit and fissure sealant, composite, glass ionomercement and silver amalgam. 3There were5high-studies whose score were more than4evaluatedaccording to the Jadad. The qualities of the literatures were generally low.4Meta analyses4.1Compared with the restoration materials of controlled group, flowablecomposite or flowable compomer in PRR improved the success rate. Therewas significant difference between them.（one year later：P=0.000；two yearlater：P=0.003）; Compared with the restoration materials of controlled group,flowable composite or flowable compomer in PRR improved the completeretention rate. There was significant difference between them.（one yearlater：P=0.000；two year later：P=0.000）; Compared with the restorationmaterials of controlled group, flowable composite or flowable compomer inPRR reduced the incidence of secondary caries. There was significantdifference between them（.one year later：P=0.005；two year later：P=0.000）.4.2There was no significant difference between flowable composite orflowable compomer and composite combined with pit fissure sealants in thesuccess rate.（one year later: P=0.269；two year later: P=0.100）; Comparedwith the conventional skill of composite combined with pit fissure sealants,flowable composite or flowable compomer in PRR improved the completeretention rate. There was significant difference between them.（one year later:P=0.026；two year later: P=0.000）；Compared with the conventional skill ofcomposite combined with pit fissure sealants, flowable composite or flowablecompomer in PRR could reduce the incidence of secondary caries after twoyears.（P=0.020）。4.3Compared with pit and fissure sealants, flowable composite or flowablecompomer in PRR improved the success rate. There was significant differencebetween them（one year later: P=0.000; two year later: P=0.000）; Comparedwith pit and fissure sealants, flowable composite or flowable compomer inPRR improved the complete retention rate. There was significant differencebetween them（one year later: P=0.000; two year later: P=0.000）; There wereno significant difference between them in the secondary caries incidence afterone year（P=0.068）; Compared with pit and fissure sealants, flowable composite or flowable compomer in PRR could reduce the incidence ofsecondary caries after two years.There was significant difference betweenthem（P=0.001）.Conclusion:1The quality of the random control trials in this research was low andlimited, should be generally improved, especially in the study design, thesample size, randomization, and blinding. There was no good homogeneitybetween eligible literatures. And it still needs larger sample, well-designedrandomized control trials to verify the effectiveness.2The meta-analysis showed that:（1）Compared with other restorationmaterials, flowable composite or flowable compomer in PRR could improvethe complete retention rate.（2）Compared with other restoration materialsflowable composite or flowable compomer in PRR could reduce the incidenceof secondary caries. However, there was no significant difference betweenthem in secondary caries incidence compared with pit and fissure sealantsafter one year（.3）Between the conventional skill of composite combined withpit fissure sealants and flowable composite or flowable compomer in PRR,there was no significant difference in success rate. But compared with otherrestoration materials, flowable composite or flowable compomer in PRR couldimprove the success rate.3The sensitivity analysis results showed that: the results of this researchby meta-analysis are stable and reliable. The clinical effect of the flowablecomposite or flowable compomer in PRR could be confirmed.4The flowable composite or flowable compomer in PRR is a clinicaleffective technology to fill pit and fissure caries of permanent teeth. |
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