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

Abstract

Objectives: Our aim was to systematically assess the efficacy of chlorhexidine (CHX) as a cavity pre-treatment or restoration mix-in on the survival of ART restorations.

Data: We included randomized controlled trials that assessed the effect of cavity pretreatment with CHX or the restoration mix-in of CHX on the survival of ART restorations (test group) versus a similar restorative approach without CHX. Risk of bias was assessed using Cochrane's randomized trial quality assessment Tool (RoB 2.0). Random-effects meta-analysis was conducted, with mean Odds Ratios and 95 % confidence intervals (OR, 95 % CI) as effect estimates. The certainty of the evidence was assessed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.

Sources: Medline, Web of Science, Cochrane Central were searched. Eligible studies were in- or excluded and data extracted for included studies by two reviewers independently.

Study selection: Four studies with 261 patients (mean age 3.8-14.6 years) and 467 ART restorations were included. All studies showed some concerns about the risk of bias. Three studies involving a total of 167 restorations in the CHX group and 188 restorations in the control group, followed up for one year, were submitted to meta-analysis. There were no significant differences between CHX vs. control (OR = 0.79, 95 % CI [0.26, 2.40], P = 0.68, I² = 3%, P = 0.35). The strength of the evidence was estimated as low.

Conclusions: Based on very limited data, CHX pre-treatment or restoration mix-in did not have any significant benefit for survival of ART restorations.

Clinical significance: There is a lack of evidence regarding the influence of chlorhexidine on the survival of ART restorations. Our results revealed that there was no significant difference in the survival of ART restorations when CHX was used as a cavity pre-treatment or mix-in.

Keywords: Atraumatic restorative treatment; Chlorhexidine; Evidence‐based dentistry; Glass-ionomer; Survival; Systematic review.