Does isolating the site of a dental restoration during treatment improve the performance of the restoration?

Restorative dental treatments are used to repair damage to teeth caused by tooth decay or accidents. Creating a physical barrier around a treatment site to reduce contamination of the site with saliva is a common practice. Reducing the amount of saliva in the area may enable the materials used for repair to bond together more effectively, improving the performance and reliability of the restoration. It may also reduce exposure to bacteria in the mouth.

Two methods of creating a barrier are commonly used; either a rubber dam around the tooth or cotton rolls together with suction to remove excess saliva. The rubber dam method involves using a sheet of latex in a frame. A small hole is made in the sheet and it is placed over the tooth to be treated creating a barrier around it. Using a rubber dam can isolate the tooth from the rest of the person’s mouth, which allows the tooth to be repaired dry and with relatively less exposure to bacteria in the mouth. A common alternative method of isolation of the tooth is the use of cotton rolls combined with the removal of excess saliva by suction. The evidence on the effects of rubber dam usage versus cotton roll usage is conflicting.

What was the research?

A systematic review to examine whether different isolation methods affect the performance of dental restorations.

Who conducted the research?

The research was conducted by a team led by Yan Wang West China Hospital of Stomatology on behalf of Cochrane Oral Health. Chunjie Li, He Yuan, May Wong, Jing Zou, Zongdao Shi and Xuedong Zhou were also on the team.

What evidence was included in the review?

The evidence in this review, which was carried out together with Cochrane Oral Health, is up-to-date as of 17 August 2016. We included four randomised controlled trials that evaluated 1037 participants, mostly children, who were undergoing different types of dental restorative treatments, using materials which require effective moisture control to reduce failure rates. For example, fissure sealing, resin or composite fillings at the gum margin, and proximal atraumatic restorative treatment in primary molars. All of the included studies compared the use of rubber dam and cotton rolls as two different isolation methods.

What did the evidence say?

There is some evidence to suggest that the use of a rubber dam may increase the survival time of dental restorations compared to the use of cotton rolls as an isolation method.
The studies did not include possible side effects.

How good was the evidence?

The evidence presented is of very low quality due to the small amount of available studies, uncertain results and problems related to the way in which the available studies were conducted.

What are the implications for dentists and the general public?

We found some very low-quality evidence, from single studies, suggesting that rubber dam usage in dental direct restorative treatments may lead to a higher survival rate of the restorations. The effect estimate should be interpreted with caution due to a high risk of bias in the analysed studies, the small number of included studies and that the type of restorative treatments varied among studies. This review found no evidence to support or refute any adverse effects that the rubber dam isolation method may have on patients. Although there was no robust evidence to favour rubber dam usage in improving the survival rate of restorations, this does not mean that rubber dam usage is not important during restorative treatments, since the clinical decision is not solely based upon its ability to reduce failure rate of restorations. The use of rubber dam still has numerous advantages, such as preventing accidental swallowing of restorative instruments or tooth fragments, protecting soft tissues from sharp instruments, or helping in behaviour management in children. Clinicians still need to practice rubber dam placement, and never using a rubber dam would not be an acceptable approach.

What should researchers look at in the future?

The fact that we are unable to make a robust conclusion on the effect of using rubber dam isolation during restorative treatments in dental patients demonstrates that more randomised controlled trials with longer follow-up periods are needed. Studies should report the survival rate of restorations and perform clinical evaluation of the quality of the restorations based upon US Public Health Service criteria. Adverse effects, participant acceptance/satisfaction and the direct cost of the treatment should also be clearly reported at the participant level per group.

Link

Wang Y, Li C, Yuan H, Wong MCM, Zou J, Shi Z, Zhou X. Rubber dam isolation for restorative treatment in dental patients. Cochrane Database of Systematic Reviews 2016, Issue 9. Art. No.: CD009858. DOI: 10.1002/14651858.CD009858.pub2.

This post is an extended version of the review’s plain language summary, compiled by Anne Littlewood at Cochrane Oral Health’s Editorial Base.