Decisão de tratamento para restaurações extensas em dentes posteriores: revisão sistemática e meta-análise em rede

Abstract

The main objective of this thesis was to demonstrate, through a network meta-analysis, the best extensive restorative treatment for permanent posterior teeth. The following databases were used: Pubmed, Scopus, Web of Science and Cochrane Library without restriction of year and language. After the removal of duplicates, 9,735 studies were selected for title and abstract reading. Of these, 152 studies were selected for complete reading. We selected 45 prospective and retrospective clinical studies that had the eligibility criteria with at least five years of follow-up and compared at least two types of extensive treatments in permanent teeth in patients of any age. For the network meta-analysis, five had to be excluded, since these studies presented only one data entry. The analysis was performed in R Studio software (Rstudio Inc., Boston, USA). The meta-analysis of direct comparisons between two treatments was performed using a random effects model with heterogeneity assessed by the chisquare statistical test (I2) at a 95% confidence interval. The network meta-analysis was evaluated through two summary graphs (prospective and retrospective) with demonstration of the comparisons between the different primary studies according to the types of materials and frequency of interventions. Two figures with a ranking of probabilities between the positions of the best to the worst materials were also separately established. Two tools were used to assess risk of bias: the Cochrane randomized clinical trials, which demonstrated a low risk of bias for the 14 selected studies and ROBINS-I from non randomized clinical trials, which demonstrated a serious risk of bias for 25 studies, moderate risk for five studies and low risk for only one study. To evaluate the quality of evidence, we used the GRADE tool that demonstrated a moderate degree of certainty for the survival outcome when all the studies were considered. The most frequent failures described in the studies were secondary caries and fracture. For the annual failure rate, the indirect materials in gold and metal-ceramic had the lowest values, of 0.28% and 0.55%, respectively. For the direct materials, the lowest annual failure rate was for the nanohybrid resin, with 1.06%. Therefore, gold and metal-ceramic had the best survival rates in extensive restorations /crowns. For direct restorations, the direct nanohybrid resins are the best indicated, which demonstrates the evolution in the mechanical properties of the resins and because they are more favorable to the patients for the cost-benefit and for impacting in the longer longevity of the tooth in the long term.