Veerasamy Yengopal

Publications of Veerasamy Yengopal

• Failure rate of atraumatic restorative treatment using high-viscosity glass-ionomer cement compared to that of conventional amalgam restorative treatment in primary and permanent teeth: a systematic review update

  Authors: Steffen Mickenautsch, Veerasamy Yengopal

  Journal of Early Intervention. 05/2012; 5(3):63-124.

  BACKGROUND: Atraumatic restorative treatment (ART) is a minimally invasive procedure that involves removing markedly softened carious enamel and dentine, using only hand instruments, and thenBACKGROUND: Atraumatic restorative treatment (ART) is a minimally invasive procedure that involves removing markedly softened carious enamel and dentine, using only hand instruments, and then restoring the resulting cavity with an adhesive restorative material. Although developed for use in the less industrialized parts of the world ART has now been accepted as part of the minimum intervention (MI) dentistry philosophy in developed countries. Currently the restorative material of choice for ART is high-viscosity glass ionomer cement (GIC). GIC is ideally suited to managing dental caries according to the principles of MI dentistry, as it can be applied in the very early stages of caries development or in the larger cavity. Additionally, it simplifies the restorative procedure and enables the dentine-pulp complex to react against the carious process. REVIEW OBJECTIVE: This systematic review update seeks to answer the question as to whether, in patients with carious cavities of any class in primary and permanent teeth, ART restorations with high-viscosity GIC have a higher failure rate than amalgam restorations placed with conventional rotary instruments, in tooth cavities of the same size, type of dentition and follow-up period after one or more years. SEARCH STRATEGY: The following databases were searched for relevant trials up to January 2012: MEDLINE accessed via PubMed; CENTRAL accessed via Cochrane Library; Open access sources: Biomed Central, Database of Open Access Journals (DOAJ), OpenJ-Gate; Regional databases: Bibliografia Brasileira de Odontologia (BBO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), IndMed, Sabinet, Scielo; Grey-Literature sources: Scirus (Medicine), OpenSIGLE, Google Scholar. Hand searching was performed for journals not indexed in the databases. References of included studies were checked. SELECTION CRITERIA: Prospective, clinical controlled trials, with focus relevant to review objective and reporting on computable data with a follow-up period of at least one year were selected without language restrictions. DATA COLLECTION AND ANALYSIS: Two review authors independently screened and extracted data from, and assessed the risk of bias in, the selected trial reports. Individual datasets were extracted from the trial results and analyzed regarding in-between-dataset heterogeneity and effect size estimates. The investigated outcome was restoration failure. Meta-analysis was conducted on condition of in-between-dataset homogeneity. Internal trial validity was assessed in terms of selection-, performance-, detection-, attrition-, publication- and reporting bias. Research gaps in the precision and consistency of the results were evaluated. MAIN RESULTS: Eighteen trials were accepted of which 10 were currently available for review. Of these 32 individual dichotomous datasets could be extracted and analyzed. The majority of the results show no differences between both types of intervention. High risk of selection-, performance-, detection- and attrition bias was established. Existing research gaps are mainly due to lack of trials and small sample size. CONCLUSION: The current evidence indicates that the failure rate of high-viscosity GIC/ART restorations is not higher than, but similar to that of conventional amalgam fillings after periods longer than one year. These results are in line with the conclusions drawn during the original systematic review. There is a high risk that these results are affected by bias, and confirmation by further trials with suitably high number of participants is needed.

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• Failure rate of atraumatic restorative treatment using high-viscosity glass-ionomer cement compared to that of conventional amalgam restorative treatment in primary and permanent teeth: a systematic review update

  Authors: Steffen Mickenautsch, Veerasamy Yengopal

  Journal of Minimum Intervention in Dentistry. 05/2012; 5(3):63-124.

  BACKGROUND: Atraumatic restorative treatment (ART) is a minimally invasive procedure that involves removing markedly softened carious enamel and dentine, using only hand instruments, and thenBACKGROUND: Atraumatic restorative treatment (ART) is a minimally invasive procedure that involves removing markedly softened carious enamel and dentine, using only hand instruments, and then restoring the resulting cavity with an adhesive restorative material. Although developed for use in the less industrialized parts of the world ART has now been accepted as part of the minimum intervention (MI) dentistry philosophy in developed countries. Currently the restorative material of choice for ART is high-viscosity glass ionomer cement (GIC). GIC is ideally suited to managing dental caries according to the principles of MI dentistry, as it can be applied in the very early stages of caries development or in the larger cavity. Additionally, it simplifies the restorative procedure and enables the dentine-pulp complex to react against the carious process. REVIEW OBJECTIVE: This systematic review update seeks to answer the question as to whether, in patients with carious cavities of any class in primary and permanent teeth, ART restorations with high-viscosity GIC have a higher failure rate than amalgam restorations placed with conventional rotary instruments, in tooth cavities of the same size, type of dentition and follow-up period after one or more years. SEARCH STRATEGY: The following databases were searched for relevant trials up to January 2012: MEDLINE accessed via PubMed; CENTRAL accessed via Cochrane Library; Open access sources: Biomed Central, Database of Open Access Journals (DOAJ), OpenJ-Gate; Regional databases: Bibliografia Brasileira de Odontologia (BBO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), IndMed, Sabinet, Scielo; Grey-Literature sources: Scirus (Medicine), OpenSIGLE, Google Scholar. Hand searching was performed for journals not indexed in the databases. References of included studies were checked. SELECTION CRITERIA: Prospective, clinical controlled trials, with focus relevant to review objective and reporting on computable data with a follow-up period of at least one year were selected without language restrictions. DATA COLLECTION AND ANALYSIS: Two review authors independently screened and extracted data from, and assessed the risk of bias in, the selected trial reports. Individual datasets were extracted from the trial results and analyzed regarding in-between-dataset heterogeneity and effect size estimates. The investigated outcome was restoration failure. Meta-analysis was conducted on condition of in-between-dataset homogeneity. Internal trial validity was assessed in terms of selection-, performance-, detection-, attrition-, publication- and reporting bias. Research gaps in the precision and consistency of the results were evaluated. MAIN RESULTS: Eighteen trials were accepted of which 10 were currently available for review. Of these 32 individual dichotomous datasets could be extracted and analyzed. The majority of the results show no differences between both types of intervention. High risk of selection-, performance-, detection- and attrition bias was established. Existing research gaps are mainly due to lack of trials and small sample size. CONCLUSION: The current evidence indicates that the failure rate of high-viscosity GIC/ART restorations is not higher than, but similar to that of conventional amalgam fillings after periods longer than one year. These results are in line with the conclusions drawn during the original systematic review. There is a high risk that these results are affected by bias, and confirmation by further trials with suitably high number of participants is needed.

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• Effect of xylitol versus sorbitol: a quantitative systematic review of clinical trials

  Authors: Steffen Mickenautsch, Veerasamy Yengopal

  International Dental Journal. 03/2012;

  Objectives: This study aimed to appraise, within the context of tooth caries, the current clinical evidence and its risk for bias regarding the effects of xylitol in comparison with sorbitol.Objectives: This study aimed to appraise, within the context of tooth caries, the current clinical evidence and its risk for bias regarding the effects of xylitol in comparison with sorbitol. Methods:: Databases were searched for clinical trials to 19 March 2011. Inclusion criteria required studies to: test a caries-related primary outcome; compare the effects of xylitol with those of sorbitol; describe a clinical trial with two or more arms, and utilise a prospective study design. Articles were excluded if they did not report computable data or did not follow up test and control groups in the same way. Individual dichotomous and continuous datasets were extracted from accepted articles. Selection and performance/detection bias were assessed. Sensitivity analysis was used to investigate attrition bias. Egger’s regression and funnel plotting were used to investigate risk for publication bias. Results:: Nine articles were identified. Of these, eight were accepted and one was excluded. Ten continuous and eight dichotomous datasets were extracted. Because of high clinical heterogeneity, no meta-analysis was performed. Most of the datasets favoured xylitol, but this was not consistent. The accepted trials may be limited by selection bias. Results of the sensitivity analysis indicate a high risk for attrition bias. The funnel plot and Egger’s regression results suggest a low publication bias risk. External fluoride exposure and stimulated saliva flow may have confounded the measured anticariogenic effect of xylitol. Conclusions:: The evidence identified in support of xylitol over sorbitol is contradictory, is at high risk for selection and attrition bias and may be limited by confounder effects. Future high-quality randomised controlled trials are needed to show whether xylitol has a greater anticariogenic effect than sorbitol.

• Anticariogenic effect of xylitol versus fluoride - a quantitative systematic review of clinical trials.

  Authors: Steffen Mickenautsch, Veerasamy Yengopal

  International dental journal. 02/2012; 62(1):6-20.

  The objective of this study was to appraise the clinical evidence and its bias risk regarding the anticariogenic effect of xylitol in comparison with that of fluoride. Databases were searched forThe objective of this study was to appraise the clinical evidence and its bias risk regarding the anticariogenic effect of xylitol in comparison with that of fluoride. Databases were searched for clinical trials up to 18 March 2011. Article inclusion criteria were as follows: caries-related primary outcomes were tested; xylitol was compared with topical fluoride in some form; two-arm (or more) clinical trial including test/control group(s); prospective study design. Article exclusion criteria were as follows: no computable data were reported; test and control groups were not followed up in the same way; chewing gum was the main form of clinical application in either group. Individual continuous datasets were extracted from accepted articles. Selection and performance/detection bias were assessed. Sensitivity analysis was used to investigate attrition bias risk. Egger's regression and funnel plot was used to investigate publication bias risk. Twelve articles were included. Of these, six were accepted and six excluded, and 21 continuous datasets were extracted. Owing to the high clinical heterogeneity, no meta-analysis was performed. The addition of xylitol to existing fluoride regimes may be beneficial in the prevention of caries. However, all identified trials were limited by potential risk of selection, performance/detection and attrition bias. The funnel plot and Egger's regression results (-2.80; 95% confidence interval -4.01, -1.58; P = 0.0001) indicated possible publication bias risk. External fluoride access may have confounded the measured anticariogenic effect of xylitol. The evidence found contains a high risk of bias and may be limited by confounder effects. Future high-quality randomised controlled trials are needed in order to provide conclusive evidence on this topic.

• Retention of orthodontic brackets bonded with resin-modified GIC versus composite resin adhesives--a quantitative systematic review of clinical trials.

  Authors: Steffen Mickenautsch, Veerasamy Yengopal, Avijit Banerjee

  Clinical oral investigations. 02/2012; 16(1):1-14.

  The aim of this systematic review was to establish whether the clinical debonding (failure) rates of orthodontic brackets bonded either with resin-modified glass ionomer (RM-GIC) or with compositeThe aim of this systematic review was to establish whether the clinical debonding (failure) rates of orthodontic brackets bonded either with resin-modified glass ionomer (RM-GIC) or with composite resin adhesive are the same. Five databases were searched for articles up to 18 November 2010. Inclusion criteria were titles/abstracts relevant to the review question and two or more arm clinical trial. Exclusion criteria were the following: no computable data recorded and subjects of both groups not followed up in the same way. From the accepted trials, datasets were analysed concerning clinical precision and internal validity. Eleven trials were accepted. From these, 15 dichotomous datasets were extracted. Relative risk with 95% confidence interval of nine datasets showed no statistically significant differences in outcome between the treatment and control group after 6 months-1.32 years. Five showed a statistically significant difference (p < 0.05), favouring resin composite bonding after 12 and 18 months. One favoured RM-GIC after 10 months. Meta-analysis found no difference in the failure rate between the two treatment groups after 12 months (RR, 1.11; 95% CI, 0.87-1.42; p = 0.40) and found in favour of composite resin adhesive after >14 months (RR, 2.25; 95% CI, 1.60-3.17; p < 0.00001). All trials had poor internal validity due to selection and detection/performance bias risk. The current evidence suggests no difference between the types of materials after 12 months but favours composite resin adhesives after a >14-month period. However, its risk of selection and detection/performance bias are high, and all results need to be regarded with caution. Further high quality randomised control trials addressing this topic are needed. The clinical relevance of this study is that RM-GIC may have the same clinical debonding (failure) rate as composite resin adhesives after 1 year when used for bonding of orthodontic brackets.

• The impact of service-learning on two groups of South African dental students.

  Authors: Ahmed Bhayat, Glynnis Vergotine, Veerasamy Yengopal, Michael J Rudolph

  Journal of dental education. 11/2011; 75(11):1482-8.

  Service-learning has become an important component in the education of medical and dental students around the world. Dental students at the University of Witwatersrand, South Africa, provide dentalService-learning has become an important component in the education of medical and dental students around the world. Dental students at the University of Witwatersrand, South Africa, provide dental services to rural communities via the Phelophepa train or a Public Oral Health Facility (POHF). The Phelophepa train is a mobile primary health care facility offering dental, pharmacy, nursing, and medical services provided by health professions students. The objective of this study was to determine the impact this experience with service-learning has had on dental students. Final-year dental students in 2008 and 2009 participated in the study by completing a self-administered questionnaire. There was a 100 percent response rate (N=55) on the demographic questions and a 98 percent response rate (N=54) on the opinion questions. Students on the Phelophepa train performed more extractions and examinations than those at the POHFs. Most students (95 percent), both on the train and at the clinics, reported that their clinical skills and efficiency had improved, and 96 percent felt more aware of the communities' needs. Almost all the students (96 percent) reported that the experience had helped them define their personal strengths and weaknesses. Complaints they mentioned included large numbers of patients (87 percent), long working hours (60 percent), and equipment being inadequate (48 percent) or not working (40 percent). This program positively impacted these students and enhanced their personal growth and social responsibility by exposing them to the needs of rural and urban communities in South Africa.

• Extent and quality of systematic review evidence related to minimum intervention in dentistry: essential oils, powered toothbrushes, triclosan, xylitol.

  Authors: Steffen Mickenautsch, Veerasamy Yengopal

  International dental journal. 08/2011; 61(4):179-92.

  To investigate extent and quality of current systematic review evidence regarding: powered toothbrushes, triclosan toothpaste, essential oil mouthwashes, xylitol chewing gum. Five databases wereTo investigate extent and quality of current systematic review evidence regarding: powered toothbrushes, triclosan toothpaste, essential oil mouthwashes, xylitol chewing gum. Five databases were searched for systematic reviews until 13 November 2010. Inclusion criteria: relevant to topic, systematic review according to title and/or abstract, published in English. Article exclusion criteria were based on QUOROM recommendations for the reporting of systematic review methods. Systematic review quality was judged using the AMSTAR tool. All trials included by reviews were assessed for selection bias. 119 articles were found, of which 11 systematic reviews were included. Of these, six were excluded and five accepted: one for triclosan toothpaste; one for xylitol chewing gum; two for powered toothbrushes; one for essential oil mouthwashes. AMSTAR scores: triclosan toothpaste 7; powered toothbrushes 9 and 11; xylitol chewing gum 9; essential oil mouthwashes 8. In total, 75 (out of 76) reviewed trials were identified. In-depth assessment showed a high risk of selection bias for all trials. The extent of available systematic review evidence is low. Although the few identified systematic reviews could be rated as of medium and high quality, the validity of their conclusions needs to be treated with caution, owing to high risk of selection bias in the reviewed trials. High quality randomised control trials are needed in order to provide convincing evidence regarding true clinical efficacy.

• Absence of carious lesions at margins of glass-ionomer cement and amalgam restorations: An update of systematic review evidence.

  Authors: Steffen Mickenautsch, Veerasamy Yengopal

  BMC research notes. 03/2011; 4:58.

  This article aims to update the existing systematic review evidence elicited by Mickenautsch et al. up to 18 January 2008 (published in the European Journal of Paediatric Dentistry in 2009) andThis article aims to update the existing systematic review evidence elicited by Mickenautsch et al. up to 18 January 2008 (published in the European Journal of Paediatric Dentistry in 2009) and addressing the review question of whether, in the same dentition and same cavity class, glass-ionomer cement (GIC) restored cavities show less recurrent carious lesions on cavity margins than cavities restored with amalgam. The systematic literature search was extended beyond the original search date and a further hand-search and reference check was done. The quality of accepted trials was assessed, using updated quality criteria, and the risk of bias was investigated in more depth than previously reported. In addition, the focus of quantitative synthesis was shifted to single datasets extracted from the accepted trials. The database search (up to 10 August 2010) identified 1 new trial, in addition to the 9 included in the original systematic review, and 11 further trials were included after a hand-search and reference check. Of these 21 trials, 11 were excluded and 10 were accepted for data extraction and quality assessment. Thirteen dichotomous datasets of primary outcomes and 4 datasets with secondary outcomes were extracted. Meta-analysis and cumulative meta-analysis were used in combining clinically homogenous datasets. The overall results of the computed datasets suggest that GIC has a higher caries-preventive effect than amalgam for restorations in permanent teeth. No difference was found for restorations in the primary dentition. This outcome is in agreement with the conclusions of the original systematic review. Although the findings of the trials identified in this update may be considered to be less affected by attrition- and publication bias, their risk of selection- and detection/performance bias is high. Thus, verification of the currently available results requires further high-quality randomised control trials.

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• Caries-preventive effect of glass ionomer and resin-based fissure sealants on permanent teeth: An update of systematic review evidence.

  Authors: Steffen Mickenautsch, Veerasamy Yengopal

  BMC research notes. 01/2011; 4(1):22.

  This article constitutes a partial update of the original systematic review evidence by Yengopal et al. from 15 January 2008 (published in the Journal of Oral Science in 2009) with primary focus onThis article constitutes a partial update of the original systematic review evidence by Yengopal et al. from 15 January 2008 (published in the Journal of Oral Science in 2009) with primary focus on research quality in regard to bias risk in trials. Its aim is to update the existing systematic review evidence from the English literature as to whether caries occurrence on pits and fissures of teeth sealed with either GIC or resin is the same. In addition to the 12 trials included during the original systematic review, 5 new trials were identified during the database search (up to 26 August 2010) and 2 further trials were included from a hand search and reference check. Of these, 3 trials were excluded and 16 were accepted for data extraction and quality assessment. The quality of accepted trials was assessed, using updated quality criteria, and the risk of bias was investigated in more depth than previously reported. In addition, the focus of quantitative synthesis was shifted to single datasets that were extracted from the accepted trials. Twenty-six dichotomous and 4 continuous datasets were extracted. Meta-analysis and cumulative meta-analysis were used in combining clinically homogenous datasets. The overall outcome of the computed datasets suggest no difference between the caries-preventive effects of GIC- and resin-based fissure sealants. This overall outcome is in agreement with the conclusions of the original systematic review. Although the findings of the trials identified in this update may be considered to be less affected by attrition- and publication bias, their risk of selection- and detection-/performance bias is high. Thus, verification of the currently available results requires further high quality randomised control trials.

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• Absence of carious lesions at margins of glass-ionomer cement (GIC) and resin-modified GIC restorations: a systematic review.

  Authors: Steffen Mickenautsch, Martin J Tyas, Veerasamy Yengopal, Luciana B Oliveira, Marcelo Bönecker

  The European journal of prosthodontics and restorative dentistry. 09/2010; 18(3):139-45.

  This systematic review sought to quantitatively answer the question as to whether, in tooth cavities of the same size, type of dentition and follow-up period, resin-modified glass-ionomer (GIC)This systematic review sought to quantitatively answer the question as to whether, in tooth cavities of the same size, type of dentition and follow-up period, resin-modified glass-ionomer (GIC) restorations, when compared to conventional GIC restorations, offer a significant caries preventive effect, as measured by the absence of caries lesions at the margin of restorations. Six databases were searched for articles in English, Portuguese or Spanish until 07 May 2009. Four articles were accepted and 22 separate datasets extracted. The difference between both types of material were computed as relative risk (RR) with 95% confidence interval (CI). No meta-analysis was undertaken due to aspects of clinical/methodological heterogeneity. The results of the extracted datasets ranged between RR 0.90 (95% CI 0.81-1.01) and 1.08 (95% CI 0.71-1.63; p > 0.05) indicating no difference in the caries preventive effect between both types of materials. Further high-quality randomized control trials are needed in order to confirm these results.

• Pulp response to resin-modified glass ionomer and calcium hydroxide cements in deep cavities: A quantitative systematic review.

  Authors: Steffen Mickenautsch, Veerasamy Yengopal, Avijit Banerjee

  Dental materials : official publication of the Academy of Dental Materials. 05/2010; 26(8):761-70.

  To quantitatively determine whether the pulp response to resin-modified glass ionomer cements placed in deep cavities differs from that generated by calcium hydroxide cement. Five databases wereTo quantitatively determine whether the pulp response to resin-modified glass ionomer cements placed in deep cavities differs from that generated by calcium hydroxide cement. Five databases were searched for articles up to 31 May 2009. Inclusion criteria: titles/abstracts relevant to topic; published in English; two-arm longitudinal in vivo trial; containing computable dichotomous datasets for test and control group. Exclusion criteria: not all entered subjects accounted for at the end of the trial; subjects of both groups not followed up in the same way; trial on animal tissue. One randomized and five non-randomized control trials, reporting on 1 and 17 datasets, respectively, were accepted. From non-randomized trials, the Relative Risk with 95% Confidence Interval of 13 datasets showed no statistically significant differences (p>0.05) and 4 showed a statistically significant difference between both materials. Meta-analysis of datasets from these trials found no difference between the inflammatory cell response after 30 days (0.87; 95%CI 0.59-1.26; p=0.46); 38% less inflammatory cell response with calcium hydroxide after 60 days (0.62; 95%CI 0.50-0.76; p<0.00001); higher number of intact odontoblasts beneath restored cavities after 381 days (0.56; 95%CI 0.38-0.82; p=0.0008). The results from the randomized control trial (1.40; 95%CI 0.92-2.14; p=0.11) indicated no difference in clinically identifiable pulp symptoms after two years. All trials showed limited internal validity due to selection bias. No conclusive statement about the superiority of either type of material can yet be made. Further high-quality randomized control trials are needed.

• Predictive value of group I oral lesions for HIV infection.

  Authors: Ahmed Bhayat, Veerasamy Yengopal, Michael Rudolph

  Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. 03/2010; 109(5):720-3.

  Attendees presenting for treatment of acute illness at primary health care facilities in South Africa were assessed to determine the prevalence of human immunodeficiency virus (HIV) infection and theAttendees presenting for treatment of acute illness at primary health care facilities in South Africa were assessed to determine the prevalence of human immunodeficiency virus (HIV) infection and the predictability of group I oral lesions (GOLs) for HIV infection. This was a cross-sectional analytical study. Patients >18 years of age were recruited and underwent an oral examination and a HIV test. A total of 522 attendees were examined and the HIV prevalence was 40%. None of them were taking antiretroviral drugs. GOLs were diagnosed in 53% of HIV patients, with pseudomembranous and erythematous candidiasis being the most common (38% and 24%, respectively). The average odds and likelihood ratios for multiple lesions were high (32 and 30, respectively) and showed a strong correlation between GOLs and a positive HIV status. The prevalence of HIV (40%) and GOLs (53%) was high. GOLs were useful markers of HIV infection, with multiple lesions being highly predictive of HIV infection.

• Demineralization of hard tooth tissue adjacent to resin-modified glass-ionomers and composite resins: a quantitative systematic review.

  Authors: Steffen Mickenautsch, Veerasamy Yengopal

  Journal of oral science. 01/2010; 52(3):347-57.

  The purpose of this systematic review was to quantitatively find out whether resin-modified glass-ionomers (RM-GIC), in comparison to fluoride-containing composite resin and composite resin withoutThe purpose of this systematic review was to quantitatively find out whether resin-modified glass-ionomers (RM-GIC), in comparison to fluoride-containing composite resin and composite resin without fluoride, are associated with a more effective reduction of demineralization in hard tooth tissues under caries challenge. Five databases were systematically searched on clinical trials up to 6 April 2009. Article inclusion criteria: titles/abstracts relevant in answering the review question, published in English, two-arm (prospective) longitudinal trial; Exclusion criteria: not all included subjects accounted for at the end of the trial; subjects of both groups not followed up the same way; no randomized, quasi-randomized controlled study design for in situ and clinical trials; contains no computable continuous data. Quality assessment of the accepted in situ and clinical trials was performed. Data were extracted in the form of datasets, containing numbers of evaluated samples and mean result with standard deviation for both groups. Fifteen articles were selected for review. Two lacked computable data and were excluded; nine laboratory trials, three randomized in situ trials and one randomized control trial were accepted. From these, 97 continuous datasets were extracted. The evidence suggests that RM-GIC is associated with a higher reduction of demineralization in adjacent hard tooth tissue than composite resin without fluoride. No difference was found when RM-GIC was compared with fluoride-containing composite resin. RM-GIC showed efficacy in reducing demineralization. However, the internal validity of the current evidence is limited and further high-quality trials are needed.

• Caries preventive effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP): a meta-analysis.

  Authors: Veerasamy Yengopal, Steffen Mickenautsch

  Acta odontologica Scandinavica. 09/2009;

  Objective. This systematic review with meta-analyses sought to answer the following question: "Does CPP-ACP [casein phosphopeptide-amorphous calcium phosphate], when introduced into the oralObjective. This systematic review with meta-analyses sought to answer the following question: "Does CPP-ACP [casein phosphopeptide-amorphous calcium phosphate], when introduced into the oral environment, provide any caries-preventive benefit superior to that of any other intervention or placebo?" Material and methods. Seven electronic databases were searched for trials relevant to the review question. Twelve articles were accepted after application of inclusion and exclusion criteria. Results. Of the accepted articles, five in situ randomized control trials (RCT) could be pooled for meta-analyses. During the short-term (7-21 days) in situ trials, participants wore appliances containing enamel slabs that were analyzed in the laboratory after exposure to CPP-ACP. The pooled in situ results showed a weighted mean difference (WMD) of the percentage remineralization scores in favor of chewing gum with 18.8 mg CPP-ACP as compared to chewing gum without CPP-ACP (WMD -8.01; 95% CI: -10.54 to -5.48; p = 0.00001), as well as compared to no intervention (WMD -13.56; 95% CI: -16.49 to -10.62; p = 0.00001). A significant higher remineralization effect was also observed after exposure to 10.0 mg CPP-ACP (-7.75; 95% CI: -9.84 to -5.66; p = 0.00001). One long-term in vivo RCT (24 months) with a large sample size (n = 2720) found that the odds of a tooth surface's progressing to caries was 18% less in subjects who chewed sugar-free gum containing 54 mg CPP-ACP than in control subjects who chewed gum without CPP-ACP (p = 0.03). Conclusion. Within the limitations of this systematic review with meta-analysis, the results of the clinical in situ trials indicate a short-term remineralization effect of CPP-ACP. Additionally, the promising in vivo RCT results suggest a caries-preventing effect for long-term clinical CPP-ACP use. Further randomized control trials are needed in order to confirm these initial results in vivo.

• Atraumatic restorative treatment versus amalgam restoration longevity: a systematic review.

  Authors: Steffen Mickenautsch, Veerasamy Yengopal, Avijit Banerjee

  Clinical oral investigations. 09/2009;

  The aim was to report on the longevity of restorations placed using the atraumatic restorative treatment (ART) approach compared with that of equivalent placed amalgam restorations. Five databasesThe aim was to report on the longevity of restorations placed using the atraumatic restorative treatment (ART) approach compared with that of equivalent placed amalgam restorations. Five databases were systematically searched for articles up to 16 March 2009. Inclusion criteria: (1) titles/abstracts relevant to the topic; (2) published in English; (3) reporting on 2-arm longitudinal in vivo trials; (4) minimum follow-up period of 12 months. Exclusion criteria: (1) insufficient random or quasi-random allocation of study subjects; (2) not all entered subjects accounted for at trial conclusion; (3) subjects of both groups not followed up in the same way. Fourteen from the initial search of 164 articles complied with these criteria and were selected for review. From these, seven were rejected and seven articles reporting on 27 separate datasets, accepted. Only identified homogeneous datasets were combined for meta-analysis. From the 27 separate computable dichotomous datasets, four yielded a statistically significant improvement of longevity of ART versus amalgam restorations: posterior class V, 28% over 6.3 years; posterior class I, 6% after 2.3 years and 9% after 4.3 years; posterior class II, 61% after 2.3 years. Studies investigating restorations placed in the primary dentition showed no significant differences between the groups after 12 and 24 months. In the permanent dentition, the longevity of ART restorations is equal to or greater than that of equivalent amalgam restorations for up to 6.3 years and is site-dependent. No difference was observed in primary teeth. More trials are needed in order to confirm these results.

• Caries-preventive effect of glass ionomer and resin-based fissure sealants on permanent teeth: a meta analysis.

  Authors: Veerasamy Yengopal, Steffen Mickenautsch, Ana C Bezerra, Soraya C Leal

  Journal of oral science. 09/2009; 51(3):373-82.

  The purpose of this quantitative systematic review was to appraise the evidence on the caries-preventive effect of glass ionomer cement (GIC) in relation to resin-based fissure sealants. Nine EnglishThe purpose of this quantitative systematic review was to appraise the evidence on the caries-preventive effect of glass ionomer cement (GIC) in relation to resin-based fissure sealants. Nine English and two Portuguese databases were searched (15 January 2008). Randomized clinical trials and systematic reviews were considered for inclusion. Trial exclusion criteria were: drop-out rates > 33%; no randomization; baseline differences in groups not statistically adjusted; and no clinically important outcomes were presented. Two authors reviewed the articles independently. The outcome measure for the caries preventive effect was caries absence on sealed teeth. Of the 112 identified articles, 25 were selected for review. Of these, 14 were excluded and 11 accepted (8 trials; 3 systematic reviews). The accepted reviews provided no evidence of superiority of either sealant material. Six trials were included for meta-analysis. The pooled odds ratio was 0.96, 95% CI 0.62-1.49, indicating no difference in the caries-preventive effect of GIC and resin-based fissure sealant material. This systematic review with meta-analysis found no evidence that either material was superior to the other in the prevention of dental caries. Thus, both materials appear equally suitable for clinical application as a fissure sealant material. (J Oral Sci 51, 373-382, 2009).

• Dental fillings for the treatment of caries in the primary dentition.

  Authors: Veerasamy Yengopal, Suyara Yasmin Harneker, Naren Patel, Nandi Siegfried

  Cochrane database of systematic reviews (Online). 02/2009;

  BACKGROUND: Childhood caries (tooth decay) consists of a form of tooth decay that affects the milk teeth (also known as baby or primary teeth) of children. This may range from tooth decay in a singleBACKGROUND: Childhood caries (tooth decay) consists of a form of tooth decay that affects the milk teeth (also known as baby or primary teeth) of children. This may range from tooth decay in a single tooth to rampant caries affecting all the teeth in the mouth. Primary teeth in young children are vital to their development and every effort should be made to retain these teeth for as long as is possible. Dental fillings or restorations have been used as an intervention to repair these damaged teeth. Oral health professionals need to make astute decisions about the type of restorative (filling) material they choose to best manage their patients with childhood caries. This decision is by no means an easy one as remarkable advances in dental restorative materials over the last 10 years has seen the introduction of a multitude of different filling materials claiming to provide the best performance in terms of durability, aesthetics, symptom relief, etc when placed in the mouth. This review sought to compare the different types of dental materials against each other for the same outcomes. OBJECTIVES: The objective of this review was to compare the outcomes (including pain relief, survival and aesthetics) for restorative materials used to treat caries in the primary dentition in children. Additionally, the restoration of teeth was compared with extraction and no treatment. SEARCH STRATEGY: Electronic searches of the following databases were undertaken: the Cochrane Oral Health Group's Trials Register (up to January 2009); CENTRAL (The Cochrane Library 2009, Issue1); MEDLINE (1966 to January 2009); EMBASE (1996 to January 2009); SIGLE (1976 to 2004); and conference proceedings on early childhood caries, restorative materials for paediatric dentistry, and material sciences conferences for dental materials used for children's dentistry (1990 to 2008). The searches attempted to identify all relevant studies irrespective of language.Additionally, the reference lists from articles of eligible papers were searched, handsearching of key journals was undertaken, and personal communication with authors and manufacturers of dental materials was initiated to increase the pool of suitable trials (both published and unpublished) for inclusion into this review. SELECTION CRITERIA: Randomised controlled trials (RCTs) or quasi-randomised controlled trials with a minimum period of 6 months follow up were included. Both parallel group and split-mouth study designs were considered. The unit of randomisation could be the individual, group (school, school class, etc), tooth or tooth pair. Included studies had a drop-out rate of less than 30%. The eligible trials consisted of young children (children less than 12 years) with tooth decay involving at least one tooth in the primary dentition which was symptomatic or symptom free at the start of the study. DATA COLLECTION AND ANALYSIS: Data were independently extracted, in duplicate, by two review authors. Disagreements were resolved by consultation with a third review author. Authors were contacted for missing or unclear information regarding randomisation, allocation sequence, presentation of data, etc. A quality assessment of included trials was undertaken. The Cochrane Collaboration statistical guidelines were followed for data analysis. MAIN RESULTS: Only three studies were included in this review. The Fuks 1999 study assessed the clinical performance of aesthetic crowns versus conventional stainless steel crowns in 11 children who had at least two mandibular primary molars that required a crown restoration. The outcomes assessed at 6 months included gingival health (odds ratio (OR) 0.3; 95% confidence interval (CI) 0.01 to 8.32), restoration failure (OR 3.29; 95% CI 0.12 to 89.81), occlusion, proximal contact and marginal integrity. The odds ratios for occlusion, proximal contact and marginal integrity could not be estimated as no events were recorded at the 6-month evaluation. The Donly 1999 split-mouth study compared a resin-modified glass ionomer (Vitremer) with amalgam over a 36-month period. Forty pairs of Class II restorations were placed in 40 patients (21 males; 19 females; mean age 8 years +/- 1.17; age range 6 to 9 years). Although the study period was 3 years (36 months), only the 6- and 12-month results are reported due to the loss to follow up of patients being greater than 30% for the 24- and 36-month data. Marks 1999a recruited 30 patients (age range 4 to 9 years; mean age 6.7 years, standard deviation 2.3) with one pair of primary molars that required a Class II restoration. The materials tested were Dyract (compomer) and Tytin (amalgam). Loss to follow up at 24 and 36 months was 20% and 43% respectively. This meant that only the 24-month data were useable. For all of the outcomes compared in all three studies, there were no significant differences in clinical performance between the materials tested.No studies were found that compared restorations versus extractions or no treatment as an intervention in children with childhood caries. AUTHORS' CONCLUSIONS: It was disappointing that only three trials that compared three different types of materials were suitable for inclusion into this review. There were no significant differences found in all three trials for all of the outcomes assessed. Well designed, randomised controlled trials comparing the different types of filling materials for similar outcomes are urgently needed in dentistry. There was insufficient evidence from the three included trials to make any recommendations about which filling material to use.

• Do oral lesions associated with HIV affect quality of life?

  Authors: Veerasamy Yengopal, Sudeshni Naidoo

  Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. 07/2008; 106(1):890-7.

  OBJECTIVE: To assess the impact of oral lesions on quality of life (QOL) in HIV-positive (HIV+) individuals using the Oral Health Impact Profile (OHIP). STUDY DESIGN: This was a cross-sectionalOBJECTIVE: To assess the impact of oral lesions on quality of life (QOL) in HIV-positive (HIV+) individuals using the Oral Health Impact Profile (OHIP). STUDY DESIGN: This was a cross-sectional analytic study that compared 2 groups of HIV+ patients. Group 1 (n = 71) consisted of patients who presented with oral manifestations of HIV infection. Patients in group 2 (n = 79) were also HIV positive but had no oral lesions. The QOL measures were assessed by either simple frequency counts or the use of item weights. RESULTS: Oral candidiasis was the most common oral lesion diagnosed. Patients in group 1 reported significantly greater impacts (P < .05) for all 7 subscales in OHIP. CONCLUSIONS: Oral lesions associated with HIV infection negatively affect the oral health-related QOL in infected patients.

• Sugar-free chewing gum and dental caries: a systematic review.

  Authors: Steffen Mickenautsch, Soraya Coelho Leal, Veerasamy Yengopal, Ana Cristina Bezerra, Vanessa Cruvinel

  Journal of applied oral science : revista FOB. 04/2007; 15(2):83-8.

  OBJECTIVE: To appraise existing evidence for a therapeutic / anti-cariogenic effect of sugar-free chewing gum for patients. METHOD: 9 English and 2 Portuguese databases were searched using EnglishOBJECTIVE: To appraise existing evidence for a therapeutic / anti-cariogenic effect of sugar-free chewing gum for patients. METHOD: 9 English and 2 Portuguese databases were searched using English and Portuguese keywords. Relevant articles in English, German, Portuguese and Spanish were included for review. Trials were excluded on lack of randomisation, control group, blinding and baseline data, drop out rate >33%, no statistical adjustment of baseline differences and no assessment of clinically important outcomes. Reviews were excluded on lack of information, article selection criteria, search strategy followed, search keywords, searched databases or lack of study-by-study critique tables. In cases of multiple reports from the same study, the report covering the longest period was included. Two reviewers independently reviewed and assessed the quality of accepted articles. RESULTS: Thirty-nine articles were included for review. Thirty were excluded and 9 accepted. Of the 9 accepted, 2 trials of reasonable and good evidence value did not demonstrate any anti-cariogenic effect of sugar-free chewing gum. However, 7 articles, with 1 of strong, and 6 of good evidence value, demonstrated anti-cariogenic effects of chewing Sorbitol, Xylitol or Sorbitol/Xylitol gum. This effect can be ascribed to saliva stimulation through the chewing process, particularly when gum is used immediately after meals; the lack of sucrose and the inability of bacteria to metabolize polyols into acids. Conclusion: The evidence suggests that sugar-free chewing gum has a caries-reducing effect. Further well-designed randomised trials are needed to confirm these findings.