Antibacterial agents in composite restorations for the prevention of dental caries

Dental caries is a multifactorial disease in which the fermentation of food sugars by bacteria from the biofilm (dental plaque) leads to localised demineralisation of tooth surfaces, which may ultimately result in cavity formation. Resin composites are widely used in dentistry to restore teeth. These restorations can fail for a number of reasons, such as secondary caries, excessive wear, marginal degradation, tooth sensitivity, pulpal death, and restorative material fracture. Caries adjacent to restorations is one of the main causes for restoration replacement. The presence of antibacterials in both the filling material and the bonding systems would theoretically be able to affect the initiation and progression of caries adjacent to restorations. To assess the effects of antibacterial agents incorporated into composite restorations for the prevention of dental caries. We searched the following databases in February 2009: the Cochrane Oral Health Group's Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, Issue 1); MEDLINE via OVID (1950 to February 2009) without filter; and EMBASE via OVID (1980 to February 2009) without filter. Randomised controlled clinical trials (RCTs) comparing resin composite restorations containing antibacterial agents with non-antibacterial containing composite restorations. Two review authors conducted screening of studies in duplicate and independently, and although no eligible trials were identified, the two authors had planned to extract data independently and assess trial quality using standard Cochrane Collaboration methodologies. We retrieved 128 references to studies, none of which matched the inclusion criteria for this review and all of which were excluded. We were unable to identify any randomised controlled trials on the effects of antibacterial agents incorporated into composite restorations for the prevention of dental caries. The absence of high level evidence for the effectiveness of this intervention emphasises the need for well designed, adequately powered, randomised controlled clinical trials.