Summary Review/Paediatric dentistry

Glass ionomer or composite resin for primary molars

Question: Is glass ionomer cement more effective than composite resin for class II restorations in primary teeth?


Data sources

PubMed, Scopus, Web of Science, Virtual Health Library (VHL), Cochrane Library, Clinical Trials and OpenGrey.

Study selection

Randomised controlled trials comparing the clinical effectiveness of Class II restorations performed with conventional (C-GIC) or resin-modified glass ionomer cement (RM-GIC) and composite resin (CR) in primary molar teeth. No date of publication or language restrictions.

Data extraction and synthesis

Study selection was carried out independently by two reviewers, with abstracted data and risk of bias assessment being performed using the Cochrane tool. Data on the restorations were dichotomised as acceptable' (restorations without need of replacement or repair) or ‘unacceptable’ (restorations presenting failures or requiring repair or replacement) after which a number of meta-analyses were conducted.


Ten studies were included in qualitative synthesis, and nine contributing to the meta-analyses. Six studies used a split-mouth design and four a parallel design. Seven studies used USPHS criteria, two applied the FDI criteria and one used their own. Seven studies reported restorations were placed under rubber dam isolation with the other three using cotton roll isolation. Six studies were at low risk of bias and four unclear risk of bias. GIC and CR presented similar failure patterns (Risk Difference [RD] = -0.04 (95%CI; -0.11 to 0.03) p=0.25, I2 = 51%), irrespective of follow-up period, type of GIC used, method of isolation or criteria used for assessment. GICs exhibited significantly lower values of secondary carious lesions ([RD] = 0.06 (95%CI; 0.0 to 0.10), p=0.008, I2 = 0%).


GICs and CRs have comparable clinical performance in Class II restorations in primary molars. GICs did show superior performance in the occurrence of secondary carious lesions, especially when RM-GIC under rubber dam isolation was used.

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Additional information

Address for correspondence: Sao Paulo State University (Unsep), School of Dentistry, Aracatuba, Department of Paediatric Dentistry and Public Health, Rua Jose Bonifacio, 1193, 16015-050 Aracatuba, SP, Brazil. E-mail:

Dias AGA, Magno MB, Delbem ACB, Cunha RF, Maia LC, Pessan JP. Clinical performance of glass ionomer cement and composite resin in Class II restorations in primary teeth: A systematic review and meta-analysis. J Dent 2018; 73: 1–13. pii:S0300-5712(18)30073-3. doi:10.1016/j.jdent.2018.04.004. [Epub ahead of print] Review. PubMed PMID: 29649506.

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Jones, G., Taylor, G. Glass ionomer or composite resin for primary molars. Evid Based Dent 19, 86–87 (2018).

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