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that certain BPA derivatives may pose health risks attributable to their estrogenic properties. BPA exposure reduction is achieved by cleaning filling surfaces with pumice and cotton roll and rinsing. Additionally, potential exposure can be reduced by using a rubber dam.62 Considering the proven benefits of resin based dental materials and minimal exposure to BPA and its derivatives, it is recommended to continue using these products while taking precautions to minimize exposure.62 There is strong evidence from a meta-analysis of 59 RCTs of Class I and II composite and amalgam restorations showing an overall success rate about 90 percent after 10 years for both materials, with rubber dam use significantly increasing restoration longevity.42 Other isolation techniques (e.g., dental isolation suction systems) may be used. Strong evidence from RCTs comparing composite restorations to amalgam restorations BEST PRACTICES: RESTORATIVE DENTISTRY THE REFERENCE MANUAL OF PEDIATRIC DENTISTRY 343 showed that the main reason for restoration failure in both materials was recurrent caries.46,48,63 In primary teeth, there is strong evidence that composite restorations for Class I restorations are successful.16,46 There is only one RCT showing success in Class II composite restorations in primary teeth that were expected to exfoliate within two years.53 In permanent molars, composite replacement after 3.4 years was no different than amalgam,46 but after seven to 10 years the replacement rate was higher for composite.61 Secondary caries rate was reported as 3.5 times greater for composite versus amalgam.48 There is evidence from a meta-analysis showing that etching and bonding of enamel and dentin significantly decreases marginal staining and detectable margins in composite restorations.42 Regarding different types of composites (packable, hybrid, nanofilled, macrofilled, and microfilled) there is strong evidence showing similar overall clinical performance for these materials.64-67 Recommendations: 1. In primary molars, there is strong evidence from RCTs that composite resins are successful when used in Class I restorations. For Class II lesions in primary teeth, there is one RCT showing success of composite resin restorations for two years. 2. In permanent molars, there is strong evidence from metaanalyses that composite resins can be used successfully for Class I and II restorations. 3. Evidence from a meta-analysis shows enamel and dentin bonding agents decrease marginal staining and detectable margins for the different types of composites. Glass-ionomer cements (GIC) Glass-ionomers cements have been used in dentistry as restorative cements, cavity liner/base, and luting cement since the early 1970s.68 Originally, glass ionomer materials were difficult to handle, exhibited poor wear resistance, and were brittle. Advancements in conventional glass ionomer formulation led to better properties, including the formation of resin-modified glass ionomers. These products showed improvement in handling characteristics, decreased setting time, increased strength, and improved wear resistance.69,70 All glass ionomers have several properties that make them favorable for use in children including: chemical bonding to both enamel and dentin; thermal expansion similar to that of tooth structure; biocompatibility; uptake and release of fluoride; and decreased moisture sensitivity when compared to resins. Fluoride is released from glass ionomer and taken up by the surrounding enamel and dentin, resulting in teeth that are less susceptible to acid challenge.71,72 One study has shown that fluoride release can occur for at least one year.73 Glass ionomers can act as a reservoir of fluoride, as uptake can occur from dentifrices, mouth rinses, and topical fluoride applications.74,75 This fluoride protection, useful in patients at high risk for caries, has led to the use of glass ionomers as luting cement for SSCs, space maintainers, and orthodontic bands.76 Regarding use of conventional glass ionomers in primary teeth, one RCT showed the overall median time from treatment to failure of glass ionomer restored teeth was 1.2 years.49 Based on findings of a systematic review and