Three-year survival of single- and two-surface ART restorations in a high-caries child population

The aim of this study was to evaluate the survival of single- and two-surface atraumatic restorative treatment (ART) restorations in the primary and permanent dentitions of children from a high-caries population, in a field setting. The study was conducted in the rainforest of Suriname, South America. ART restorations, made by four Dutch dentists, were evaluated after 6 months, 1, 2, and 3 years. Four hundred seventy-five ART restorations were placed in the primary dentition and 54 in first permanent molars of 194 children (mean age 6.09 ± 0.48 years). Three-year cumulative survivals of single- and two-surface ART restorations in the primary dentition were 43.4 and 12.2%, respectively. Main failure characteristics were gross marginal defects and total or partial losses. Three-year cumulative survival for single-surface ART restorations in the permanent dentition was 29.6%. Main failure characteristics were secondary caries and gross marginal defects. An operator effect was found only for two-surface restorations. The results show extremely low survival rates for single- and two-surface ART restorations in the primary and permanent dentitions. The variable success for ART may initiate further discussion about alternative treatment strategies, especially in those situations where choices have to be made with respect to a well-balanced, cost-effective package of basic oral health care

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

<p>Abstract</p> <p>Background</p> <p>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) 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.</p> <p>Methods</p> <p>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.</p> <p>Results</p> <p>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.</p> <p>Conclusion</p> <p>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.</p

Two years survival rate of class II composite resin restorations prepared by ART with and without a chemomechanical caries removal gel in primary molars

The aim was to test the null hypotheses that there is no difference: (1) in carious lesion development at the restoration margin between class II composite resin restorations in primary molars produced through the atraumatic restorative treatment (ART) with and without a chemomechanical caries removal gel and (2) in the survival rate of class II composite resin restorations between two treatment groups after 2 years. Three hundred twenty-seven children with 568 class II cavitated lesions were included in a parallel mouth study design. Four operators placed resin composite (Filtek Z 250) restorations bonded with a self-etch adhesive (Adper prompt L pop). Two independent examiners evaluated the restorations after 0.5, 1, and 2 years using the modified Ryge criteria. The Kaplan–Meier survival method was applied to estimate survival percentages. A high proportion of restorations were lost during the study period. Therefore, the first hypothesis could not be tested. No statistically significant difference was observed between the cumulative survival percentages of restorations produced by the two treatment approaches over the 2-year period (ART, 54.1 ± 3.4%; ART with Carisolv™, 46.0 ± 3.4%). This hypothesis was accepted. ART with chemomechanical gel might not provide an added benefit increasing the survival percentages of ART class II composite resin restorations in primary teeth

Survival of atraumatic restorative treatment (ART) sealants and restorations: a meta-analysis

The purpose of this study is to perform a systematic investigation plus meta-analysis into survival of atraumatic restorative treatment (ART) sealants and restorations using high-viscosity glass ionomers and to compare the results with those from the 2005 ART meta-analysis. Until February 2010, four databases were searched. Two hundred four publications were found, and 66 reported on ART restorations or sealant survival. Based on five exclusion criteria, two independent reviewers selected the 29 publications that accounted for the meta-analysis. Confidence intervals (CI) and or standard errors were calculated and the heterogeneity variance of the survival rates was estimated. Location (school/clinic) was an independent variable. The survival rates of single-surface and multiple-surface ART restorations in primary teeth over the first 2 years were 93% (CI, 91–94%) and 62% (CI, 51–73%), respectively; for single-surface ART restorations in permanent teeth over the first 3 and 5 years it was 85% (CI, 77–91%) and 80% (CI, 76–83%), respectively and for multiple-surface ART restorations in permanent teeth over 1 year it was 86% (CI, 59–98%). The mean annual dentine lesion incidence rate, in pits and fissures previously sealed using ART, over the first 3 years was 1%. No location effect and no differences between the 2005 and 2010 survival rates of ART restorations and sealants were observed. The short-term survival rates of single-surface ART restorations in primary and permanent teeth, and the caries-preventive effect of ART sealants were high. Clinical relevance: ART can safely be used in single-surface cavities in both primary and permanent teeth. ART sealants have a high caries preventive effect

Caries preventive effect of occlusal sealant extension to ART restorations compared with non-extended amalgam restorations.

Item does not contain fulltextPURPOSE: To estimate the survival of retention of sealant extension to occlusal ART restorations over 6.3 years; and to test the null-hypothesis that there is no difference in dentine caries lesion development in sealant extension to ART restorations in comparison with sealant free extensions to amalgam restorations in occlusal surfaces over 6.3 years. MATERIALS AND METHODS: In a parallel group design, 318 and 254 grade 2 children were randomly assigned to the ART and amalgam group respectively. Eight dentists placed 925 evaluatable single- and multiple-surfaces restorations. A total of 424 sealed extensions to occlusal ART and 284 sealant free extensions to occlusal amalgam restorations were available for analyses. The modified actuarial method was used to estimate survival percentages. The jackknife method was applied to calculate the SE in the cumulative survival percentages. RESULTS: After 6.3 years, 11.2% (SE = 2.2%) of sealant extensions were fully retained and 16.7% (SE = 2.8%) were partially retained. After 6.3 years, 86.4% (SE = 2.2%) of the sealed pits and fissures adjacent to occlusal ART restorations and 89.9% (SE = 2.4%) of non-sealed pits and fissures adjacent to occlusal amalgam restorations were free of dentine caries lesions. Neither this difference nor those at earlier evaluation years were statistically significant (p > 0.05). CONCLUSION: Sealing pits and fissures adjacent to occlusal ART restorations did not result in a caries preventive benefit over non-sealed pits and fissures adjacent to occlusal amalgam restorations in this group of children over 6.3 years

Survival of ART and amalgam restorations in permanent teeth of children after 6.3 years.

Contains fulltext : 49718.pdf (publisher's version ) (Closed access)The null hypothesis tested was that there is no difference in the survival percentages of all restorations placed through the Atraumatic Restorative Treatment (ART) approach, with high-viscosity glass ionomer, and those produced through the traditional approach, with amalgam (TA), in the permanent dentitions of children after 6.3 years. Using a parallel group design, we randomly assigned a total of 370 children, aged 6 to 9 years, to the ART group and 311 children, also aged 6 to 9 years, to the TA group. Eight dentists placed a total of 1117 single- and multiple-surface restorations. The cumulative survival percentages for ART glass-ionomer restorations were statistically significantly higher than those of amalgam restorations at all time intervals except the first (p < or = 0.044). After 6.3 years, the cumulative survival percentages of ART and amalgam restorations were 66.1% (SE = 3.1%) and 57.0% (SE = 3.3%), respectively. We concluded that the restorations produced with the ART approach, with high-viscosity glass ionomer, survived longer than those produced with the traditional approach, with amalgam, in the permanent teeth of young children

Effects of glass ionomer sealants in newly erupted first molars after 5 years: a pilot study.

OBJECTIVES: The aim of the study was to investigate the caries-preventive effect of high-filled glass ionomer sealant in newly erupted first molars in a high-risk group. This investigation is part of a larger study amongst eight hundred and thirty-five 6-7-year-old Syrian children. METHODS: Children that had 1, 2 or 3 just erupted or erupting and at least one unerupted first molar (control) were enrolled in this pilot study. A total of 60 children fulfilled the inclusion criteria. There were 49 children with a total of 83 sealants available for examination at the evaluation year 5. RESULTS: Almost two out of the three sealants (69%) had disappeared between evaluation years 2 and 3. 1.2% (SE = 1.2) of the sealants survived were fully retained and 10.3% (SE = 3.3) of the sealants survived were fully and partially retained at the evaluation year 5. Caries prevalence of the children in the study group at the evaluation year 5 was 55%. The Odds ratio concerning sealed and control group at year 5 was 2.6 with 95% confidence limits of 1.2 and 5.7, implying a relative risk (RR) of 2.1. Unsealed unerupted first molars had 2.1 times higher chance than sealed newly erupted first molars to develop dentinal lesions in this child population after 5 years. CONCLUSIONS: It is concluded that sealing newly erupted first molars with high-filled glass ionomer may be a caries-preventive measure in high-risk children. However, a well-designed clinical trial should be implemented to confirm the initial findings

Caries-preventive effect of a one-time application of composite resin and glass ionomer sealants after 5 years.

Item does not contain fulltextThe aim of the present trial was to (1) compare the caries-preventive effect of glass ionomer sealants, placed according to the atraumatic restorative treatment (ART) procedure, with composite resin sealants over time and (2) investigate the caries-preventive effect after complete disappearance of sealant material. Forty-six boys and 57 girls, mean age 7.8 years, were randomly divided into two treatment groups in a parallel-group study design. A light-polymerized composite resin sealant material and a high-viscosity glass ionomer were each placed in 180 fully erupted first molars in their respective treatment groups. Evaluation took place annually for 5 years by calibrated examiners. After 5 years, 86% composite resin and 88% glass ionomer sealants did not survive. Three categories of re-exposure periods for caries development in pits and fissures after complete loss of sealants were distinguished: 0-1, 1-2 and 2-3 years. In the 2- to 3-year group, 13 and 3% of pits and fissures previously sealed with composite resin and glass ionomer, respectively, were diagnosed as having developed a dentine lesion. The relative risks (95% CI) of dentine lesion development in surfaces sealed with glass ionomer compared to those sealed with composite resin after 3, 4 and 5 years were 0.22 (0.06-0.82), 0.32 (0.14-0.73) and 0.28 (0.13-0.61), respectively. The relative risks of dentine lesion development in pits and fissures previously sealed with glass ionomer compared with composite resin over re-exposure periods of 1-2 and 2-3 years were 0.26 (0.14-0.48) and 0.25 (0.09-0.68), respectively. We conclude that the caries-preventive effect of high-viscosity glass ionomer sealants, placed using the ART procedure, was between 3.1 and 4.5 times higher than that of composite resin sealants after 3-5 years. Furthermore, high-viscosity (ART) glass ionomer sealants appear to have a four times higher chance of preventing caries development in re-exposed pits and fissures of occlusal surfaces in first molars than light-cured composite resin sealant material over a 1- to 3-year period. A well-designed clinical trial using different types of oral health personnel should be implemented to confirm these initial results