Article
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Objectives. To assess and compare the cumulative survival rate of amalgam and atraumatic restorative treatment (ART) restorations in primary molars over 3 years. Methods. 280 children aged 6–7 years old were enrolled in a cluster randomized controlled clinical trial using a parallel group design covering two treatment groups: conventional restorative treatment with amalgam (CRT) and atraumatic restorative treatment (ART) using a high-viscosity glass-ionomer (HVGIC) Ketac Molar Easymix. Three pedodontists placed 750 restorations (364 amalgam and 386 ART in 126 and 154 children, respectively) which were evaluated at 0.5, 1, 2 and 3 years. The proportional hazard rate regression model with frailty correction, ANOVA and Wald tests, and the Jackknife procedure were applied in analysing the data. Results. The cumulative survival rates over 3 years for all, single- and multiple-surface CRT/amalgam restorations (72.6%, 93.4%, 64.7%, respectively) were no different from those of comparable ART/HVGIC restorations (66.8%; 90.1% and 56.4%, respectively) (p = 0.10). Single- surface restorations had higher survival rates than multiple-surface restorations for the both treatment procedures (p < 0.0001). A higher proportion of restorations failed because of mechanical reasons (94.8%) than of secondary caries (5.2%). No difference in reasons for restoration failures between all types of amalgam and ART/HVGIC restorations were observed (p = 0.24). Significance. The high-viscosity glass-ionomer used in this study in conjunction with the ART is a viable option for restoring carious dentin lesions in single surfaces in vital primary molars.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... Regarding the design, the 62 articles included in the review comprised randomized clinical trials [14,[25][26][27][28][29][30][31][32][33][34][35][36][37], controlled [14,25,34,38,39], split-mouth [28,35,36,, parallel [30,32,33,[64][65][66][67][68][69][70], only non-randomized and non-controlled clinical trial [71,72], retrospective clinical [73] and some articles did not specify their design [74][75][76][77][78][79][80]. The results of individual studies are presented in Supplementary Table S3. ...
... Regarding the design, the 62 articles included in the review comprised randomized clinical trials [14,[25][26][27][28][29][30][31][32][33][34][35][36][37], controlled [14,25,34,38,39], split-mouth [28,35,36,, parallel [30,32,33,[64][65][66][67][68][69][70], only non-randomized and non-controlled clinical trial [71,72], retrospective clinical [73] and some articles did not specify their design [74][75][76][77][78][79][80]. The results of individual studies are presented in Supplementary Table S3. ...
... For the analysis of the occurrence of SC, the studies applied, in the great majority, the USPHS criterion [72], and ART criterion [30,32,33,64,68] were also used. Some articles did not report the criteria used. ...
Article
Full-text available
Background This systematic review and network meta-analysis aimed to compare the clinical efficacy of bioactive and conventional restorative materials in controlling secondary caries (SC) and to provide a classification of these materials according to their effectiveness. Methods A search was performed in Pubmed, Web of Science, Embase, BBO, Lilacs, Cochrane Library, Scopus, IBECS and gray literature. Clinical trials were included, with no language or publication date limitations. Paired and network meta-analyses were performed with random-effects models, comparing treatments of interest and classifying them according to effectiveness in the permanent and deciduous dentition and at 1-year or 2/more years of follow-up. The risk of bias and certainty of evidence were evaluated. Results Sixty-two studies were included in the qualitative syntheses and 39 in the quantitative ones. In permanent teeth, resin composite (RC) (RR = 2.00; 95%CI = 1.10, 3.64) and amalgam (AAG) (RR = 1.79; 95%CI = 1.04, 3.09) showed a higher risk of SC than Glass Ionomer Cement (GIC). In the deciduous teeth, however, a higher risk of SC was observed with RC than with AAG (RR = 2.46; 95%CI = 1.42, 4.27) and in GIC when compared to Resin-Modified Glass Ionomer Cement (RMGIC = 1.79; 95%CI = 1.04, 3.09). Most randomized clinical trials studies showed low or moderate risk of bias. Conclusion There is a difference between bioactive restorative materials for SC control, with GIC being more effective in the permanent teeth and the RMGIC in the deciduous teeth. Bioactive restorative materials can be adjuvants in the control of SC in patients at high risk for caries.
... Similarly, Honkala et al. [3] and Hilgert et al., [4] conducted studies to evaluate and compare the feasibility and accumulative survival rate for amalgam and ART restored primary molars over 2-year and 3-year follow-ups, respectively. Both studies stated that there was no significant difference in survival of ART and amalgam restorative techniques. ...
... Yu et al., [5] formed nine treatment groups where primary molar cavities in 60 Chinese children [8] 2014 258 6-7 Amalgam ART Survival rate No significant difference Honkala et al. [3] 2003 35 5.7 mean Amalgam ART Survival rate No significant difference Hilgert et al. [4] 2014 280 6-7 Amalgam ART Survival rate No significant difference Mijan et al. [9] 2014 302 6-7 Amalgam ART UCT Survival rate No significant difference Frencken et al. [6] 2007 835 6-7 Amalgam ART Survival rate No significant difference Yu et al. [5] 2004 60 7.4 mean Rotary (GIC and amalgam) ART Survival rate No significant difference Approval from ethical and scientific committee was acquired. Table 2 shows the reviewed treatment outcome. ...
... Restorations coded 0 and 1 were marked as survived, those coded 2-6 were grouped as failures, and codes 7-9 were considered censored observations. [8,[3][4][5]10] Adverse effects were not reported by any study. ...
Article
Full-text available
Background: In this COVID era, it's critical to promote nonaerosol procedures. Atraumatic restorative treatment (ART) is one of them, and it's particularly effective in children for lowering anxiety, enhancing dental health, and giving restorative care. Aim: The aim of this study was to assess the survival rate of ART compared with conventional treatment procedures in primary dentition. Materials and methods: The review was done in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analysis statement and is been registered in PROSPERO (CRD42021213729). The studies included comprised clinical investigations with randomized controlled trials (RCTs) which compared the survival rate of ART and conventional restorative treatments using the same or different restorative materials to treat carious lesion. RCTs in which ART was compared with conventional treatment on patients in the age group of 6-10 years with minimum follow-up of 6 months. Studies available as open access and free full text in PubMed, DOAJ, and Google Scholar databases, and published in English Language only were included in the study. Cochrane's collaboration tool for RCTs was used for the assessment of risk of bias. Results: The survival rate of single surface and multiple surface in primary dentition treated according to the ART compared with conventional treatment was found to be similar. Conclusion: The ART approach is equally helpful in managing dental caries in children and this method may be considered a useful intervention in clinical practice to enhance the dental health of children.
... Traditionally the restorative treatment of children under general anesthesia has focused on aggressive treatment of the dental caries, with full coverage stainless steel crowns (SSCs) being the treatment of choice. Recently there have been several authors who have challenged the rationale behind placing SSCs for initial dental caries [2,3]. One of the reasons for the placement of SSCs for all multiple surface dental treatments is the high failure rates reported with conventional resin composites [4,5]. ...
... The introduction of high viscosity, glass ionomer cements (HVGIC) in the 1990s has led to their increased use in posterior restorations for children and adults with special health care needs [3,9,10]. There is literature to suggest that when used in the alternate restorative treatment (ART) technique, these cements provide long term results similar to silver amalgam [11,12]. ...
... There is literature to suggest that when used in the alternate restorative treatment (ART) technique, these cements provide long term results similar to silver amalgam [11,12]. There have been comparative studies to suggest that these cements may be as effective as resin based composites in children, with the added benefit of fluoride release [3,11]. ...
Article
Full-text available
Aim: This study aimed to compare survivability between high viscosity glass ionomer cements (HVGIC) and resin composites in the restoration of teeth under general anesthesia. Methods: A total of 258 restorations in 87 patients treated under general anesthesia (without rubber dam) were followed up over a period of two years. Structural failure (breakage or loss of restoration) and secondary caries were recorded as present/absent dichotomies. Failures were recorded at the follow intervals of 3, 6, 12, 18 and 24 months. Kaplan Meir survival curves and Cox-Mendel regression models were developed to predict survivability. Results: Overall failure of both HVGIC (58.5%) and resin composites (60.8%) was high There was no significant differences overall for the two year survivability of either HVGIC or resin composite restorations. However HVGIC restorations placed in anterior teeth were likely to fracture significantly faster than resin composites. While HVGIC restorations had lower incidence of secondary caries than composite the differences were not statistically significant. Conclusion: There is no significant difference in survivability of HVGIC when compared to resin composite as a restorative material when placed in primary teeth under general anesthesia without the use of a rubber dam.
... Approximal posterior restorations showed higher mean AFRs than single-surface occlusal restorations (1.17% and 8.0% for conventional and ART techniques, respectively) irrespective of the restorative technique (Table 3) [65][66][67][68][69] in the deciduous dentition showed higher mean AFR (4.78%) than those in the permanent dentition (1.17%). On the other hand, mean AFR (8.95%) of GIC-ART technique in the primary dentition (12 studies; article 17, 24-25, 53, 55, 58-64; MF 2.29 years) [28][29][30][70][71][72][73][74][75][76][77][78] was comparable to that in the permanent dentition (8.0%) but still higher compared to the conventional technique in the same dentition (Tables 2,4). ...
... The mean AFRs of silver-reinforced and normal-viscosity GIC were 20.39% and 14.91%, respectively. Regarding approximal ART-GIC technique in the primary dentition (17 studies; article 10, 17, 24, 51-64; MF 2.35 years) [28,30,31,[70][71][72][73][74][75][76][77][78][91][92][93][94][95], the outcome showed substantially higher mean AFR (25.77%) than that of conventional technique (9.46%), and was higher than that of ART technique in the permanent dentition (10.7%) (Tables 2,4). ...
... Regarding occlusal GIC restorations in the permanent and deciduous dentitions, the main reasons for failure of conventional technique related to mechanical failure such as restoration fracture [18,69], marginal fracture at the cavosurface margin [65], restoration loss [69] and material wear [68]. For occlusal ART restorations in both dentitions, similar failure causes were found namely, restoration loss [48,70,76], restoration fracture [45,52], marginal defect [45,48,49], and excessive wear [48]. In addition, dentine carious lesion development only and combined marginal defect with carious dentine lesion development [49] were also identified as reasons for failure. ...
Article
Objectives: To review the clinical performance of GIC restorations using calculated annual failure rates and qualitative descriptions based on conventional and ART techniques from two aspects: occlusal and approximal cavities in permanent or deciduous posterior teeth. Sources: Search strategies was undertaken of the PubMed database from January 1983 to March 2018. Additional articles were collected by hand searching. Study selection: The following basic search terms, "(glass ionomer cement) and (clinical performance or survival or ART or atraumatic restorative or high viscosity)" with inclusion and exclusion criteria according to PRISMA flow diagram. Data: At total of 904 articles were initially identified. Finally, 67 articles were included for quantitative and qualitative analysis after applying the inclusion and exclusion criteria. Assessment of risk of bias was performed for all included studies using ROBINS-I. Conclusions: For single-surface occlusal or multi-surface GIC restorations, the conventional technique showed better survival than ART technique regardless of dentition type (primary or permanent). When comparing in the same treatment technique, AFRs of approximal or multi-surface GIC restorations were greater than those of single-surface (occlusal) restorations, irrespective of dentition type. RMGIC-conventional technique seems to be promising for restoring approximal cavities of primary teeth compared to other restorative materials. Clinical significance: The GIC-ART technique is an alternative option for single-surface (occlusal) restorations in permanent and primary teeth. However, the application of the GIC-ART technique for load-bearing approximal restorations should be carefully considered before employing this option, especially in primary teeth.
... Its high-viscosity type, in conjunction with the atraumatic restorative treatment (ART) approach, has been shown to produce restorations whose survival is not statistically significantly different from that of comparable amalgam restorations [3] and that of composite resin restorations in primary teeth [4]. A recently published study confirmed this conclusion [5]. ...
... Children whose parents or caregivers completed and signed the consent forms were included in the study. Details of the study were published previously [5] and a summary of it is provided below. ...
... The restorative material used was Ketac Molar Easymix ® (3 M ESPE, Seefeld, Germany). Two trained, calibrated and independent evaluators (dentists) assessed the restorations in the primary teeth according to the ART restoration criteria [5] on the school premises after 6 months, 1, 2 and 3 years. Secondary caries was defined as an obvious cavitated dentine carious lesion. ...
Article
Objectives: When planning primary oral health care services the cost implications of adopting new intervention practices are important, especially in resource-strapped countries. Although on a trajectory to be phased-out, amalgam remains the standard of care in many countries. Methods: Adopting a government perspective, this study compared the costs of performing amalgam and ART/high-viscosity glass-ionomer cement (HVGIC) restorations and the consequences of failed restorations over 3 years in suburban Brasilia, Brazil. Cost data were collected prospectively; cost estimates were developed for the study sample and a projection of 1,000 single- and 1,000 multiple-surface restorations per group. Probabilistic sensitivity analysis was conducted in TreeAge Pro. Results: Results were mixed. For single-surface restorations, ART/HVGIC will cost US51perfailureprevented,whileformultiplesurfacerestorations,ART/HVGICwascosteffectivewithasavingsofUS51 per failure prevented, while for multiple-surface restorations, ART/HVGIC was cost-effective with a savings of US11 compared to amalgam. Probabilistic sensitivity analysis (Monte Carlo simulation) predicted amalgam would be cost effective 49.2% of the time compared to HVGIC at 50.6% of the time at a willingness to pay threshold of US237perfailureprevented.Personnelaccountedformorethanhalfthecostburdenforbothmethods;instrumentsandsuppliesaccountedforaboutonethird.TheperrestorationcosttoreplaceamalgamwithHVGICrangesfromUS237 per failure prevented. Personnel accounted for more than half the cost burden for both methods; instruments and supplies accounted for about one third. The per restoration cost to replace amalgam with HVGIC ranges from US1 to a savings of US$0.84. Conclusion: Replacing amalgam with a high-viscosity glass-ionomer as part of the ART method comes at a minimal increase in cost for governments. Increasing the number of restorations seems to diminish the cost burden. Clinical significance: ART/HVGIC could be considered a viable alternative to amalgam in primary teeth.
... The main characteristics of datasets from included studies are displayed in Table 1. Half of the studies were conducted in a dental practice 15,16 , and the other half in a school 17,18 . Amalgam was the material of choice in most papers to be used as a control group (75%) 15,16,18 . ...
... Half of the studies were conducted in a dental practice 15,16 , and the other half in a school 17,18 . Amalgam was the material of choice in most papers to be used as a control group (75%) 15,16,18 . Only one study compared ART with resin composite restorations (25%) 17 . ...
... Only one study compared ART with resin composite restorations (25%) 17 . The majority of criteria used as the outcome evaluations were based on ART criteria (75%) 15,16,18 . Moreover, the majority of the studies followed the patients for 2 16,17 and 3 years 15,18 . ...
Article
Background: A previous systematic review showed that atraumatic restorative treatment (ART) can be an option to restore the occlusoproximal cavities in primary teeth; however, few studies fulfilled the criteria of inclusion to generate a high level of evidence. Aim: To update the existing systematic review and address questions regarding survival rate of ART restorations compared to the conventional approach in occlusoproximal cavities in primary molars. Design: The search was extended beyond the original search through the PubMed/MEDLINE database up to February 2016. Furthermore, Web of Science and EMBASE were searched. The inclusion criteria were subjects related to the scope of the systematic review. After selection by title and abstract, potentially eligible articles were read in full and included in accordance with exclusion criteria. Meta-analysis was carried out with the outcome being the survival rate of restorations. Results: The search strategy identified 560 potentially relevant studies, in addition to 127 from the original systematic review. A total of four articles were included in the qualitative and quantitative analyses. Meta-analysis showed no statistically significant difference between ART and conventional approaches in survival rate of occlusoproximal cavities (OR = 0.887, 95% CI: 0.574-1.371). Conclusion: ART restorations have similar survival rate compared to conventional treatment and can be considered an option to restore occlusoproximal cavities in primary molars.
... For years, researchers have faced uncertainties regarding the durability of ART restorations using glassionomer cement [26]. There was a need for a thorough assessment of the material's ability to survive and resist the demands of the oral environment, especially when compared to amalgam restorations, considered the gold standard for restorative procedures [26]. ...
... For years, researchers have faced uncertainties regarding the durability of ART restorations using glassionomer cement [26]. There was a need for a thorough assessment of the material's ability to survive and resist the demands of the oral environment, especially when compared to amalgam restorations, considered the gold standard for restorative procedures [26]. An umbrella review [35] indicates similar levels of success between both materials in restoring primary teeth, but more studies are needed to corroborate these findings. ...
Article
Introduction: The present study aimed to identify the 100 most-cited articles concerning Atraumatic Restorative Treatment (ART) through a bibliometric analysis. Methods: The search was conducted in the Web of Science database in December 2023. Scopus and Google Scholar were used to compare the number of citations. The following data were extracted from the articles: title, authors, number of citations, access type, institution, country, continent, year of publication, journal, keywords, study design, and theme. Collaborative networks were generated using the VOSviewer software. Google Trends was used to investigate the global popularity of "atraumatic restorative treatment" research. Results: The 100 selected articles, published between 1996 and 2019, were cited 5,092 times, ranging from 21 to 239 citations. Caries Research (12%) and Community Dentistry and Oral Epidemiology (12%) published the highest number of articles. Clinical study (52%) was the most prevalent study design. The main theme addressed was restoration longevity (43%). Conventional high-viscosity glass ionomer was the most used restorative material (69%). The country with the highest number of articles was the Netherlands (33%) and Europe was the continent with most publications (38%). The Rabboud University of Nijmegen had the highest number of articles (25%). Frencken JE was the most prominent author (38%). The most common keyword was "atraumatic restorative treatment" (n=60). According to Google Trends, Tanzania was the country that searched the most about ART. Conclusion: The 100 most cited articles on ART were mainly composed of clinical studies focusing on the longevity of restorations and originated in Europe.
... The literature presents several in vivo studies related to the survival rate of ART restorations with different GIC. [25][26][27][28] However, few studies have evaluated the survival rate of ART restorations with GIC combined with antimicrobial agents, such as antibiotics and CHX, together with the effects of these materials on the oral microbiota. 27 ...
... ,28 Mathew et al.29 evaluated the addition of 1% CHX diacetate to GIC Fuji IX and demonstrated low marginal infiltration compared to the control group without CHX, suggesting that this mixture can be considered a valuable alternative, especially in ART procedures. Konde et al.30 conducted a clinical trial and evaluated 47 children aged 5-8 years who received ART procedures in deciduous molars with nanoparticulated RM-GIC. ...
Article
Aim: This study evaluated the short-term clinical and microbiological performance of resin-modified glass ionomer cement (RM-GIC) cement containing chlorhexidine (CHX) for atraumatic restorative treatment (ART) in primary teeth. Materials and methods: The clinical trial was conducted in 36 children that received ART in primary molars either with GIC (group I, n = 18) or GIC containing 1.25% CHX (group II, n = 18). The survival rate of restorations was checked 7 days, 3, and 6 months after their application when saliva and biofilm were collected for microbiological assessment of mutans streptococci (MS) counts. Data were analyzed using the Kruskal-Wallis/Mann-Whitney U tests for clinical analysis and microbiological evaluations (p < 0.05). Results: The survival rate of restorations was similar comparing groups I with II. Microbiological analysis showed a significant reduction in MS levels 7 days after the treatment in both saliva and biofilm of children treated with RM-GIC containing CHX (group II); however, MS counts at 3 and 6 months did not differ from the initial counts. Conclusion: A total of 1.25% CHX improved the microbiological properties of GIC in the short term without impairing the clinical performance of ART restorations. Clinical significance: Glass ionomer cement (GIC) containing CHX could be an alternative in ART procedures with the objective of promoting an additional antimicrobial effect, which is interesting for children with high counts of MS during the initial phase of adaptation to dental treatment. How to cite this article: da Silva ME, de Sena MD, Colombo NH, et al. Short-term Clinical and Microbiological Performance of Resin-modified Glass Ionomer Cement Containing Chlorhexidine for Atraumatic Restorative Treatment. Int J Clin Pediatr Dent 2023;16(S-1):S27-S32.
... These relatively disappointing results were associated with the physical and mechanical properties of conventional GICs, which could reduce their clinical use as long-term restoratives compared with composite resins for load-bearing areas [8]. However, the mechanical properties of GICs have improved subsequently and the relatively new category of high-viscosity GICs (HVGICs) are currently showing better success and/or survival rates, especially for single-surface atraumatic restorative treatment (ART) restorations [9][10][11]. ...
... In view of the improved HVGICs, the present study analyzed the porosity of commercially available hand-mixed conventional GIC and HVGICs used in restorative dentistry using a non-destructive 3D technique. The materials used in the present study have been previously evaluated in randomized clinical trials, showing encouraging results, with cumulative survival rates ranging from 45% to 68% after 18 months in multiple surface restorations in primary molars [10,25,26], and for this reason, they were chosen for the present evaluation. ...
Article
Full-text available
Objectives: This study aimed to compare and evaluate the porosity and pore size distribution of high-viscosity glass ionomer cements (HVGICs) and conventional glass ionomer cements (GICs) using micro-computed tomography (micro-CT). Materials and methods: Forty cylindrical specimens (n = 10) were produced in standardized molds using HVGICs and conventional GICs (Ketac Molar Easymix, Vitro Molar, MaxxionR, and Riva Self-Cure). The specimens were prepared according to ISO 9917-1 standards, scanned in a high-energy micro-CT device, and reconstructed using specific parameters. After reconstruction, segmentation procedures, and image analysis, total porosity and pore size distribution were obtained for specimens in each group. After checking the normality of the data distribution, the Kruskal-Wallis test followed by the Student-Newman-Keuls test was used to detect differences in porosity among the experimental groups with a 5% significance level. Results: Ketac Molar Easymix showed statistically significantly lower total porosity (0.15%) than MaxxionR (0.62%), Riva (0.42%), and Vitro Molar (0.57%). The pore size in all experimental cements was within the small-size range (< 0.01 mm3), but Vitro Molar showed statistically significantly more pores/defects with a larger size (> 0.01 mm3). Conclusions: Major differences in porosity and pore size were identified among the evaluated GICs. Among these, the Ketac Molar Easymix HVGIC showed the lowest porosity and void size.
... Considering the number of surfaces involved in ART approach, it can be observed that multiple surface restorations (MS) commonly present lower survival rates compared to single surface restorations (SS). 24,32,33 MS restorations showed to be more susceptible to marginal faults, excesses or lack of material, as well as pulp exposures. Poor oral hygiene might also have contributed to the lower survival rate of proximal restorations after two years of evaluation. ...
... In studies where dentists were more experienced in the approach to ART, there were fewer restorations with marginal cervical failures and residual caries, suggesting that the level of experience may influence the success of restorations. 20,32 On the other hand, Bonifácio et al. 30 did not find differences about the survival rate of proximal restorations performed by two dentists with different levels of clinical experience in ART. ...
Article
Full-text available
Trata-se de uma revisão de a literatura acerca do desempenho clínico do cimento de ionômero de vidro (CIV) utilizado no tratamento restaurador atraumático (TRA). Realizaram-se buscas nas bases de dados: Biblioteca Virtual em Saúde Odontologia, Medline, Pubmed e Science Direct, utilizando os descritores “cimentos de ionômeros de vidro”, “tratamento dentário restaurador sem trauma” e “análise de sobrevida”, bem como os respectivos termos em inglês. Foram selecionados 23 artigos nos idiomas português e inglês, publicados nos últimos dez anos, seguindo critérios de inclusão e exclusão pré-determinados. Percebeu-se que a maioria dos estudos aplicou o TRA em crianças (66%), direcionado à dentição decídua (57%) e em cavidades de superfície única e múltipla (48%), simultaneamente. A maioria dos estudos acompanhou o desempenho clínico das restaurações no período de 12 (35%) e 24 meses (35%). O CIV de alta viscosidade foi mais utilizado e as marcas Fuji IX e Ketac Molar foram as mais empregadas no TRA. Concluiu-se que O CIV associado ao TRA demonstra ser uma alternativa viável para tratar cárie em dentes decíduos e permanentes. A longo prazo, o CIV apresenta desempenho superior em cavidades de superfície única em relação às multisuperfície. De modo geral, as taxas de sucesso das restaurações oscilaram entre: 57,5 e 98%, em superfícies únicas, e 24,4 e 97,8%, em superfícies múltiplas. Esta abordagem mostrou ser confiável e efetiva quando comparada a técnica restauradora convencional. O defeito marginal e a perda parcial ou total da restauração foram identificados como principais causas de falha.
... The larger number of teeth with multiple-surface restorations obtained in the present investigation reflects the higher number of multiple-surface cavities restored at the start. 13 However, despite the extensive efforts by the authors to obtain a large number of exfoliated teeth, the number of collected teeth was small, which reduced the power of the present investigation. ...
... Only 5.2% of the defective amalgam and ART/HVGIC restorations occurred due to secondary carious lesion development. 13 . ...
Article
Purpose: To determine whether the frequency of microleakage at the margin of the tooth-restoration interface in primary molars restored with high-viscosity glass-ionomer cement (HVGIC) differs from that of primary molars restored with amalgam. Materials and methods: The HVGIC restorations were performed according to the ART method. A total of 19 naturally exfoliated primary molars (10 amalgam and 9 ART/HVGIC) with clinically assessed intact restorations fulfilled the inclusion criteria. SEM analyses using replicas were performed to assess the microgap presence and size of the tooth-restoration interface The depth of a microgap was measured from histological sections after infiltration of 50% (w/v) AgNO3 solution. Independent variables were restorative material, age of restoration, and number of tooth surfaces. Data analyses included Fisher's Exact version of the chi-squared test, independent t-test and one-way ANOVA. Results: More ART/HVGIC than amalgam-restored teeth were gap free (p = 0.14). The mean gap size for teeth with a gap between amalgam (322.0 µm) and ART/HVGIC (201.0 µm) restorations did not differ statistically significantly. AgNO3 infiltration was not influenced by restorative material or age of restoration. Infiltration in multiple-surface was higher than in single-surface restorations (p = 0.02). Conclusion: The occurrence of marginal microleakage in primary molars restored by ART/HVGIC is no different from that observed in primary molars restored with amalgam. Microleakage was deeper in multiple-surface than in single-surface restorations. Despite the presence of microleakage, restoration functionality up to exfoliation is secured, reinforcing the importance of biofilm removal and behavioral education of patients.
... Esses resultados relativamente menos favoráveis foram associados às propriedades físicas e mecânicas dos GICs convencionais, o que poderia reduzir seu uso clínico como restauradores de longo prazo em comparação com resinas compostas para áreas de suporte de carga (Van Dijken et al., 2010). No entanto, as propriedades mecânicas dos GICs melhoraram posteriormente e a categoria relativamente nova de GICs de alta viscosidade (HVGICs) está atualmente mostrando melhores taxas de sucesso e/ou sobrevivência, especialmente para restaurações de tratamento restaurador atraumático (ART) de superfície única ; (Hilgert et al., 2014); (Amorim et al., 2018). ...
Article
Full-text available
Objetivo: Revisar e analisar criticamente as principais inovações nas formulações dos cimentos de ionômero de vidro, identificando as tendências e os desafios futuros para sua aplicação clínica. Metodologia: Foi adotada uma revisão narrativa, utilizando bases de dados como Google Scholar, SciELO, Cochrane e PubMed. Foram selecionados artigos científicos dos últimos 15 anos, em português e inglês, que abordassem inovações nos cimentos de ionômero de vidro. Os critérios de inclusão e exclusão foram rigorosamente aplicados para garantir a relevância dos estudos analisados. Resultados e discussão: Os resultados indicaram que o uso de nanopartículas, resinas e materiais bioativos têm contribuído significativamente para a melhoria das propriedades dos cimentos de ionômero de vidro. No entanto, a escassez de ensaios clínicos e a diversidade nas metodologias utilizadas nos estudos revisados limitam a capacidade de generalização das conclusões. A discussão enfatiza a necessidade de mais pesquisas clínicas para validar as inovações laboratoriais e explorar combinações de materiais que possam oferecer soluções ainda mais eficazes. Conclusão: As inovações nos cimentos de ionômero de vidro apresentam um potencial considerável para transformar a prática odontológica, promovendo tratamentos mais duráveis e acessíveis.
... Furthermore, GICs are often recommended as a replacement for amalgam. Research has shown that GICs are more suitable for single-surface fillings compared to amalgam [5]. Highly viscous glass-ionomer cements, the composition of glass hybrids, and the incorporation of elastomeric micelles are recent advancements in GIC developments [6,7]. ...
Article
Full-text available
In 2017, Europe implemented a ban on amalgam restorations for children aged <15 years and for pregnant/breastfeeding women, highlighting the need for alternative filling materials exhibiting less surface roughness and enhanced longevity. This in vitro study aimed to examine the surface roughness variations of five amalgam-replacement materials across three time points and using six finishing methods: (1) no finishing (control), (2) Arkansas burs, (3) diamond burs, (4) tungsten carbide burs, (5) SofLex discs in descending grit size, and (6) coarse SofLex discs combined with silicone polishing. We prepared 960 samples. Each material group, i.e., Cention Forte (CNF), DeltaFil (DLF), Ketac Universal (KTU), IonoStar Molar (ISM), and Equia Forte HT (EQF), comprised 60 samples (n = 10 per finishing method) created using standardized 3D-printed metal molds. Surface roughness (Sa) was measured immediately after finishing, after 30 days of storage in distilled water, and after thermocycling (5000 cycles) using a non-contact profilometer. The results indicate that conventional and hybrid glass-ionomer cements have smoother surfaces than high-viscosity GICs. The DLF and CNF groups exhibited stable outcomes. These findings underscore the importance of selecting appropriate finishing methods based on the restorative material to minimize surface roughness.
... They are preferred for both primary and permanent tooth restorations due to their beneficial properties, such as their anti-cariogenic effects, chemical adhesions to dental tissues, and biocompatible structures resulting from fluoride ion (F -) release [3]. These properties have made GIC a critical material in treating initial carious lesions and pediatric patients with high caries risk [4]. ...
... composites and its resilience to abrasion is clearly greater than that of conventional GIC. 8 However, isolated studies provide contradictory findings regarding the durability of restorations in primary teeth. Hence, systematic reviews, particularly those using meta-analysis, are required to support clinicians in their clinical decision-making. ...
Article
Full-text available
Aim This systematic review was designed to compare the clinical effectiveness of high-viscosity glass ionomer cement (HVGIC) restorations to direct composite resin (CR) restorations in single- or multisurface cavities in primary teeth. Background Restorative procedures are typically used to treat caries in primary teeth. Due to their improved preservation of the natural tooth structure and their adhesion to the remaining tooth structure, CR and GIC have drawn attention as the preferred restorative materials. In the literature, over the past 20 years, the term HVGIC has developed. Compared to C-GICs, HVGICs appear to have a higher survival rate. However, isolated studies provide contradictory findings regarding the durability of restorations in primary teeth. Materials and methods Major electronic databases were thoroughly searched to find publications from the years 2000 to 2021. Studies included were randomized and nonrandomized clinical trials on children aged 3–13 years, in which restoration of primary teeth using HVGIC and CR was performed. Results This systematic review includes four studies [three randomized controlled trials (RCTs) and one nonrandomized controlled trial]. No statistically significant difference between these materials was seen in any of the included studies. Conclusion This systematic review of findings supports the assertion that both HVGIC and CR restorations deliver satisfactory outcomes in terms of clinical efficacy and overall survivability. It was found that, for both materials, class I restorations had statistically higher survival rates than class II restorations. Long-term studies are essential to evaluate the clinical efficacy of both restorations. Clinical significance This systematic review outlines the application of HVGIC and CR as restorative materials for pediatric dentists to use in their everyday dental practices. How to cite this article Krishnakumar K, Kalaskar R, Kalaskar A, et al. Clinical Effectiveness of High-viscosity Glass Ionomer Cement and Composite Resin as a Restorative Material in Primary Teeth: A Systematic Review of Clinical Trials. Int J Clin Pediatr Dent 2024;17(2):221–228.
... Por outro lado, o sucesso na técnica de ART está condicionado à disponibilização de materiais que possuam o máximo de propriedades esperadas para o bom desempenho das restaurações [25][26][27][28] . Contudo, neste estudo, o tipo de cimento de ionômero de vidro (CVI) disponibilizado para uso foi apontado pela maioria dos CDs participantes como o responsável pelo sucesso parcial quanto aos resultados clínicos obtidos com o uso da TRA; por interferir seja na longevidade da restauração, na adesão do CVI ao tecido cariado ou durante a execução da técnica. ...
Article
Resumo: Objetivou-se analisar aspectos referentes ao emprego da Técnica de Restauração Atraumática (TRA) nas atividades dos Cirurgiões-Dentistas (CDs) da Atenção Básica à Saúde (ABS) do Recife, no Distrito Sanitário IV, planejadas para o controle e tratamento da cárie dentária. Promoveu-se uma caracterização do perfil profissional e sobre aspectos relacionados ao emprego da técnica. Tratou-se de um estudo observacional de caráter descritivo. A amostra foi o universo dos CDs (23), que estavam em exercício profissional em 23 unidades de saúde do Distrito Sanitário IV, no primeiro semestre de 2017. Para a coleta de dados foi elaborado um questionário estruturado submetido à validação e foi aplicado face a face. A análise de dados realizou cálculos de estatística descritiva. Foram calculadas a distribuição de frequência absoluta e relativa das variáveis estudadas. Apenas dois dentistas não foram entrevistados por estarem afastados do trabalho, isto significou em uma perda de 8,69%. Prevaleceu entre os entrevistados a idade de 41 a 57 anos (52,83%); e o sexo feminino (80,95%); 80,95% ingressaram na ABS por concurso; 90,48% possuíam pós-graduação, sendo 80,95% na especialidade Saúde da Família. A maioria afirmou utilizar a TRA e que a ABS recomenda o uso (85,75%). A técnica era utilizada para restaurações provisórias e definitivas (61,11%) e quase 50% dos entrevistados relataram que a qualidade do produto interferia na execução, duração e adesão das restaurações. Os CDs indicaram a TRA para diferentes idades e condições de vida, onde prevaleceu o uso para crianças (42,86%) e gestantes (42,86%). A grande maioria dos CDs se declarou habilitado, mas com necessidade de capacitação (95,24%). Conclui-se que a TRA é indicada e está incorporada às práticas de cuidados da maioria dos entrevistados, contudo investimentos em educação permanente dos profissionais e provimento de material recomendado para o uso eficaz da técnica devem ser planejados.Descritores: Atenção Primária à Saúde. Saúde Bucal. Cimentos de Ionômeros de vidro. Cárie dentária.
... 4 High-viscosity GIC is the material of choice for ART is considered one of the most effective materials for ART restorations, as it shows proper clinical performance and longevity. [6][7][8][9][10][11] However, more affordable options in the Brazilian market are already included in public health services. Vitro Molar 12-17 (Nova DFL) is one of those, which is considered a low-cost option with favorable mechanical characteristics and fluoride release. ...
Article
Full-text available
Abstract There are many glass ionomer cements available on the Brazilian market for Atraumatic Restorative Treatment (ART), however, there is still a gap in the literature regarding their cost-effectiveness. Objectives To evaluate the influence of restorative materials (Ketac Molar, 3M ESPE; and Vitro Molar, Nova DFL) in the two-year survival rate and cost-effectiveness of occluso-proximal ART restorations in primary molars. Methodology A total of 117 children (aged four to eight years) with at least one occluso-proximal carious lesion in primary molars were selected and randomly divided in treatment groups (KM or VM) in this parallel randomized controlled trial. Treatments followed ART premises and were conducted in public schools by trained operators in Barueri, Brazil. A trained, calibrated, and blinded examiner performed the evaluations after two, six, 12, and 24 months (k=0.92). Kaplan-Meier survival analysis was used to estimate restoration survival and Cox regression was used to test the association with clinical factors (α=5%). For cost analysis, material and professional costs were considered. Monte Carlo analysis was used to generate a cost-effectiveness plane and bootstrapping was used to compare material costs over the years. Results The overall survival rate was 36.9% after two years (48.6% for KM and 25.4% for VM). Restorations with VM failed more than those with KM (HR=1.70; 95% CI=1.06–2.73; p=0.027). VM presented lower initial cost, but no difference was observed between groups considering the two-year incremental cost. Conclusion After a two-year evaluation, KM proved to be a better option than VM for occluso-proximal ART restorations in primary molars. ClinicalTrials.gov: NCT02267720
... However, available restorative materials for primary teeth are characterised by strengths and limitations: Amalgam (A) is not a technically sensitive material but its preparation design causes more substance loss, which is contrary to the modern minimally invasive approach in dentistry (Daou et al. 2009;Hilgert et al. 2014). Composite resins (CRs) are minimally invasive, and a successful adhesion can be obtained to primary teeth when used in combination with universal adhesives ). ...
Article
Full-text available
Purpose To systematically review the clinical performance of restorative materials after pulp therapy of carious primary teeth. It is part 2 of a systematic review on the clinical effectiveness of restorative materials for the management of carious primary teeth supporting the European Academy of Paediatric Dentistry (EAPD) guideline development. Methods Four electronic databases were systematically searched up to December 28th, 2020. Randomised controlled clinical trials (RCTs) on restorative materials for the restoration of carious primary teeth after pulp therapy were included. Failure rate, annual failure rate (AFR) and reasons for failure were recorded. Studies were sorted by restorative materials. The Cochrane Risk of bias tool for randomised trials (RoB 2.0) was used for quality assessment. Results After identification of 1685 articles and screening of 41 papers from EAPD review group 1, 5 RCTs were included. Restored primary molars with pulpotomy presented the following AFRs: composite resin (CR) 0%, preformed metal crowns (PMCs) 2.4–2.5%, resin-modified glass-ionomer cement combined with CR 3.8%, compomer 8.9%, and amalgam 14.3%. Maxillary primary incisors receiving pulpectomy exhibited AFRs of 0–2.3% for composite strip crowns (CSCs) depending on the post chosen. Reasons for failure were secondary caries, poor marginal adaptation, loss of retention and fracture of restoration. All studies were classified as high risk of bias. Meta-analyses were not feasible given the clinical/methodological heterogeneity amongst studies. Conclusion Considering any limitations of this review, CR and PMCs can be recommended for primary molars after pulpotomy, and CSCs for primary incisors receiving pulpectomy. However, a need for further well-designed RCTs was observed.
... In general, it became evident that resin-modified glass ionomer cement inhibited secondary caries at restoration margins making them a possible restorative alternative in a population with high caries risk, such as children or elderly patients [20][21][22]. However, studies on the bioactive materials and their effect on preventing caries are still limited. ...
... In relation to these patient behaviour management problems, operator skill related factors, and material properties, the ideal restorative material for primary teeth has not been found so far: Amalgam (A) is characterised by low technique-sensitivity but quite aggressive preparation requirements without actually sufficient space for this, since primary teeth are smaller and pulp is closer to the outer surface (Daou et al. 2009;Hilgert et al. 2014). Resin-based composites (CR) are minimally invasive and quite easily bonded when recent universal adhesives are employed. ...
Article
Full-text available
Purpose To systematically search the available evidence and evaluate the clinical effectiveness of restorative materials for restoration of carious primary teeth. The findings aimed to support the European Academy of Paediatric Dentistry (EAPD) guidelines development. Methods Literature search was performed by searching 4 electronic databases for eligible randomised controlled clinical trials (RCTs) comparing restorative materials for the restoration of carious primary teeth up to December 28th, 2020. Quality assessment was performed with the revised Cochrane risk-of-bias tool for randomized trials (RoB 2). Results Of 1685 identified articles 29 RCTs were finally deemed as eligible for inclusion. Annual failure rates were: Amalgam 1–28%; atraumatic restorative treatment 1.2–37.1%; glass-ionomer cement (GIC) 7.6–16.6%, metal-reinforced GIC 29.9%, resin-modified GIC 1.9–16.9%, high-viscosity GIC 2.9–25.6%; glass carbomer ≤ 46.2%; compomer 0–14.7%; composite resin (CR) 0–19.5%, bulk-fill CR 0–16.9%; zirconia crowns 3.3%, composite strip crowns 15%, and preformed metal crowns (Hall-Technique) 3.1%. Secondary caries, poor marginal adaptation, loss of retention, and fracture of restoration were reported as reasons for failure. Four studies were evaluated at unclear and 25 at high risk of bias. Clinical and methodological heterogeneity, and the diversity of tested materials across included studies did not allow for meta-analyses. Conclusions Within the limitations of this systematic review, namely, the heterogeneity and the overall high risk of bias among included studies, clear recommendations based on solid evidence for the best restorative approach in primary teeth cannot be drawn. There is a need for future thoroughly implemented RCTs evaluating restorations in primary teeth to close this knowledge gap.
... Multi-surface fillings have been identified as risk factors for failures in deciduous teeth restored with total 39 or partial caries removal in the ART approach. [40][41][42] It would be expected that Cention N could overcome this flaw since the manufacturer states that it presents higher mechanical properties compared to conventional (Fuji II) and different HVGICs brands. 10 Also, we opted to use Cention N in dual-cure mode, as light-curing the material resulted in higher Vickers hardness. ...
Article
Full-text available
Background: The clinical performance of new restorative materials must be evaluated before recommending its use in primary teeth. Aim: This randomized clinical trial evaluated the survival rates of restorations in single and occluso-proximal cavities of primary teeth performed with a new dual-cure resin-based material in comparison with a resin-modified glass ionomer cement after 12 months of follow-up. Materials and methods: A total of 107 restorations were placed in 27 children by one experienced pediatric dentist. Two materials were tested: Vitremer and a dual-cure resin-based material with (CentionN+Adh) and without (Cention N-Adh) adhesive system application. Two calibrated and blinded examiners evaluated the restorations at 3, 6, and 12-month. The longevity of the restorations was analyzed using Kaplan-Meier survival curves and Log-rank test (α = 5%). Results: The overall survival rates after 12-month were 81.9% for Vitremer, 70.4% for Cention N+Adh, and 66.7% for Cention N-Adh, which had the poorer performance (HR = 0.54; 95% CI= 0.31-0.95; p = 0.031). When considering the type of the cavities, the difference was significant only for occluso-proximal cavities when Cention N-Adh was used (HR = 0.46; CI = 0.26-0.81; p = 0.008). Conclusion: All evaluated materials are suitable for restoring occlusal cavities after selective caries removal. However, Cention N needs to be used with adhesive in occluso-proximal cavities. Clinical significance: Cention-N can be used for deciduous teeth restorations, with similar longevity rates as resin modified glass ionomer cements.Trial registration number RBR-9nqszr. How to cite this article: da Cunha CM, Wambier LM, Paris Matos TD, et al. New Dual-cure Resin-based Material in Occlusal and Occluso-proximal Restorations of Primary Teeth: Results of a Randomized Clinical Trial. Int J Clin Pediatr Dent 2022;15(1):38-46.
... El éxito del Tratamiento Restaurador Atraumático dependerá del adecuado diagnóstico y la selección de la pieza dentaria a restaurar, el fracaso es atribuido a muchos factores entre ellos la limitada experiencia y entrenamiento del profesional 10, la remoción insuficiente de caries, acondicionamiento inadecuado de la cavidad e inapropiado mezclado del material (polvo/líquido); sin embargo, con mayor frecuencia estas condiciones no se registran en los estudios de seguimiento, solo se reportan tipos de fallas como la pérdida parcial o total de la restauración y diferentes tipos de desgaste o fracturas que requerirán reparación o reemplazo. 3-20-21-22 Otros factores en el fracaso de las restauraciones son los relacionados al paciente, como la contaminación por saliva o sangre, tipo de aislamiento, nivel de cooperación del paciente niño, número de restauraciones por niño y falta de cumplimiento de las indicaciones post tratamiento como no ingerir líquidos o alimentos una hora después 3-2 no obstante, Hilgert y col (2014) 23 reportan la no existencia de diferencias significativas en los resultados de las restauraciones a pesar de haber utilizado aislamiento relativo con rollos de algodón, Roshan y Sakeenabi (2011) 11 , Abbass MMS y col (2019) 21 consideran las limitaciones de la estructura morfológica o anatómica de los dientes deciduos, fallas en el control de la saliva en los niños y la susceptibilidad de las restauraciones superficiales o poco profundas, Hesse D y col (2016) 22 , Abbass MMS y col (2019) 21 indican como relevante el factor personal o "factor operador" como la formación académica, el nivel de experiencia, el entrenamiento en el protocolo, la posición del operador y del paciente, la iluminación, el confort del operador y la accesibilidad para la eliminación de la caries, Frencken y col (2013) 24 atribuyen las fallas a las características físicas del ionómero y el manejo del material por el operador. ...
... El éxito del Tratamiento Restaurador Atraumático dependerá del adecuado diagnóstico y la selección de la pieza dentaria a restaurar, el fracaso es atribuido a muchos factores entre ellos la limitada experiencia y entrenamiento del profesional 10, la remoción insuficiente de caries, acondicionamiento inadecuado de la cavidad e inapropiado mezclado del material (polvo/líquido); sin embargo, con mayor frecuencia estas condiciones no se registran en los estudios de seguimiento, solo se reportan tipos de fallas como la pérdida parcial o total de la restauración y diferentes tipos de desgaste o fracturas que requerirán reparación o reemplazo. 3-20-21-22 Otros factores en el fracaso de las restauraciones son los relacionados al paciente, como la contaminación por saliva o sangre, tipo de aislamiento, nivel de cooperación del paciente niño, número de restauraciones por niño y falta de cumplimiento de las indicaciones post tratamiento como no ingerir líquidos o alimentos una hora después 3-2 no obstante, Hilgert y col (2014) 23 reportan la no existencia de diferencias significativas en los resultados de las restauraciones a pesar de haber utilizado aislamiento relativo con rollos de algodón, Roshan y Sakeenabi (2011) 11 , Abbass MMS y col (2019) 21 consideran las limitaciones de la estructura morfológica o anatómica de los dientes deciduos, fallas en el control de la saliva en los niños y la susceptibilidad de las restauraciones superficiales o poco profundas, Hesse D y col (2016) 22 , Abbass MMS y col (2019) 21 indican como relevante el factor personal o "factor operador" como la formación académica, el nivel de experiencia, el entrenamiento en el protocolo, la posición del operador y del paciente, la iluminación, el confort del operador y la accesibilidad para la eliminación de la caries, Frencken y col (2013) 24 atribuyen las fallas a las características físicas del ionómero y el manejo del material por el operador. ...
Article
Full-text available
La Técnica de Restauración Atraumática (TRA) es un procedimiento preventivo–restauradormínimamente invasivo, como alternativa de tratamiento para poblaciones vulnerables conpoco o nulo acceso a servicios de salud, que consiste en la remoción del tejido dentario cariado utilizando sólo instrumentos manuales y un material adhesivo de restauración: el ionómerode vidrio de alta viscosidad debido a sus propiedades físicas y químicas, como la adhesión ala estructura dental, la biocompatibilidad, la reacción de fraguado químico y el desarrollo yla liberación de fluoruro, que le confieren características preventivas. Objetivo: Revisar laevidencia sobre la eficacia clínica, mediante el desempeño clínico y la supervivencia de losionómeros en el tratamiento restaurador atraumático en dentición decidua. Métodos: Se realizó la búsqueda de información: estudios in vitro, ensayos clínicos aleatorizados y revisionessistemáticas con antigüedad máxima de 10 años, en las bases de datos Medline, Scielo y Scopus, con las estrategias de búsqueda (“Dental Atraumatic Restorative Treatment/therapeuticuse”[Mesh] OR “Dental Atraumatic Restorative Treatment/trends”[MesH] OR ART OR PRAT) y((“Dental Atraumatic Restorative Treatment”[Mesh]) AND (“Glass Ionomer Cements”[Mesh])OR “Ketac-Molar Quick” [Supplementary Concept]). Conclusiones: Existe evidencia científicasuficiente para determinar el éxito de las restauraciones TRA en lesiones de una superficieen dentición decidua, incluso en comparación con los materiales restauradores de los tratamientos convencionales. El desempeño clínico y la supervivencia es alta cuando se utilizan ionómeros de alta viscosidad. Aún no hay consenso acerca de las ventajas del uso de ionómerosde menor costo, encapsulados, reforzados con metal y/o con propiedades mejoradas.
... The poor mechanical properties of conventional GICs did previously limit wider application, but this reality seems to be changing. Several studies demonstrated good performance of the GICs with good success rate, 4,27,28,29 demonstrating the potential of high viscosity GICs materials with applications in minimally dentistry. 27 The results of this study have far-ranging implications including for public services and manufacturers, as some of these materials may not withstand the clinical situations indicated in their manufacturers' instructions. ...
Article
Full-text available
The objective was to evaluate the compressive strength (CS), diametral tensile strength (DTS), flexural strength (FS), and Knoop microhardness (KH) of different conventional restorative glass-ionomer cements (GICs) and to correlate these mechanical properties (MP) with the stabilization time (ST) of their chemical bonds. Eighteen GICs were tested: Bioglass [B], Chemfil Rock [CR], Equia Forte [EF], Gold Label 2 [GL2], Gold Label 9 [GL9], Glass Ionomer Cement II [GI], Ionglass [IG], Ion Z[ IZ], Ionomaster [IM], Ionofil Plus [IP], Ionostar Plus [IS], Ketac Molar Easymix [KM], Magic Glass [MG], Maxxion R [Ma], Riva Self Cure [R], Vidrion R [V], Vitro Fil [VF] and Vitro Molar [VM]. The mechanical strength tests were performed in a universal testing machine. KH readings were done with a diamond indenter. STs were examined by Fourier Transform Infrared spectroscopy (FTIR). Data were analyzed with ANOVA and Tukey test (p<0.05). The Spearman rank test was used to evaluate the dependence between the MPs and ST results. The highest MP values were EF, GL2, GL9, GI and KM and the lowest for MG, MA, B, VF and IM. The longest ST was for GL2 and the shortest was for B. ST correlated positively with MP. GICs with longer chemical bonds ST are generally stronger and the ST value obtained from FTIR was useful in predicting the strength of GICs tested.
... follow-up. The restorations were evaluated by two independent trained evaluators, who did not take part in the treatment phase, using the ART criteria 18,19 . Calibration and training of the evaluators on the ART criteria was performed before the study in children that attended the pedodontics service of the University Dental Clinic until a good agreement was observed. ...
Article
Full-text available
We aimed to compare subjective (S) vs. objective (O) selective carious tissue removal using hand-excavation versus a self-limiting polymer bur, respectively. A community-based single-blind cluster-randomized controlled superiority trial was performed. This is a 1-year-interim analysis. 115 children (age 7-8 years) with ≥1 vital primary molar with a deep dentin lesion (>1/2 dentin depth) were included (60 S/55 O). The cluster was the child, with eligible molars being treated identically (91 S/86 O). Cavities were prepared and carious tissue on pulpo-proximal walls selectively removed using hand instruments (S), or a self-limiting polymer bur (Polybur P1, Komet). Cavities were restored using glass-hybrid material (Equia Forte, GC). Treatment times and children's satisfaction were recorded. Generalized-linear models (GLM) and multi-level Cox-regression analysis were applied. Initial treatment times were not significantly different between protocols (mean; 95%CI S: 433; 404-462 sec; O: 412; 382-441 sec; p = 0.378/GLM). There was no significant difference in patients' satisfaction (p = 0.164). No pulpal exposures occurred. 113 children were reexamined. Failures occurred in 22/84 O-molars (26.2%) and 26/90 S-molars (28.9%). Pulpal complications occurred in 5(6%) O and 2(2.2%) S molars, respectively. Risk of failure was not significantly associated with the removal protocol, age, sex, dental arch or tooth type (p > 0.05/Cox), but was nearly 5-times higher in multi-surface than single-surface restorations (HR: 4.60; 95% CI: 1.70-12.4). Within the limitations of this interim analysis, there was no significant difference in treatment time, satisfaction and risk of failure between O and S.
... One of these treatments is the atraumatic restorative technique (ART), indications for which were described by Holmgren and Frencken in 1999 9) . Currently, the guidelines suggest the placement of high viscosity glass ionomer cement (GIC) 10) which exhibits similar coefficient of thermal expansion to dental tissue, long term release of fluoride and acceptable biocompatibility 11) . In spite of the incorporation of fluoride in GIC's, secondary caries is still an unsolved problem knowing that the amount of released fluoride is not enough to guarantee its anticariogenic activity 12) . ...
Article
Full-text available
Copper nanoparticles (NCu) were synthetized and added to commercial glass ionomer cement, to evaluate in vitro its antibacterial activity against oral cavity strains. The NCu were synthesized by copper acetate reduction with L-ascorbic acid and characterized by FTIR, Raman, XPS, XRD and TEM. Then, commercial glass ionomer cement (GIC) was modified (MGIC) with various concentrations of NCu and physicochemically characterized. Cell viability was tested against human dental pulp fibroblasts (HDPFs) by Alamar-Blue assay and antibacterial test was performed against S. mutans and S. sanguinis by colony forming unit (CFU) growth method. Synthesized NCu rendered a mixture of both metallic copper and cuprous oxide (Cu2O). HDPF viability reduces with exposure time to the extracts (68–72% viability) and MGIC with 2–4 wt% NCu showed antimicrobial activity against the two tested strains.
... Introduced to provide simple restorative care to young children, patients with special health care needs, and the elderly in less-industrialized areas of the world, ART has also been adopted by developed countries because of the several benefits it offers. 18 Currently, for ART, the restorative material of choice is high-viscous glass ionomer cement, 18 19 Examples of high viscosity glass ionomer cement are Fuji IX GP (GC America) and Ketac TM Molar (3M ESPE). According to the manufacturers of these materials, the relatively higher viscosity is due to the addition of polyacrylic acid to the powder and finer grain-size distribution. ...
... Table 3 shows a comparison of the estimated survival rates of teeth restored with GIC, based on their survival period. Hilgert et al. 10 reported that there is no difference in the survival rates of intact and defective restorations in primary molars. Mijan et al. 11 investigated the survival rates of teeth treated according to three different protocols; conventional restorative treatment (CRT), atraumatic restorative technique (ART) and ultra-conservative technique (UCT), and observed that there was no difference in their 3.5 years survival rates. ...
Article
Background Tertiary prevention is still an integral part of a child's healthcare. In community dental service (CDS), we aim to try to restore carious primary teeth in young children as a means of caries control. Aim To assess the survival rates of individual carious primary molars within CDS, based on the type of dental interventions. Design Retrospective observational study. Methods Fifty patients' notes were reviewed, and patients were selected using a defined protocol. The Kaplan-Meier method was used to estimate the survival curves. Results Out of 251 teeth, the estimated survival rates of teeth restored with stainless steel crowns (SSC) was the highest at 46.7 months, GIC-restored teeth at 45.8 months and unrestored teeth at 18.2 months. There was no correlation seen between the survival rates and the number of further interventions required. The difference between the survival rates of teeth restored with GIC, SSC and unrestored was statistically significant (p <0.05). There was minimal use of SSCs within this sample. Conclusion Our present findings indicate that restored teeth have higher survival rates than unrestored teeth. However, it must be emphasised that restorative treatment may not always be feasible and other factors should be considered in the treatment planning.
... A glass ionomer that is specifically designed for ART is available, which is termed a high-viscosity glass ionomer (such as Ketac Molar Easymix ® , 3M ESPE, Seefeld, Germany) [18,31,32]. It possesses a high powder-to-liquid ratio, with improved mechanical properties, including wear resistance, compressive strength, and marginal adaptability [18,31]. ...
Article
Full-text available
This review discusses the techniques and uses of atraumatic restorative treatment (ART) and interim therapeutic restoration (ITR) and states the differences between these two approaches. ART and ITR are similar approaches and are performed using the same material, but they differ in the purpose of their use. ART is used in cases when there are obstacles to reaching dental care units and has been proven to have high success rates in primary and permanent dentitions. ITR is used as a temporary restoration that will be replaced with a more definitive one. ITR is used in cases when the ideal dental treatment cannot be performed. Conventional glass polyalkenoate (ionomer) restorative cement (GIC) is the material of choice that has been used for ART and ITR. This is because of its fluoride release properties, including its ability to bond to enamel and dentine, its pulpal biocompatibility, and its ease of manipulation. High-viscosity glass ionomer performed better than low and medium-viscosity glass ionomer in ART. Combining GIC with conditioner, as well as the use of a chemo-mechanical approach, improved the success rate of ART. Both ATR and ITR are acceptable strategies, with success rates comparable to the traditional treatment methods.
... On the basis of three studies, no significant difference in the 2year survival percentages between single-and multiplesurface ART/HVGIC and amalgam restorations in primary molars was reported [164]. For single-surface cavities in primary molars, this finding is supported by a 3-year study that compared ART with amalgam restorations [129]. For multiple-surface cavities in primary molars, a systematic review performed with only RCTs concluded that ART/HVGIC restorations have similar survival percentages to conventional treatment of amalgam and resin composite restorations [165]. ...
Article
Full-text available
Objective The aim of the present study is to update the results of two previous meta-analyses, published in 2006 and 2012, on the survival percentages of atraumatic restorative treatment (ART) restorations and ART sealants. The current meta-analysis includes Chinese publications not investigated before. Materials and methods Until February 2017, six databases were interrogated (two English, one Portuguese, one Spanish and two Chinese). Using six exclusion criteria, a group of six independent reviewers selected 43 publications from a total of 1958 potentially relevant studies retrieved. Confidence intervals and/or standard errors were calculated and the heterogeneity variance of the survival rates was estimated. Results The survival percentages and standard errors of single-surface and multiple-surface ART restorations in primary posterior teeth over the first 2 years were 94.3% (± 1.5) and 65.4% (± 3.9), respectively; for single-surface ART restorations in permanent posterior teeth over the first 3 years, they were 87.1% (± 3.2); and for multiple-surface ART restorations in permanent posterior teeth over the first 5 years, they were 77% (± 9.0). The mean annual dentine-carious-lesion-failure percentages in previously sealed pits and fissures using ART sealants in permanent posterior teeth over the first 3 and 5 years were 0.9 and 1.9%, respectively. Conclusions ART single-surface restorations presented high survival percentages in both primary and permanent posterior teeth, whilst ART multiple-surface restorations presented lower survival percentages. ART sealants presented a high-caries-preventive effect. Clinical relevance ART is an effective evidence-based option for treating and preventing carious lesions in primary and permanent posterior teeth.
... This is in accordance with a previous systematic review that did not recommend GIC for class II cavities in primary molars and showed that RMGIC presented better performance in small to moderate size proximal restorations. 34 Moreover, the three studies comparing 35 It is important to highlight that high-viscosity GIC used following the ART approach have shown similar survival rates in primary molars compared with conventional technique (drilling and restoring and/or hand excavation associated with resin composite, amalgam, or compomer). 36,37 The follow-up period ranged from 12 to 60 months, but most studies followed the patients for 24 months. ...
Article
Full-text available
This study aimed to compare the longevity of different conventional restorative materials placed in posterior primary teeth. This systematic review was conducted following the PRISMA statement and registered in PROSPERO (CRD42016035775). A comprehensive electronic search without date or language restrictions was performed in PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Scopus, Turning Research Into Practice (TRIP) and Clinical Trials databases up to January 2017, selecting randomized clinical trials that assessed the longevity of at least two different conventional restorative materials performed in primary molars. Seventeen studies were included in this systematic review. Pairwise and network meta-analyses were performed and relative risks and 95% confidence intervals (CI) calculated. Two reviewers independently selected the studies, extracted the data, and assessed the risk of bias. Restorations of primary molars with conventional glass ionomer cement showed increased risk of failure than compomer, resin-modified glass ionomer cement, amalgam, and composite resin. Risk of bias was low in most studies (45.38% of all items across studies). Pediatric dentists should avoid conventional glass ionomer cement for restoring primary molars.
... Despite the aforementioned limitations, there are reports of significant percentages of success in clinical evaluations of extensive classes I and II cavities in molars restored with ART technique, comparable to the results obtained with the use amalgam [21,25,39], but GIC properties still need to be improved s [7]. ...
Article
Full-text available
Introduction: Due to its chemical, mechanical and biological properties, the glass ionomer cements (GIC) consist in one of the most versatile direct restorative materials, with many potential clinical indications, especially in the context of minimally invasive dentistry. Nevertheless, they have some limitations and require the knowledge of their characteristics and procedures of application in order to achieve their maximum potential. Objective: To demonstrate through literature review the main characteristics, indications, limitations and future perspectives for the use of GIC. Literature review: The database, such as Pubmed and Lilacs were used. Additionally, books were also evaluated and included. Conclusion: The GIC is in constant evolution and is one of the materials that are best suited in the context of preventive and conservative dentistry. It has satisfactory properties and versatility. On the other hand, presents inferior properties when compared to other direct restorative materials, requiring caution during its handling.
... Two calibrated independent examiners assessed the restorations at 6, 12, 24 and 36 months using established ART restoration criteria [27]. The inter-examiner consistency, expressed as kappa coefficient and percentage of agreement (P o ), were 0.82 and 89.7%, respectively. ...
Article
Full-text available
Objectives: To assess the 3-year cumulative survival rate of atraumatic restorative treatment (ART) and conventional resin composite restorations (CRT) placed in persons with disability. Materials and methods: Patients referred for restorative care to the Haemophilia Foundation special care service were treated by one of two specialists. Patients and/or caregivers were provided with written and verbal information regarding treatment options and selected the alternative they preferred. Treatment was provided as selected unless this option proved clinically unfeasible when an alternative technique was proposed. The treatment protocols were ART (hand instruments/high-viscosity glass-ionomer) in the clinic or CRT (rotary instrumentation/resin composite) in the clinic or under general anaesthesia (GA). After 6, 12, 24 and 36 months, two independent, trained and calibrated examiners evaluated restoration survival using established ART codes. The proportional hazard model with frailty corrections gave survival estimates over 3 years. Results: Sixty-six patients (13.6 ± 7.8 years) with 16 different disability profiles participated. CRT in the clinic proved feasible for five patients (13%), and 14 patients received CRT under GA (21%). ART was used for 47 patients (71.2%). Altogether, 298 dentine carious lesions were restored in primary and permanent teeth (182 ART; 116 CRT). The 3-year cumulative survival rates and jackknife standard errors for the 182 ART and 116 CRT restorations were 94.8 ± 2.1 and 82.8 ± 5.3%, respectively (p = 0.01). Conclusions: The 3-year follow-up results confirm that ART is an effective treatment protocol. Clinical relevance: Patients with disability, many of whom have difficulty coping with CRT, may benefit from the ART approach.
... 6 This has led to changes in the professional medical and dental communities' use of dental amalgam worldwide, and to the introduction of and switching to tooth-colored materials as alternative materials for caries restoration. [7][8][9] Alexander et al recently looked into dentists' decision-making of restoratives in the absence of an amalgam option. 10,11 The aims of the current study were to assess the current use of various restoration materials among pediatric and general practitioner dentists in Israel, and to compare their preferences according to seniority and professional specialty. ...
Article
Objectives: To assess the current choice of various restoration materials among Israeli pediatric dentists according to seniority and specialty. Study design: Participating dentists completed a 23-item questionnaire on their qualifications, type of practice and preference of restorative material. Results: Seventy-five dentists (average age 46.27±12.6 years, 58 females) participated. Forty-one were specialist pediatric dentists and 34 were general practitioners. Amalgam was preferred by 49.3%, followed by composite (41.3%), glass ionomer cement (5.3%) and compomer (4%). Only 13.3% of the dentists thought amalgam bears environmental and health hazards, compared to 49.3% for composite. Satisfaction was high for amalgam and composite, less for glass ionomer cements and least for compomer. General practitioners preferred amalgam (70.6%) while pediatric dentists preferred composite (51.2%), P < 0.003. Conclusions: Amalgam and composite were the materials of choice among the participating Israeli dentists. Most of them (86.7%) responded that amalgam does not possess any health issues. Their satisfaction with the restoration materials was highest for amalgam and composite, a choice significantly affected by whether they were in general practice (amalgam) or specialized in pediatric dentistry (composite).
... Conventional GICs can be used to restore and seal caries lesion without the need of electric, rotatory and photocuring devices. [29,30] In the present study, it was observed that the addition of 10 wt.% of Nb 2 O 5 reduced microhardness values (p < .05) of two commercial GICs, while the other cement had it decreased at 20 wt.% of Nb 2 O 5 addition (p < .05). Higher concentrations of Nb 2 O 5 weakened the bulk of the cement and may lead to this result because this oxide is probably not chemically attacked by poly acrylic acid and it is not able to react in acid-basic reaction to take part in GICs setting. ...
Article
Full-text available
Objective: To determine the influence of niobium pentoxide (Nb2O5) addition on the physical and chemical properties of glass ionomer cements (GICs). Materials and methods: Five, 10 or 20 wt.% of Nb2O5 were incorporated into commercial GICs (Maxxion R, Vitro Molar, Vitro Fil R) and one group of each GIC remained without Nb2O5 (control groups). The GICs were evaluated by Knoop hardness, compressive strength, acid erosion, particle size and radiopacity. Data were analyzed by two-way ANOVA followed by Tukey's test. Results: The addition of 10% and 20% reduced the microhardness of two GICs (p < .05). Compressive strength showed no difference among groups (p > .05). Nb2O5 did not influence Maxxion R and Vitro Fil R regarding the acid erosion test (p > .05). Vitro Molar increased its acid erosion with 10% of Nb2O5 (p < .05). Maxxion R presented 15.78 μm, while Vitro Molar and Vitro Fil R showed 5.14 μm and 6.18 μm, respectively. As the Nb2O5 concentration increased, the radiopacity increased for all groups. Vitro Molar and Vitro Fil R did not present significant difference to at least 1 mm aluminum (p > .05). Conclusion: The addition of 5 wt.% Nb2O5 did not affect the tested physical and chemical properties of the GICs and improved the radiopacity of one of the cements. These materials are therefore suitable for further testing of biomimetic remineralization properties.
... Restoration fracture and marginal defects were the most common causes for failure in the amalgam group compared to loss of material in the GIC group [2]. In primary molars three years follow-up showed no significant differences between amalgam and GIC in single and multiple-surface restorations [3]. GIC restorations affect mineral components and remineralization of adjacent enamel and dentin [4][5]. ...
Article
Full-text available
Abstract Objectives: To examine the effect of energy application on microhardness of glass-ionomer cement (GIC), and the effect of the temperature applied on pulp temperature, in vitro and in vivo. Methods: Discs of EQUIA (GC Co. Japan) were examined for microhardness using Vickers indentations after heat application of 50 or 60oC for 30 or 60 seconds using light curing devices or a specific heating device, and compared to self setting GIC. The measurements were performed after 30, 60 minutes and after 5 days. Heat was applied to GIC occlusal restorations in deciduous and permanent teeth both in vitro and in vivo and the effect on pulp temperature was measured using a thermo-coupling device. Results: The best microhardness results were observed using a specific heating device at 50oC for 30 or 60 seconds, and the differences to self setting material after 60 minutes were statistically significant. After 5 days the differences in microhardness were non-significant. Temperature of 60oC caused the pulp temperature to rise with more than the accepted 5.5oC and may cause irreversible damage to the pulp. Similar pulpal temperature changes were observed in vitro and in vivo in deciduous and permanent teeth. Significance: The application of heat energy to GIC using a heating device improved the surface microhardness significantly during the first 60 minutes. The temperature to be used is around 50oC for 30 or 60 seconds in order not to cause irreversible damage to the pulp.
... After three years, both materials showed higher survival rates when used in single-surface restorations and no significant difference was found between the cumulative survival rates of amalgam and ART restorations. It should be noted that the high-viscosity GIC was used with a higher than usual powder-to-liquid ratio [48]. ...
Article
Full-text available
Objectives: (1) To describe caries lesions development and the role of fluoride in controlling disease progression; (2) to evaluate whether the use of fluoride-releasing pit and fissure sealants, bonding orthodontic agents and restorative materials, in comparison to a non-fluoride releasing material, reduces caries incidence in children or adults, and (3) to discuss how the anti-caries properties of these materials have been evaluated in vitro and in situ. Methods: The search was performed on the Cochrane Database of Systematic Reviews and on Medline via Pubmed. Results: Caries is a biofilm-sugar dependent disease and as such it provokes progressive destruction of mineral structure of any dental surface - intact, sealed or restored - where biofilm remains accumulated and is regularly exposed to sugar. The mechanism of action of fluoride released from dental materials on caries is similar to that of fluoride found in dentifrices or other vehicles of fluoride delivery. Fluoride-releasing materials are unable to interfere with the formation of biofilm on dental surfaces adjacent to them or to inhibit acid production by dental biofilms. However, the fluoride released slows down the progression of caries lesions in tooth surfaces adjacent to dental materials. This effect has been clearly shown by in vitro and in situ studies but not in randomized clinical trials. Significance: The anti-caries effect of fluoride releasing materials is still not based on clinical evidence, and, in addition, it can be overwhelmed by fluoride delivered from dentifrices.
Preprint
Full-text available
Background: This systematic review and network meta-analysis aimed to compare the clinical efficacy of bioactive and conventional restorative materials in controlling secondary caries (SC) and to provide a classification of these materials according to their effectiveness. Methods: A search was performed in Pubmed, Web of Science, Embase, BBO, Lilacs, Cochrane Library, Scopus, IBECS and gray literature. Clinical trials were included, with no language or publication date limitations. Paired and network meta-analyses were performed with random-effects models, comparing treatments of interest and classifying them according to effectiveness in the permanent and deciduous dentition and at 1-year or 2/more years of follow-up. The risk of bias was evaluated based on the Cochrane guidelines. Results: Sixty-two studies were included in the qualitative syntheses and 39 in the quantitative ones. In permanent teeth, resin composite (RC) (RR=2.00; 95%CI = 1.10, 3.64) and amalgam (AAG) (RR=1.79; 95%CI = 1.04, 3.09) showed a higher risk of SC than Glass Ionomer Cement (GIC). In the deciduous teeth, however, a higher risk of SC was observed with RC than with AAG (RR=2.46; 95%CI = 1.42, 4.27) and in GIC when compared to Resin-Modified Glass Ionomer Cement (RMGIC=1.79; 95%CI = 1.04, 3.09). Most articles showed low or moderate risk of bias. Conclusion: There is a difference between bioactive restorative materials for SC control, with GIC being more effective in the permanent teeth and the RMGIC in the deciduous teeth. Bioactive restorative materials can be adjuvants in the control of SC in patients at high risk for caries.
Article
Full-text available
Caries management at the lesion level is dependent on the lesion activity, the presence of a cavitation (either cleanable or non-cleanable), and lesion depth as evaluated via radiographic examination. A variety of non-invasive, micro-invasive, and minimally invasive treatment (with or without restoration) options are available for primary and permanent teeth. Non-invasive strategies include oral hygiene instructions, dietary counseling, and personal as well as professional use of fluoridated products that reduce demineralization and increase re-mineralization. Micro-invasive procedures include the use of occlusal resin sealants and resin infiltrants, while minimally invasive strategies comprise those related to selective removal of caries tissues and placement of restorations. Deep caries management includes indirect pulp capping, while exposed pulp may be treated using direct pulp capping and partial or complete pulpotomy. The aim of the present study was to review available evidence on recommended preventive and restorative strategies for caries lesions in Latin American/Caribbean countries, and subsequently develop evidence-based recommendations for treatment options that take into consideration material availability, emphasize ways to adapt available treatments to the local context, and suggest ways in which dentists and health systems can adopt these treatments.
Article
Objectives The hypothesis tested was that there is no significant difference between the survival estimates of atraumatic restorative treatment/high-viscosity glass-ionomer cement (ART/HVGIC) restorations, in posterior primary and permanent teeth, and traditional amalgam and resin composite restorations. Data sources The databases PubMed, DOAJ, LILACS, IndMed, Google Scholar and CNKI were searched. Data selection Using inclusion and exclusion criteria led to 14 eligible randomised trials. A low risk of bias was observed for two reports. Homogeneity was obtained for single-surface ART restorations after one and two years in the primary dentition. Data synthesis No statistically significant difference was found between the weighted mean survival percentages of ART/HVGIC and traditional treatments in both single- and multiple-surface restorations in primary molars and in single-surface restorations in posterior permanent teeth at years 1, 2, 3 and 5. At years 4.3 and 6.3, the difference between the two treatments was statistically significant, favouring the ART/HVGIC restorations. No statistically significant difference was found between the weighted mean survival percentages of ART/HVGIC and traditional treatments in multiple-surface restorations in posterior permanent teeth. Conclusion The ART method using HVGICs can be considered as a replacement for traditional restorations in single- and multiple-surface cavities in primary molars, and in single-surface cavities in posterior permanent teeth, particularly for amalgam.
Article
Full-text available
Objectives Aim of this systematic review was to summarize the factors that affect the success rate of atraumatic restorative treatment (ART) restorations in children. Data/Sources Two independent reviewers conducted a literature search in the databases PubMed, Medline and Web of Science until October 2019 with no initial time limit. Articles reporting on clinical outcomes of ART restorations placed in children were included. Study selection A total of 67 articles were included in this review reporting on clinical outcomes of ART restorations placed in children in 47 studies. The overall estimated success rate and 95 % confidence interval (CI) of ART restorations were 0.71 (0.65−0.77) and 0.67 (0.56−0.78) at the 12-month and the 24-month follow-up, respectively. Operator was one of the significant factors associated with the success rate of ART restorations. ART restorations placed by dental students/therapists had a significantly lower success rate compared with those placed by dentists. Besides, type of restoration (single-surface vs. multiple-surface restoration) was also associated with the success rate of ART restorations. Other factors including dentition, restorative material, clinical setting, and moisture control method had no significant influence on the success rate of ART restorations in children. Conclusion It is concluded that ART approach can be used to manage cavitated caries lesions in children. Operator and type of restoration are significant factors influencing the success rate of ART restorations. Clinical significance : This study provides valuable information on the factors that affect success rate of ART restorations in children, which helps clinicians to make informed decisions on provision of ART restorations in children.
Article
Background: There is no scientific evidence supporting the choice of luting cement for cementation of zirconia crowns. Aim: The purpose of this split-mouth study was to compare the efficacy of using Bio-active cement versus Packable glass ionomer for cementation of posterior pediatric zirconia crowns. Design: 50 first mandibular primary molars were restored by zirconia crowns and were randomly divided to be luted with either; 1) Bio-active cement, 2) Packable glass ionomer. Crowns' retention, fracture, and gingival condition; were evaluated at 1 week, 1, 3, 6, 9, 12, 18, 24 and 36-month intervals. Statistical analysis was carried out using Fisher Exact test, Kaplan-Meier survival analysis and Wilcoxon signed rank test. Results: At 3-36-month follow-ups; there were statistically significant (p=0.009- ≤0.001) less debonded crowns in packable glass ionomer group. There were no fractured crowns for either cements. There was no statistically significant difference between gingival index scores. Conclusions: Packable glass ionomer is more retentive than bio-active cement when used for cementing zirconia pediatric crowns. Posterior zirconia pediatric crowns have high fracture resistance after 36 months clinical performance, irrespective of luting cement. Luting cement for zirconia pediatric crowns has no apparent effect on gingival condition around crowns.
Thesis
Les matériaux de restauration à usage temporaire sont d’utilisation fréquente dans la pratique quotidienne des chirurgiens-dentistes. Le statut de matériau temporaire et la relativement courte durée de fonction intra-orale ne doivent pas laisser penser que la composition et les propriétés dudit matériau pourraient être négligées et dénuées d’importance. Les matériaux d’obturation temporaire, comme les matériaux d’usage, ont un cahier des charges complexe. Dans la première partie de notre travail, nous sommes revenus sur l’ensemble des objectifs qu’un matériau de restauration temporaire se devrait d’idéalement remplir. Dans un seconde partie, nous avons décrit par famille les matériaux à disposition des praticiens avant de développer dans une troisième partie les critères aidant au choix clinique. Enfin, dans notre dernière partie, nous avons précisé les indications des différents matériaux temporaires en odontologie conservatrice selon la situation clinique, les objectifs à atteindre et le statut pulpaire des dents concernées.
Article
Full-text available
Objetivo: este estudo examinou a relação entre a largura vestíbulo-lingual e a taxa de sobrevivência de múltiplas restaurações superficiais, após o ciclo mecânico simulado. Material e Métodos: foram avaliadas três larguras de cavidades: Regular (R = 3,21mm), Grande (L = 4,81mm) e Muito Grande (VL - 6,42mm). Trinta extraído os dentes foram selecionados, preparados, restaurados com cimento de ionômero de vidro de alta viscosidade através da técnica de ART e sujeitos a ciclos mecânicos simulados. Em cada grupo, as amostras foram classificadas de acordo com quatro diferentes pontuações: 0 - sem fratura, 1 - fratura sem necessidade de reparo, 2 - fratura com possível reparo e 3 - restauração completa perda / impossível de reparar. O teste de Kruskal-Wallis foi utilizado para a análise dos desfechos categóricos. Resultados: houve diferença estatisticamente significante entre todos grupos (p <0,05), onde a variável “largura buco-lingual” afetou diretamente os resultados. Conclusão: cavidades com dimensões controladas, mais próximas do que é academicamente indicados, têm uma taxa de sucesso mais favorável, compatível com os encontrados em cavidades oclusais.
Article
Background: Dental caries is a sugar-dependent disease that damages tooth structure and, due to loss of mineral components, may eventually lead to cavitation. Dental caries is the most prevalent disease worldwide and is considered the most important burden of oral health. Conventional treatment methods (drill and fill) involve the use of rotary burs under local anaesthesia. The need for an electricity supply, expensive handpieces and highly trained dental health personnel may limit access to dental treatment, especially in underdeveloped regions.To overcome the limitations of conventional restorative treatment, the Atraumatic Restorative Treatment (ART) was developed, mainly for treating caries in children living in under-served areas of the world where resources and facilities such as electricity and trained manpower are limited. ART is a minimally invasive approach which involves removal of decayed tissue using hand instruments alone, usually without use of anaesthesia and electrically driven equipment, and restoration of the dental cavity with an adhesive material (glass ionomer cement (GIC), composite resins, resin-modified glass-ionomer cement (RM-GICs) and compomers). Objectives: To assess the effects of Atraumatic Restorative Treatment (ART) compared with conventional treatment for managing dental caries lesions in the primary and permanent teeth of children and adults. Search methods: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 22 February 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 1), MEDLINE Ovid (1946 to 22 February 2017), Embase Ovid (1980 to 22 February 2017), LILACS BIREME Virtual Health Library (Latin American and Caribbean Health Science Information database; 1982 to 22 February 2017) and BBO BIREME Virtual Health Library (Bibliografia Brasileira de Odontologia; 1986 to 22 February 2017). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. Selection criteria: We included randomised controlled trials (RCTs) with at least six months' follow-up that compared the effects of ART with a conventional restorative approach using the same or different restorative dental materials to treat caries lesions. Data collection and analysis: Two review authors independently screened search results, extracted data from included studies and assessed the risk of bias in those studies. We used standard methodological procedures expected by Cochrane to evaluate risk of bias and synthesise data. Where pooling was appropriate we conducted meta-analyses using the random-effects model. We assessed the quality of the evidence using GRADE criteria. Main results: We included a total of 15 eligible studies randomising 3760 participants in this review. The age of participants across the studies ranged from 3 to 101 years, with a mean of 25.42 years. 48% of participants were male. All included studies were published between 2002 and 2016. Two of the 15 studies declared that the financial support was from companies that manufacture restorative material. Five studies were individually randomised parallel-group studies; six were cluster-randomised parallel-group studies; and four were randomised studies that used a split-mouth design. Eleven studies evaluated the effects of ART on primary teeth only, and four on permanent teeth. The follow-up period of the included studies ranged from 6 months to 36 months. We judged all studies to be at high risk of bias.For the main comparison of ART compared to conventional treatment using the same material: all but two studies used high-viscosity glass ionomer (H-GIC) as the restorative material; one study used a composite material; and one study used resin-modified glass ionomer cement (RM-GIC)).Compared to conventional treatment using H-GIC, ART may increase the risk of restoration failure in the primary dentition, over a follow-up period from 12 to 24 months (OR 1.60, 95% CI 1.13 to 2.27, five studies; 643 participants analysed; low-quality evidence). Our confidence in this effect estimate is limited due to serious concerns over risk of performance and attrition bias. For this comparison, ART may reduce pain during procedure compared with conventional treatment (MD -0.65, 95% CI -1.38 to 0.07; 40 participants analysed; low-quality evidence)Comparisons of ART to conventional treatment using composite or RM-GIC were downgraded to very low quality due to indirectness, imprecision and high risk of performance and attrition bias. Given the very low quality of the evidence from single studies, we are uncertain about the restoration failure of ART compared with conventional treatment using composite over a 24-month follow-up period (OR 1.11, 95% CI 0.54 to 2.29; one study; 57 participants) and ART using RM-GIC in the permanent teeth of older adults with root caries lesions over a six-month follow-up period (OR 2.71, 95% CI 0.94 to 7.81; one study; 64 participants).No studies reported on adverse events or costs. Authors' conclusions: Low-quality evidence suggests that ART using H-GIC may have a higher risk of restoration failure than conventional treatment for caries lesions in primary teeth. The effects of ART using composite and RM-GIC are uncertain due to the very low quality of the evidence and we cannot rely on the findings. Most studies evaluated the effects of ART on the primary dentition.Well-designed RCTs are required that report on restoration failure at clinically meaningful time points, as well as participant-reported outcomes such as pain and discomfort. Due to the potential confounding effects from the use of different dental materials, a robust body of evidence on the effects of ART compared with conventional treatment using the same restoration material is necessary. We identified four ongoing trials that could provide further insights into this area.
Article
Full-text available
Abstract Objectives: Addition of chlorhexidine has enhanced the antimicrobial effect of glass ionomer cement (GIC) indicated to Atraumatic Restorative Treatment (ART); however, the impact of this mixture on the properties of these materials and on the longevity of restorations must be investigated. The aim of this study was to evaluate the effects of incorporating chlorhexidine (CHX) in the in vitro biological and chemical-mechanical properties of GIC and in vivo clinical/ microbiological follow-up of the ART with GIC containing or not CHX. Material and Methods: For in vitro studies, groups were divided into GIC, GIC with 1.25% CHX, and GIC with 2.5% CHX. Antimicrobial activity of GIC was analyzed using agar diffusion and anti-biofilm assays. Cytotoxic effects, compressive tensile strength, microhardness and fluoride (F) release were also evaluated. A randomized controlled trial was conducted on 36 children that received ART either with GIC or GIC with CHX. Saliva and biofilm were collected for mutans streptococci (MS) counts and the survival rate of restorations was checked after 7 days, 3 months and one year after ART. ANOVA/Tukey or Kruskal-Wallis/ Mann-Whitney tests were performed for in vitro tests and in vivo microbiological analysis. The Kaplan-Meier method and Log rank tests were applied to estimate survival percentages of restorations (p
Chapter
This chapter outlines the physical and chemical properties of glass-ionomer (GIC) and resin-modified glass-ionomer cements. The latter part proceeds to summarise various aspects of their clinical performance. It is noted that these materials are brittle in nature when fully matured or set. Glass-ionomer cements, due to the process of the setting reaction, reach their full strength about 24 h after the initial mixing. The resin-modified materials have an additional hydrophilic resin included that improves early strength and aesthetics but importantly reduces the initial sensitivity to water, allowing early finishing shortly after placement. Application of a resin coating on the surface of GICs has shown some improvement in the fracture strength, but seems to be material dependent based on current evidence. The improvement in strength is thought to be due to the resin-filling surface defects and cracks where fracture may be initiated. Not all materials or studies have shown consistent outcomes for this coating method. There is limited evidence to suggest that the wear resistance may also be enhanced with the resin coating. Ion release is also described in this chapter. This part shows that the initial release of ions, in particular fluoride, is high but tapers off to steady low-level release. The clinical benefits are still not well understood. The latter part of the chapter summarises various aspects of the clinical performance of GICs. Studies of retention in non-carious cervical lesions are described, as well as recent work using the atraumatic restorative treatment (ART) technique. The last part outlines results from fissure sealant studies that tend to show poor retention of GIC sealants. However, even though retention may be limited, it appears that GICs can afford some long-lasting anticariogenic effects to the fissure system.
Chapter
This chapter aims to discuss the evidence available to date from various laboratory and clinical studies about the use of glass-ionomer cements (GICs) in the management of deep caries. The contemporary minimally invasive approach to the operative management of cavitated deep lesions approaching the pulp relies on the selective removal of infected and/or affected dentine close to the pulp, followed by the use of a suitable adhesive restorative material to seal and bond to the underlying peripheral cavity margins/walls. In order to optimize the clinical outcome, an appreciation is required as to how this physico-chemical interaction occurs between GIC and sound as well as caries-affected substrates. The ionic transfer between GIC and tooth structure is described and discussed, with a particular emphasis on its anti-caries and remineralizing potential and also any effects, deleterious or otherwise, on the dental pulp when placed in close proximity to it. The clinical techniques available to restore teeth using high-viscosity GICs are outlined, including Atraumatic Restorative Treatment (ART) and the layered/laminate/sandwich restoration with resin composite. The findings of studies assessing the clinical longevity of such restorations in comparison to other direct plastic restorative materials are analyzed, both in the primary and secondary dentition. From the evidence presented, it is clear that GIC and its derivatives, whilst not perfect, have a major role to play in the minimally invasive restorative management of deep caries lesions.
Article
Full-text available
This study aimed to test the hypothesis that there is no difference in the survival rates of molars treated according to the conventional restorative treatment (CRT) using amalgam, atraumatic restorative treatment (ART) using high-viscosity glass ionomer, and ultraconservative treatment (UCT) protocol after 3.5 years. Cavitated primary molars were treated according to CRT, ART, and UCT (small cavities were restored with ART and medium/large cavities were daily cleaned with toothpaste/toothbrush under supervision). Molar extractions resulting from toothache, sepsis, or pulp exposure were failures. The Kaplan-Meier method was used to estimate the survival curves. The numbers of treated teeth, among the 302 6-7-year-old children, were 341 (CRT), 244 (ART), and 281 (for UCT group: 109 small ART, 166 open cavities, and 6 combinations). Protocol groups were similar at baseline regarding gender and mean decayed missing filled tooth score, but not regarding age and type of surface. The numbers of molars extracted were 22 (CRT), 16 (ART), and 26 (UCT). Fistulae were most often recorded. After 3.5 years, the cumulative survival rate ± standard error for all molars treated was 90.9 ± 2.0 % with CRT, 90.4 ± 2.4 % with ART, and 88.6 ± 1.9 % with UCT (p = 0.13). Only a type of surface effect was observed over the 3.5-year period: survival rates for molars were higher for single- than for multiple-surface cavities. There was no difference in the cumulative survival rates of primary molars treated according to the CRT, ART, and UCT protocols over a 3.5-year period. Keeping cavities in primary molars biofilm-free might be another treatment option alongside restoring such cavities through conventional and ART protocols.
Article
Full-text available
Objective To test the null-hypotheses that no difference in diametral tensile, compressive and flexural strengths exists between: (1) The EQUIA system and (2) The Chemfil Rock (encapsulated glass-ionomers; test materials) and the Fuji 9 Gold Label and the Ketac Molar Easymix (hand-mixed conventional glass-ionomers; control materials); (3) The EQUIA system and Chemfil Rock. Material and Methods Specimens for testing flexural (n = 240) and diametral tensile (n=80) strengths were prepared according to standardized specifications; the compressive strength (n=80) was measured using a tooth-model of a class II ART restoration. ANOVA and Tukey B tests were used to test for significant differences between dependent and independent variables. Results The EQUIA system and Chemfil Rock had significantly higher mean scores for all the three strength variables than the Fuji 9 Gold Label and Ketac Molar Easymix (α=0.05). The EQUIA system had significant higher mean scores for diametral tensile and flexural strengths than the Chemfil Rock (α=0.05). Conclusion The two encapsulated high-viscosity glass-ionomers had significantly higher test values for diametral tensile, flexural and compressive strengths than the commonly used hand-mixed high-viscosity glass-ionomers.
Article
Full-text available
Adding heat to glass ionomers during setting might improve mechanical properties. The aim was to compare the biaxial flexural strength (BFS) between and within four glass ionomers, by time of exposure to a high-intensity LED light-curing unit. Materials and methods. Samples of Fuji 9 Gold Label, Ketac Molar Easymix, ChemFil Rock, and the EQUIA system were divided into three treatment groups (n = 30): without heating (Group 1), heated with LED lamp of 1400 mW/cm(2) for 30 s while setting (Group 2), and heated with LED lamp of 1400 mW/cm(2) for 60 s while setting (Group 3). Samples were stored for 48 hours in distilled water at 37°C until tested. BFS was tested, using a universal testing machine at a crosshead speed of 1 mm/min. Data were analyzed, using ANOVA test with the Bonferroni correction (α = 0.05). Heating the glass-ionomer cements with an LED curing light of 1400 mW/cm(2) during setting for 30 s increased the BFS value of all GICs. No statistically significant difference in mean BFS scores was found between the EQUIA system and ChemFil Rock at 30 s and 60 s. The mean BFS value was statistically significantly higher for the EQUIA system and ChemFil Rock than for Fuji 9 Gold Label and Ketac Molar Easymix at all exposure times.
Article
Full-text available
Objectives The aims of this study were to compare 2-year cumulative survival rates of amalgam and atraumatic restorative treatment (ART) restorations in primary molars and to investigate the determinants of the survival rate of restorations. Materials and methods A controlled clinical trial using a parallel group design was carried out on 258 children aged 6–7 years old, allocated to two treatment groups: conventional restorative treatment using amalgam and ART using high-viscosity glass ionomer. A total of 364 amalgam restorations and 386 ART restorations were placed by three pedodontists in 126 and 158 children, respectively, and were evaluated after 0.5, 1, and 2 years. Restorations were placed in vital primary molars with neither pain nor signs of pulp involvement. The survival analysis was conducted using the proportional hazard rate regression model with frailty correction. Results The 2-year cumulative survival rates for all amalgam (77.3 %) and ART (73.5 %) restorations were not statistically significantly different, but there was an effect of “type of surface” (single/multiple) and “cavity filling time” on the survival rates. Both amalgam and ART single-surface restorations had higher survival rates than multiple-surface restorations of the same material. Secondary caries was responsible for 36 and 38 % of failures in amalgam and ART restorations, respectively. Mean time for restoring all type of cavities with amalgam and ART restorations was 13.6 and 13.7 min, respectively. Conclusions Amalgam and ART restorations presented similar survival rates over a 2-year period for all, single-surface, and multiple-surface restorations. Clinical relevance In the cause of finding alternatives to amalgam, ART restorations using high-viscosity glass ionomer might be a suitable option for managing cavitated dentine carious lesions in vital primary molars.
Article
Full-text available
The atraumatic restorative treatment (ART) approach was born 25 years ago in Tanzania. It has evolved into an essential caries management concept for improving quality and access to oral care globally. Meta-analyses and systematic reviews have indicated that the high effectiveness of ART sealants using high-viscosity glass ionomers in carious lesion development prevention is not different from that of resin fissure sealants. ART using high-viscosity glass ionomer can safely be used to restore single-surface cavities both in primary and in permanent posterior teeth, but its quality in restoring multiple surfaces in primary posterior teeth cavities needs to be improved. Insufficient information is available regarding the quality of ART restorations in multiple surfaces in permanent anterior and posterior teeth. There appears to be no difference in the survival of single-surface high-viscosity glass-ionomer ART restorations and amalgam restorations. The use of ART results in smaller cavities and in high acceptance of preventive and restorative care by children. Because local anaesthesia is seldom needed and only hand instruments are used, ART is considered to be a promising approach for treating children suffering from early childhood caries. ART has been implemented in the public oral health services of a number of countries, and clearly, proper implementation requires the availability of sufficient stocks of good high-viscosity glass ionomers and sets of ART instruments right from the start. Textbooks including chapters on ART are available, and the concept is being included in graduate courses at dental schools in a number of countries. Recent development and testing of e-learning modules for distance learning has increasingly facilitated the distribution of ART information amongst professionals, thus enabling more people to benefit from ART. However, this development and further research require adequate funding, which is not always easily obtainable. The next major challenge is the continuation of care to the frail elderly, in which ART may play a part. ART, as part of the Basic Package of Oral Care, is an important cornerstone for the development of global oral health and alleviating inequality in oral care.
Article
Full-text available
BACKGROUND: This 3 rd systematic review update includes evidence from further Chinese trials that were identified during reference re-check and regression analysis of the possible influence of split-mouth study design on overall results.
Article
Full-text available
BACKGROUND: 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.
Article
Full-text available
This protocol has been registered with the International Prospective Register for Systematic Reviews (PROSPERO) on the 05 January 2012 under registration number CRD42012001887 (Available online from http://www.crd.york.ac.uk/PROSPERO/full_doc.asp?ID=CRD42012001887). This protocol comprises an update of an existing systematic review report by the authors as part of the SYSTEM initiative: Mickenautsch S, Yengopal V, Banerjee A. Atraumatic restorative treatment versus amalgam restoration longevity: a systematic review. Clin Oral Investig 2010; 14: 233-40. The protocol of this original review was not registered. This update will differ from the original review by changing and adding the following: PICO question: while the original review focused on the comparative success rate, this update will focus on the comparative failure rate between ART and amalgam restorations; Systematic literature search: extended to the databases for open access journals (OpenJ-Gate); regional databases (LILACS, BBO, IndMed, SABINET, Scielo); grey literature sources (Scirus/Medicine, OpenSIGLE, GoogleScholar); hand-searching of additional journals that were identified as not been indexed in above databases; searching of reference lists of included articles; Search term development: a detailed search strategy will be added; the search cut-off date will be extended beyond the date of the original systematic review; Article inclusion criteria: while the original review focused on articles published in English, only, this update will have no restriction on the publication language type; Article exclusion criteria: while the original review used lack of randomisation/quasi-randomisation as criteria for exclusion, this update will include all clinical controlled trials for data extraction; Data extraction: The information extracted from trials will be more extensive in terms of general trial information, intervention integrity, methodological quality and bias risk; Data analysis and reporting: in addition to a computed relative point estimate (RR = Risk ratio), the results will also be converted into an absolute outcome measure (RD = Risk difference), as well as an illustrative comparative risk for both, test- and control intervention, and reported accordingly; a summary of findings table will be added; statistical heterogeneity will be investigated using regression analysis; sensitivity analysis will be added in order to establish whether all findings are robust to the type of data analysis used; The original quality assessment of studies, including its criteria, will be replaced by a more stricter assessment of selection-, detection-, performance-, attrition bias risk; the assessment of publication- and reporting bias risk in the accepted trials will be added; Research gaps within accepted trials in terms of imprecision, inconsistency, lack of right information and shortcomings in bias risk control will be identified using a designated worksheet and subsequently more detailed recommendations for further research will be added to the this systematic review update.
Article
Full-text available
Unlabelled: Atraumatic Restorative Treatment (ART) is considered to be well accepted, both by children and by adult patients. The objective of this review is to present and discuss the evidence regarding the acceptability of ART, from the patient's perspective. Aspects related to dental anxiety/fear and pain/discomfort have been highlighted, to facilitate better understanding and use of the information available in the literature. Conclusions: The ART approach has been shown to cause less discomfort than other conventional approaches and is, therefore, considered a very promising "atraumatic" management approach for cavitated carious lesions in children, anxious adults and possibly, for dental-phobic patients.
Article
Full-text available
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. 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.
Article
Full-text available
The aim of the present study was to assess the caries experience of children aged 6 to 7 years old in a socially deprived suburban area of Brazil's Federal District, using the ICDAS II system and to investigate determinants of dental caries. The survey was carried out in six public schools by three calibrated examiners, on a sample of 835 children. ICDAS II codes had to be converted into dmf/DMF components at surface and tooth levels, resulting in unfamiliar caries variables, to enable some meaningful reporting of the findings. The prevalence of dental caries, including enamel and dentinal carious lesions, in primary teeth was 95.6% and in permanent teeth it was 63.7%. Mean values of d(2)mf(2)-t (enamel and dentinal lesions), d(3)mf(3)-t (dentine lesions), D(2)MF(2)-T and D(3)MF(3)-T indices were 6.9 ± 3.8, 3.2 ± 3.4, 1.7 ± 1.6 and 0.2 ± 0.5, respectively. Enamel carious lesions predominated in the dmf-t/s and DMF-T/S indices. Seven-year-old children had statistically significantly more enamel and dentine carious lesions in permanent teeth than 6-year-old children had. Using ICDAS II, the prevalence of dental caries in both dentitions was very high. In both dentitions, the decay component predominated, with hardly any restorations or extractions observed. The new ICDAS II system leads to overvaluation of the seriousness of dental caries experience and made reporting of outcomes cumbersome. Guidelines on analysing data and reporting results should be agreed upon before this system can be used in epidemiological surveys globally.
Article
Full-text available
Unlabelled: 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.
Article
Full-text available
The purpose of this study was to find an answer as to what to do with Atraumatic Restorations (ART) failures: re-restore or leave the preparation further unfilled? Cross sectional study. In 2006, 804 children in Kenya each had one proximal cavity treated using the ART approach. Out of the original group of 192 children, who had lost their restorations but still had the treated molars in situ, were selected for further study in 2008. The length of time that the restorations had been in situ was known while the colour, hardness and the extent of infected dentine was then evaluated and documented. Analysis of the data obtained was conducted using SPSS 16.0. Chi Square tests were performed with the variables of hardness, colour and infected dentine, and a 5% confidence interval was used. The Spearman's Rank Correlation Coefficient was also calculated. The results showed that 66% of the molars that had lost restorations had hard dentine, 78% of the preparations showed dark dentine and 50.7% appeared to have no infected dentine. These percentages increased with the increase in the survival time of the restorations. It is not always necessary to re-restore primary molars after ART restoration loss. Further research is necessary to confirm these findings.
Article
Full-text available
To compare the level of pain among children treated according to the Atraumatic Restorative Treatment (ART) and the Conventional Restorative Treatment (CRT). Forty children of both genders, 4- to 7-years old, presenting Class I cavitated dentin lesions in primary molars were randomly allocated to 2 groups. One group (CRT) received conventional restorative treatment using rotary instruments, while in the other one (ART) hand instruments were used to perform the restorations. All children were treated by the same operator A high-viscosity glass-ionomer cement (Fuji IX) was used to restore the teeth in both groups. Children's pain was measured at the end of the first restorative treatment session using the Wong-Baker FACES Pain Rating Scale (dependent variable). Age, gender, treatment time and treatment group were independent variables. ANOVA and ANCOVA tests were used to analyze the data. The CRT procedure took longer than the ART procedure (p < 0.001). Children from the ART group reported less pain than those from the CRT group (p = 0.0037). Four year olds reported more pain than 5- to 7-year olds (p < 0.0001) in both groups. Restorations placed using ART were less time consuming, children felt less pain when the ART approach was used, and younger children (4-years) reported more pain than the older ones for both restorative treatments.
Article
Full-text available
The aims of this prospective randomised clinical study were to clinically evaluate a radiopaque, highly filled, hybrid, light-activated resin-based composite for posterior teeth (Occlusin, ICI Dental, Macclesfield, UK and GC Dental, Tokyo, Japan) and compare the performance of restorations placed using rubber dam or cotton roll isolation. One clinician placed 100 (42 Class I and 58 Class II) restorations of the material under investigation. The isolation mode for each restoration was determined randomly: 52 preparations were protected from contamination with cotton rolls and aspiration, and 48 preparations were isolated under rubber dam. At baseline and periodically thereafter (0.5, 1, 2, 3, 4, 5, 6, and 10 years), each composite was evaluated by two practitioners using a modified (USPHS) rating system. After 10 years, 37 restorations were reviewed. The results showed satisfactory clinical performance with and without rubber dam after 10 years. A concern was the number of failures at 10 years due to unsatisfactory proximal contact. The evaluations for the surviving restorations were acceptable but with a large reduction in the percentage with ideal occlusal and proximal anatomy. The 10-year comparison of isolation modes showed no statistically significant differences (Kruskal-Wallis test) for each of the evaluation criteria. Furthermore, survival analysis showed no significant difference between the groups (Mantel-Haenszel method). It was concluded that the 10-year clinical behaviour of the restorations of a posterior composite placed under well-controlled, effective isolation with cotton rolls and aspiration, was not significantly different from the behaviour of restorations placed using rubber dam isolation.
Article
Full-text available
The changing oral health needs in South Africa require that both the teaching and clinical techniques of atraumatic restorative treatment (ART) form a part of the restorative undergraduate curriculum. This study was undertaken to establish and compare the estimated costing of an amalgam, composite resin and ART restoration within the Board of Health Funders (BHF) recommended scale of benefits at the School of Oral Health Sciences Oral and Dental Hospital, University of the Witwatersrand (SOHS). Fixed and variable costs were calculated by pricing items and equipment used in each procedure. The output values were established according to the recommended scale of benefits (BHF, 1999). This enabled the calculation of contribution margins and net income for each of the three restorations. The annual capital cost for the ART approach is approximately 50% of the other two options (e.g. per multiple surface restoration ART = R1.58; amalgam and composite resin restorative procedures: R3.12 and R3.10 respectively), despite the fact that ART restorations are rendered in a modern dental setting. Our study shows that implementation of the ART approach within the clinic setting of the SOHS can be accomplished without additional cost. Furthermore ART can be performed as an economically viable alternative to conventional treatment procedures within the clinic setting. The study represents a first step towards determining the cost efficiency of implementing ART as a pragmatic and cost-effective restorative option within the SOHS, University of the Witwatersrand.
Article
Full-text available
To investigate the outcome of non-restoration of carious deciduous teeth by means of a retrospective analysis of clinical case notes of children regularly attending two general dental practices and receiving preventive care. Using a carefully defined protocol the fate of deciduous teeth diagnosed as carious into dentine but symptomless and left unrestored was determined from the sequential examination of the clinical records of 481 children attending at least annually. The age at initial diagnosis of carious teeth ranged from 1-12 years with the majority of cavities (1,005) presenting by 6 years of age. In all, 1,587 teeth were followed until loss from the mouth. Of these, 190 (12%) were extracted because of pain and a further 60 (4%) became painful and were treated, leaving 1,337 (84%) that remained symptomless until being lost. Of the 1,337 symptomless teeth, 178 were extracted under general anaesthesia at the same time as painful ones. The final group of 1,159 (74%) teeth were exfoliated without causing pain after a mean survival time of 1,332 days. Excluding from the analysis the 178 extracted, but symptomless teeth, leaves a total of 1,409 teeth of which 18% gave pain and were extracted or treated and the remaining 82% exfoliated. The strongest determinant of pain was age on diagnosis, the other factors being tooth type and extent of the cavity when first seen. The carious teeth most likely to cause symptoms were found to be molars that developed cavities with pulpal involvement by the age of 3 years, 34% of which caused pain. In contrast, those least likely to cause pain were carious molar teeth presenting without pulpal involvement after 8 years, only 6% of which produced symptoms. In these patients, the majority of unrestored carious deciduous teeth remain symptomless until shed. The results provide evidence to aid the treatment planning of carious deciduous teeth in children regularly receiving regular preventive dental care.
Article
Full-text available
To compile a survey of the longevity and reasons for failure of stainless steel crowns, amalgam, glass-ionomer, composite and compomer restorations in stress-bearing cavities of primary molars. This work reviewed the dental literature of 1971 up to July 2003 for longitudinal, controlled clinical studies and retrospective cross-sectional studies. Only studies investigating the clinical performance of restorations in primary teeth with an observation period of at least 2 years were included. Annual failure rates of stainless steel crowns, amalgam, glass-ionomer, composite and compomer restorations were determined and failure reasons were discussed. Annual failure rates in stress-bearing cavities of primary molars were determined to be: 0-14% for stainless steel crowns, 0-35.3% for amalgam restorations, 0-25.8% for glass-ionomer restorations, 2-29.1% for atraumatic restorative treatments, 0-15% for composite restorations, and 0-11 for compomer restorations. Main reasons for failure were secondary caries, marginal deficiencies, fracture, and wear.
Article
In recent years, multiple imputation has emerged as a convenient and flexible paradigm for analysing data with missing values. Essential features of multiple imputation are reviewed, with answers to frequently asked questions about using the method in practice.
Article
To obtain longevity of oral rehabilitations successfully, evidence-based examination and careful treatment planning are required. If standards of diagnosis and treatment planning are not firmly established the risk of treatment done in haphazard ways increases, making long term success of the cases difficult to achieve. Among many treatment criteria for full mouth re-construction, this case report is focused on the criteria of occlusal section.
Article
Data showed that among 5-year-old Chinese, 96.7% of cavitated primary teeth were left untreated. The study aimed to report on the course of cavitated primary teeth within the Chinese health-care system over a period of 3.5 years. Selection of high caries risk children for inclusion in a sealant comparison study was based on the presence of cavitated dentine lesions in their primary teeth. At the 6-month sealant evaluation point many of these cavitated dentine lesions had not been treated. This necessitated monitoring these cavitated teeth 6-monthly for those exfoliated, restored, with a cavity left open, having caused toothache (symptom) and having (or having had) an abscess or fistulae (symptom). Care-seeking instruction was given at every evaluation point. anova and t-test were used in analysing the data. A total of 1012 cavitated primary teeth in 305 children (7.6 to 9.3 years old), were followed for 3.5 years. A total of 92.9% of cavitated primary teeth were left open, while 7.1% were restored at some stage during the observation period; 98.5% of restored teeth and 95.5% of cavitated teeth left open exfoliated and 93.9% of restored teeth and 81.5% of cavitated primary teeth left open exfoliated without any symptoms. Having (or having had) toothache was the symptom most frequently related to exfoliated restored teeth and to exfoliated cavitated teeth left open. Restored primary teeth survived statistically significantly longer than cavitated primary teeth left open: 1.99 ± 0.07 years and 1.68 ± 0.03 years, respectively. The large majority of cavitated primary teeth in this child population exfoliated without symptoms.
Article
The analysis of censored failure times is considered. It is assumed that on each individual are available values of one or more explanatory variables. The hazard function (age-specific failure rate) is taken to be a function of the explanatory variables and unknown regression coefficients multiplied by an arbitrary and unknown function of time. A conditional likelihood is obtained, leading to inferences about the unknown regression coefficients. Some generalizations are outlined. LIFEtables are one of the oldest statistical techniques and are extensively used by medical statisticians and by actuaries. Yet relatively little has been written about their more formal statistical theory. Kaplan and Meier (1958) gave a comprehensive review of earlier work and many new results. Chiang in a series of papers has, in particular, explored the connection with birth-death processes; see, for example, Chiang (1968). The present paper is largely concerned with the extension of the results of Kaplan and Meier to the comparison of life tables and more generally to the incorporation of regression-like arguments into life-table analysis. The arguments are asymptotic but are relevant to situations where the sampling fluctuations are large enough to be of practical importance. In other words, the applications are more likely to be in industrial reliability studies and in medical statistics than in actuarial science. The procedures proposed are, especially for the two-sample problem, closely related to procedures for combining contingency tables; see Mantel and Haenzel (1959), Mantel (1963) and, especially for the application to life tables, Mantel (1966). There is also a strong connection with a paper read recently to the Society by R. and J. Peto (1972). We consider a population of individuals; for each individual we observe either the time to "failure" or the time to ccloss" or censoring. That is, for the censored individuals we know only that the time to failure is greater than the censoring time. Denote by T a random variable representing failure time; it may be discrete or continuous. Let F(t) be the survivor function, %(t) = pr (T2 t)
Article
The analysis of censored failure times is considered. It is assumed that on each individual are available values of one or more explanatory variables. The hazard function (age‐specific failure rate) is taken to be a function of the explanatory variables and unknown regression coefficients multiplied by an arbitrary and unknown function of time. A conditional likelihood is obtained, leading to inferences about the unknown regression coefficients. Some generalizations are outlined.
Article
Background Atraumatic restorative treatment (ART) has demonstrated good longevity when used for single-surface restorations, but lower success rates are reported for occlusoproximal surfaces. AimThis systematic review and meta-analysis aimed to verify the pooled success rate of occlusoproximal ART restorations in primary teeth considering the outcomes: longevity, pulp damage, or caries lesion progression. DesignLiterature searching was carried out on the studies reporting clinical trials indexed in PubMed and in English language, comprising the outcomes. A meta-analysis was undertaken considering the results from reviewed studies. ResultsAn initial search resulted in 126 articles, and three of them were finally selected. The main reasons for excluding articles were the absence of control group, as amalgam, composite resin, or compomer restorations to be compared with ART (hand excavation+high-viscous GIC). The pooled estimate (odds ratio; 95% confidence interval) for ART approach success was 1.04 (0.65-1.66). Conclusion Atraumatic restorative treatment restorations performed with high-viscous GIC present similar survival/success rates to conventional approach using composite resin or amalgam for occlusoproximal restorations in primary teeth and can be suggested as a good option for occlusoproximal cavities in primary molars. In addition, further randomized controlled clinical investigations concerning occlusoproximal restorations in primary teeth are still necessary.
Article
Unlabelled: Whether deciduous teeth should be restored has caused controversy for at least 150 years and the argument rages on. Dental caries is a controllable process. The role of operative dentistry and restorations, as far as caries control is concerned, is to make cavitated, uncleansible lesions accessible to plaque control. However, deciduous teeth are exfoliated and perhaps non-operative treatments (plaque control, fluoride, diet) are all that are required to take cavitated teeth pain-free to exfoliation. Are such techniques child-friendly, obviating the need for anaesthesia or the use of handpieces? Alternatively, are they wanton neglect? This paper is written by a cariologist who never treated children, to present alternative managements and rehearse these arguments from a cariological perspective. Clinical relevance: This paper might serve as a discussion document for a group of dentists deciding practice policy with regard to the management of caries in deciduous teeth.