Effectiveness of three minimal intervention approaches for managing dental caries: survival of restorations after 2 years

Abstract

The present study was aimed at comparing the effectiveness of three minimally invasive restorative treatment approaches for dentinal lesions in occlusal surfaces. The approaches tested comprised a conventional and a modified-conventional treatment and a modified Atraumatic Restorative Treatment (ART). The conventional approach was performed in a university dental clinic whilst the modified-conventional, employing portable equipment, and the modified ART, using hand instruments and a caries removal solution (Caridex, were carried out in the field. Using the split-mouth design, 430 matched contralateral pairs of occlusal cavities were restored with amalgam or glass-ionomers in permanent molars of 152 school children by one dental therapist. The restorations were assessed using a modified USPHS-Ryge criteria. After 2 years, the cumulative survival percentages for occlusal amalgam and glass-ionomer restorations were 92 and 96%, respectively. The survival of all restorations in the conventional, modified-conventional and the modified ART group was 96, 96 and 91%, respectively. The survival of occlusal amalgam and glass-ionomer restorations per treatment group was as follows: 94 and 99%, respectively (conventional group); 95 and 97%, respectively (modified-conventional group), and 89 and 93%, respectively (modified ART group). The differences in survival percentage between restorations with amalgam and glass-ionomer, and between the three restorative treatment approaches were not statistically significant. In countries facing scarcity in resources for dental care, ART seems a promising restorative approach to occlusal caries in posterior teeth. However, a longer clinical observation period is required to substantiate this initial conclusion.