Survival of Glass Ionomer Atraumatic Restorations (ART): 10-year Results

This work reports on a longitudinal evaluation of a high-strength glass ionomer cement (Fuji IX/GC) employed in a modified atraumatic restorative approach (ART). Objectives: this study evaluated the clinical behavior of glass ionomer (GI) restorations after a 10-year period, and verified the enamel/ionomer interface by scanning electron microscopy (SEM). Methods: in 1997, 417 GI restorations were placed in 43 pregnant patients with high treatment needs (mean number of decayed teeth 9.8). Minimal cavity preparations were performed using excavators to remove soft carious dentin; the openings of small lesions were widened using high speed burs; the restorative material was used following the manufacturer's instructions. Evaluations at baseline and after 1, 2 and 10 years were performed by two calibrated examiners using the criteria proposed by Frencken for ART restorations. Results: the inter-examiner agreement was high (kappa= 0.9). After one year, 383 restorations were evaluated in 39 patients with a success rate of 95%. After 2 years, 302 restorations were evaluated in 34 patients and the estimated cumulative success rate (Kaplan-Meier curve) was 90.6%. After 10 years, 154 restorations were evaluated in 15 patients with a cumulative success of 53.6%. The clinical performance of GI in small preparations (Class I, III and V) was compared (chi square) with its performance in preparations with larger loss of tooth structure (II, IV and reconstructions), which revealed superior behavior for the former (cumulative success rate 61% x 39%, respectively). This tendency had already been observed at the 2-year recall (p =.07) and was evident at the 10-year recall (p=.011). SEM analysis showed a continuous and smooth interface between GI and enamel. Conclusion: The GI provided a satisfactory clinical performance after 10 years, with an unexpected good result for large restorations. This study was supported by FAPESP – grant 2007/04276-0.