ART and fluoride treatments for decayed primary molars: 30-month results

OBJECTIVE: To compare the outcomes of using atraumatic restorative treatment (ART) restorations, and annual applications of silver diamine fluoride (SDF) to treat decayed primary molars.

METHODS: Study was implemented in Guangzhou, China, in 2005. Primary molars with Class I caries lesions into dentine but not involving pulp in children aged 6-7 years were randomly allocated into one of two treatment groups: 1) glass ionomer restoration using the ART technique, and 2) caries arrest treatment by annual topical applications of SDF solution. Treatments were provided in school using hand instruments only. The treated teeth were clinically assessed every 6 months by two calibrated examiners using caries probes, disposable mouth mirrors and an intra-oral LED light source. ART treatment was classified as successful if the restoration was intact and had no major defects. SDF treatment was classified as successful if the treated lesion became arrested. For both treatments, failure was recorded if there was pain in the treated teeth, the tooth being non-vital, or received other treatments.

RESULTS: At baseline, 67 and 73 Class I caries lesions in 103 children were treated with ART restoration and SDF application respectively. Three-quarters of the treated lesions (n=105) were followed for 30 months. The 12-month success rate of ART restorations was higher than that of SDF treatment (87% vs. 63%, p<0.001) while at 24 months, the difference in success rates between the two treatments became insignificant (75% vs 70%, p>0.05). After 30 months, a higher success rate was obtained in the SDF treated teeth than the ART restorations (80% vs. 54%, p=0.004).

CONCLUSION: The success rate of ART restorations started with a high value and decreased gradually while that of SDF treatment had increased throughout the study after annual applications.

Funded by the Research Grants Council of Hong Kong (Ref: HKU7422/04M).