ART restorations for older patients

Geriatric Dentistry ART restorations for older patients Background.—Atraumatic restorative treatment (ART) restores carious teeth in a cost-effective and easy to administer way that may be especially appealing to older patients. Compared to conventional techniques, ART is costeffective, and its use in underserved and disadvantaged communities demonstrates its accessibility and reduced need for advanced instrumentation. The 2-year survival of restorations placed using ART principles was compared with that for conventional restorations in a population of partially dentate older patients. Methods.—A randomized controlled clinical trial was undertaken using 99 independently living adults age 65 to 90 years who had carious lesions. The participants were randomly assigned to receive either ART or conventional (CT) restorations, then survival of the restorations was tested after 6 months and 1 and 2 years of function. Results.—A total of 300 restorations were placed, with 142 in the 51 ART patients and 158 in the 48 CT patients. Most were placed on one surface only, with 45.2% of the ART group and 41.1% of the CT group placed on root surfaces. After 2 years 34 ART patients (96 restorations) and 37 CT patients (121 restorations) remained in the study (71.2% of the original number). Patients who did not complete the study had a mean age of 77.1 years, whereas those who did complete it had a mean age of 71.5 years. No other significant differences were noted between the patients who did and did not complete the study. In the ART group, 77% of the restorations were assessed as good, 6.2% had a slight marginal defect, 2% had slight wear, and 13.5% were partially or completely missing. One restoration had secondary caries. The cumulative survival for the ART group was 85.4%. Failures occurred after 6 months in 28.6% of cases, after 1 year in 28.6% of cases, and after 2 years in 42.8% of cases.

In the CT group, 80.1% of the restorations were considered in good condition, 10.7% had an acceptable marginal defect, and 9% were partially or completely missing. The cumulative survival for the CT group was 90.9% after 2 years. Failures occurred in 18.2% of cases after 6 months, 18.2% after 1 year, and 63.6% after 2 years. In both groups, failures occurred on root, buccal/ lingual, incisal/occlusal, and interproximal surfaces. Analysis of contributing variables, including type of treatment (ART or CT) showed none had any effect on survival of the restorations. Discussion.—The differences in survival between the two groups were not statistically significantly different. ART may be most appropriate for older patients because it is effective, easy to perform, and less costly than conventional techniques.

Clinical Significance.—Restoration survival rates were high in both of the treatment groups after 2 years. The advantages of ART over conventional approaches make it highly appropriate for older adults. In addition, if preventive measures are included with the ART restoration, caries progression in these patients may also be halted, which would result in higher rates of tooth retention.

da Mata C, Allen PF, McKenna G, et al: Two-year survival of ART restorations placed in elderly patients: A randomised controlled clinical trial. J Dent 43:405-411, 2015 Reprints available from C da Mata; fax: þ353 021 490 1193; e-mail: [email protected]

Volume 60



Issue 5



2015

e147