Longevity of atraumatic restorative treatment versus amalgam

Restorative Dentistry Longevity of atraumatic restorative treatment versus amalgam Background.—In atraumatic restorative treatment (ART), highly-softened carious enamel and dentin are removed using hand instruments, after which adhesive restorative material is used to restore the cavity. The procedure is known to be minimally invasive by nature and was developed for use in lesser industrialized areas of the world. However, it is currently being accepted in developed countries as a part of the minimum intervention philosophy. High-viscosity glass ionomer cement (GIC) is the material of choice for ART restorations. GIC can be applied in early stages of caries or in larger cavities and it is known to simplify the restorative process. The hand instruments are used to remove the caries-infected dentin following which a seal is created between the GIC and the remaining enamel margin and caries-affected dentin lining the surfaces of the cavity. Calcium bonds to the mineral content of the tooth supply, which is the major adhesive force. GICs slowly leach fluoride ions into the adjacent tooth tissue, which could slow down or halt the progression of caries. Success with ART was compared with that from amalgam, which has since long been considered as the ‘‘gold standard’’ for restorative materials. Methods.—Systematic searches were conducted on five databases to seek relevant articles written in English language, which reported two-arm longitudinal in vivo trials with a follow-up period of a minimum of 12 months. Seven articles were accepted for this study, thus covering 27 separate datasets. Results.—The success rates of ART and amalgam did not differ significantly. Four datasets indicated a higher success rate for ART as compared with conventional amalgam restorations. In terms of success, the ART rates were 28% better for posterior Class V restorations over a period of 6.3 years, 6% better over a period of 2.3 years, 9% better for posterior Class I restorations over a period of 4.3 years, and 61% better for posterior Class II restorations over

a period of 2.3 years. For primary dentition restorations, there were no significant differences between ART and amalgam after 12 and 24 months. In permanent dentition restorations, the longevity of ART restorations was either as good as or in some cases better than that of amalgam restorations. Discussion.—The success rates of ART restorations was comparable with that of amalgam restorations for a maximum of 6.3 years. However, the rates varied depending on the site of the restoration. Primary tooth restorations can be performed through ART or amalgam preparations without any differences in longevity.

Clinical Significance.— Conventional drilling and amalgam did not produce better restorations as compared with ART when considering longevity. GIC was judged as being better in 4 of the 27 datasets that were considered for this study. The site and type of cavity affected longevity in these cases. Primary teeth can be restored using ART principles or amalgam without any differences in longevity. However, it should be noted that all the studies had limited internal validity because of vague randomized sequence allocation and/or allocation concealment. Therefore, further study is warranted.

Mickenautsch S, Yengopal V, Banerjee A: Atraumatic restorative treatment versus amalgam restoration longevity: A systematic review. Clin Oral Invest 14:233-240, 2010 Reprints available from S Mickenautsch, Div of Public Oral Health, Univ of the Witwatersrand, 7 York Rd, Parktown, Johannesburg 2193, South Africa; e-mail: [email protected]

Stepwise versus direct complete excavation of deep caries lesions Background.—Severe inflammatory lesions of the pulp and pulp necrosis may develop in cases with deep caries lesions. A stepwise approach to caries excavation rather

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Dental Abstracts

than direct complete excavation was suggested as an alternative that may diminish the risk of pulp exposure and increase the chances of the pulp healing. Stepwise