Cavity treatment in primary molars and malocclusion: quasi-randomised clinical trial.

Rafael T Gomide,Anne Marie Kuijpers-Jagtman,Soraya C Leal,Jorge Faber,Jo E Frencken

doi:10.7717/peerj.8439

Abstract

BackgroundAn innovative caries treatment protocol for primary teeth, termed Ultra-Conservative Treatment (UCT), restores small cavities through the Atraumatic Restorative Treatment (ART) protocol and cleans medium to large open cavities with toothbrush and fluoride toothpaste. However, UCT-treated primary molars were found to exfoliate earlier than amalgam (CRT) and ART-restored cavities, which may lead to unacceptable loss of space for normal eruption of permanent successors. The null-hypothesis tested was that there is no difference between the three treatment protocols and the intra-arch distances, and index of orthodontic treatment need (IOTN) after 4 years.MethodsDental casts were taken at baseline (T0) and four (T4) years. The space of the premolars (D + E space), arch perimeter, anterior and total arch depth were measured using a morphometric computer programme. The presence and level of malocclusion were assessed according to the IOTN index. Dependent variables were all intra-arch distances and the IOTN while the independent variable was treatment protocol (CRT, ART and UCT). Data were analysed using linear and logistic regression.ResultsThe sample consisted of 867 pairs of casts of 272 initial 6–7-year-olds. No difference was observed between the UCT protocol and the two restorative protocols for the intra-arch variables in both maxilla and mandible over the 4 year period. There was no difference between the UCT and the CRT and ART protocols regarding the occurrence of orthodontic treatment need (malocclusion). In conclusion, the UCT treatment protocol does not differ significantly from the traditional amalgam (CRT) and ART restorative protocols with respect to intra-arch distances and malocclusion. The earlier exfoliation of UCT-treated primary molars does not lead to a worsening of the eruption pattern of permanent successors.

Highlights

Cavitated dentine carious lesions are very prevalent in primary and permanent dentitions (Marcenes et al, 2013)
From the original 302 schoolchildren included in the clinical trial, five were excluded because they had a tooth anomaly and 25 children from the conventional restorative protocol (CRT) and Atraumatic Restorative Treatment (ART) protocols were diagnosed with pulp infection and were not treated restoratively
Five baseline pairs of casts did not match the respective children and a box containing 32 pairs of baseline casts from children treated according to the Ultra-Conservative Treatment (UCT) protocol was lost in transit

Summary

Introduction

Cavitated dentine carious lesions are very prevalent in primary and permanent dentitions (Marcenes et al, 2013). The UCT protocol, in part, is based on the growing evidence that the caries process in a cavity can be stopped by removing the biofilm from within it regularly with toothbrush and fluoride toothpaste (Kidd, 2012). An innovative caries treatment protocol for primary teeth, termed Ultra-Conservative Treatment (UCT), restores small cavities through the Atraumatic Restorative Treatment (ART) protocol and cleans medium to large open cavities with toothbrush and fluoride toothpaste. UCT-treated primary molars were found to exfoliate earlier than amalgam (CRT) and ART-restored cavities, which may lead to unacceptable loss of space for normal eruption of permanent successors. The UCT treatment protocol does not differ significantly from the traditional amalgam (CRT) and ART restorative protocols with respect to intra-arch distances and malocclusion. The earlier exfoliation of UCT-treated primary molars does not lead to a worsening of the eruption pattern of permanent successors

Methods

Results

Discussion

Conclusion