Three-year survival of ART high-viscosity glass-ionomer and resin composite restorations in people with disability.

Abstract

To assess the 3-year cumulative survival rate of atraumatic restorative treatment (ART) and conventional resin composite restorations (CRT) placed in persons with disability. Patients referred for restorative care to the Haemophilia Foundation special care service were treated by one of two specialists. Patients and/or caregivers were provided with written and verbal information regarding treatment options and selected the alternative they preferred. Treatment was provided as selected unless this option proved clinically unfeasible when an alternative technique was proposed. The treatment protocols were ART (hand instruments/high-viscosity glass-ionomer) in the clinic or CRT (rotary instrumentation/resin composite) in the clinic or under general anaesthesia (GA). After 6, 12, 24 and 36months, two independent, trained and calibrated examiners evaluated restoration survival using established ART codes. The proportional hazard model with frailty corrections gave survival estimates over 3years. Sixty-six patients (13.6±7.8years) with 16 different disability profiles participated. CRT in the clinic proved feasible for five patients (13%), and 14 patients received CRT under GA (21%). ART was used for 47 patients (71.2%). Altogether, 298 dentine carious lesions were restored in primary and permanent teeth (182 ART; 116 CRT). The 3-year cumulative survival rates and jackknife standard errors for the 182 ART and 116 CRT restorations were 94.8±2.1 and 82.8±5.3%, respectively (p=0.01). The 3-year follow-up results confirm that ART is an effective treatment protocol. Patients with disability, many of whom have difficulty coping with CRT, may benefit from the ART approach.