Restorations In Primary Molars Research Articles

Two years survival rate of Class II ART restorations in primary molars using two ways to avoid saliva contamination

To compare the survival rates of Class II Atraumatic Restorative Treatment (ART) restorations placed in primary molars using cotton rolls or rubber dam as isolation methods. A total of 232 children, 6-7 years old, both genders, were selected having one primary molar with proximal dentine lesion. The children were randomly assigned into two groups: control group with Class II ART restoration made using cotton rolls and experimental group using rubber dam. The restorations were evaluated by eight calibrated evaluators (Kappa > 0.8) after 6, 12, 18 and 24 months. A total of 48 (20.7%) children were considered dropout, after 24 months. The cumulative survival rate after 6, 12, 18 and 24 months was 61.4%, 39.0%, 29.1% and 18.0%, respectively for the control group, and 64.1%, 55.1%, 40.1% and 32.1%, respectively for the rubber dam group. The log rank test for censored data showed no statistical significant difference between the groups (P = 0.07). The univariate Cox Regression showed no statistical significant difference after adjusting for independent variables (P > 0.05). Both groups had similar survival rates, and after 2 years, the use of rubber dam does not increase the success of Class II ART restorations significantly.

Influence of different isolation methods on the survival of proximal ART restorations in primary molars after two years

This was to evaluate the influence of two methods of tooth-isolation on the survival rate of proximal ART restorations in the primary molars. The study was conducted in two rural divisions in Kenya, with 7 operators randomly paired to a group of 8 assistants. A total of 804 children each had one proximal cavity in a primary molar restored using the ART approach. During restorations 2 isolation methods, rubber dam or cotton wool rolls, and 3 brands of glass ionomer cements were used by the operators. The restorations were then followed for a period of 2 years. SPSS 14.0 was used to analyse and relate the data obtained to the method of isolation used. After 2 years 30.8% of the ART restorations had survived. Higher survival rates of the restorations were obtained when using rubber dam irrespective of the GIC material or the operator. Generally the survival rate of the proximal restorations in the present study was very low, but the use of rubber dam resulted in a higher survival rate of the restorations.

A Competing Risk Survival Analysis Model to Assess the Efficacy of Filling Carious Primary Teeth

In recent years a strategy of selective, symptom-based intervention of carious primary teeth has been developed amongst some British general dental practitioners. Practice-based studies appear to provide evidence that policies of restoration of symptomless carious primary teeth do not confer any significant benefits above those associated with non-restorative care. However, results from these studies contrast with those of many clinical trials and prospective studies of primary molar restorations. In the current investigation, cohort study data from 5,168 carious primary molar teeth from 2,654 British children aged 4–5 years at baseline, augmented with Dental Practice Board treatment data, was utilised to assess the effect of restorative treatment on the likelihood of carious teeth subsequently progressing to either exfoliation or extraction. The effect of demographic and tooth level covariates on the fate of these teeth was also assessed. Multivariate multilevel parametric survival models were applied to the analysis of the carious-exfoliation and carious-extraction transitions to which the teeth were subject, assuming an underlying data hierarchy with teeth nested within individuals. Time of occurrence of caries affected survival experience, with teeth in which caries occurred later in life being associated with higher survival rates to extraction. Amongst filled teeth, later fillings were also associated with higher survival rates to extraction. Demographic and tooth level variables had a limited effect on survival experience. Treatment was found to be significantly associated with survival with respect to extraction, with survival rates of over 80% at 14 years, double those of untreated teeth.

Comparison of Conventional versus Colored Compomers for Class II Restorations in Primary Molars: A 12-Month Clinical Study

Objective: To evaluate the 12-month clinical performance of conventional (Compoglass F) and colored (Twinky Star) compomer restorative materials in class II restorations of primary molars. Materials and Methods: A total of 196 restorations were placed in 98 children aged between 5 and 10 years (mean age: 7.43 ± 1.31 years) who had bilateral matched pairs of carious posterior class II primary molars. A split-mouth design was used in which 2 materials (Compoglass F, Twinky Star) were randomly placed on contralateral sides by 3 dentists. At baseline, after 6 and after 12 months, the restorations were evaluated using modified US Public Health Service criteria for: secondary caries, marginal integrity, marginal discoloration, anatomic form and surface texture. The Alpha and Bravo scores were considered as clinical success. The data were subjected to statistical analysis by the Wilcoxon and McNemar tests (p < 0.05). The Kaplan-Meier survival method was applied to estimate survival percentages. Results: No significant difference was found among the groups at all recalls regarding marginal integrity, marginal discoloration, anatomic form, secondary caries and surface texture. The 12-month mean cumulative survival rate of Compoglass F was 95.7%, while in the Twinky Star group, the survival rate was 93% in class II restorations with no significant difference between the groups for either material. Conclusion: Both conventional and colored compomer materials are suitable restorative materials for primary teeth for at least 12 months. Colored compomers could also be a good alternative to tooth-colored compomers in the restoration of primary molars.

Influence of the cavity‐size on the survival rate of proximal ART restorations in primary molars

To evaluate the influence of the size of proximal cavities on the survival rate of the atraumatic restorative treatment (ART) restorations. A total of 804 children, aged 6-8 years, from a low socio-economic community, with an ART restorable proximal carious lesion in their primary molars, participated. Over a 3-week period, three 'experienced' and four 'inexperienced' operators randomly paired with four 'experienced' and four 'inexperienced' assistants, made the restorations at site using hand instruments. They randomly used Fuji IX, Ketac Molar Easymix and Ketac Molar Aplicap glass ionomer cements to restore the cavities, under randomly selected rubber dam and cotton roll isolation methods. The fillings were independently evaluated by nine trained and calibrated evaluators. After 1 year, the survival rate of the fillings evaluated in the study was 44.8%. Irrespective of the other factors involved, restorations with the highest survival rate were of size between 2 and 3 mm (mesio-distal, bucco-lingual, and depth) or volumes 10.0-19.9 mm(3) (Chi-square, P = 0.002, KM mean survival of 345 days). While the survival rates for class II ART restorations were still low, the choice of medium-sized proximal cavities gave better survival rates for this technique.

Clinical success of compomer and amalgam restorations in primary molars. Follow up in 36 months.

The purpose of this study was to evaluate the three-year clinical performance of a compomer and an amalgam in primary molars and to determine fluoride content in the enamel of these teeth after exfoliation. Twenty patients aged six to eight years randomly received one compomer and one amalgam restoration. Restorations were evaluated at baseline, 12, 24 and 36 months according to modified USPHS criteria. In six pairs of exfoliated teeth fluoride content at 1 and 5 mm distance from the restorations was determined. Replicas were made to determine marginal adaptation (MA) by scanning electron microscopy (SEM). At occlusal margins compomer restorations had better MA than amalgam restorations (p < 0.01). Compomer and amalgam restorations did not lead to different fluoride uptake in adjacent enamel and had an overall clinically satisfactory performance. The study confirmed that the assessed compomer is a suitable restorative material for class I and class II restorations in primary molar teeth.

Tunnel restorations in primary molars

Tunnel restorations in primary molars

Two years survival rate of class II composite resin restorations prepared by ART with and without a chemomechanical caries removal gel in primary molars.

The aim was to test the null hypotheses that there is no difference: (1) in carious lesion development at the restoration margin between class II composite resin restorations in primary molars produced through the atraumatic restorative treatment (ART) with and without a chemomechanical caries removal gel and (2) in the survival rate of class II composite resin restorations between two treatment groups after 2 years. Three hundred twenty-seven children with 568 class II cavitated lesions were included in a parallel mouth study design. Four operators placed resin composite (Filtek Z 250) restorations bonded with a self-etch adhesive (Adper prompt L pop). Two independent examiners evaluated the restorations after 0.5, 1, and 2 years using the modified Ryge criteria. The Kaplan–Meier survival method was applied to estimate survival percentages. A high proportion of restorations were lost during the study period. Therefore, the first hypothesis could not be tested. No statistically significant difference was observed between the cumulative survival percentages of restorations produced by the two treatment approaches over the 2-year period (ART, 54.1 ± 3.4%; ART with Carisolv™, 46.0 ± 3.4%). This hypothesis was accepted. ART with chemomechanical gel might not provide an added benefit increasing the survival percentages of ART class II composite resin restorations in primary teeth.

Split mouth randomized controlled clinical trial of beveled cavity preparations in primary molars: an 18-Month follow up

Objectives This split-mouth, double-blind, randomized controlled study evaluated the clinical performance of composite restorations in Class I beveled margin cavity preparations in primary molars. Methods A total of 94 Class I cavity preparations were performed in the carious primary molars of 32 children aged 4–10 years. Two cavity designs were used: conventional conservative preparation (G1) and modified preparation with cavosurface bevel (G2). All teeth were restored using TPH Spectrum™. The restorations were evaluated by two calibrated investigators at baseline, 6, 12 and 18 months using slight modified USPH criteria. The visible plaque index and fiber optic transilumination (FOTI) were also used. The data were statistically evaluated using Wilcoxon and Friedman tests ( p < 0.05). The rank correlations between secondary caries, visible plaque index and FOTI were obtained using Pearson correlation ( p < 0.01). Results Of the 94 restorations performed and evaluated at baseline, 76 restorations were available after 18 months. Seventy-three restorations were considered as clinical success, 10 were censored for drop out reasons and 5 were lost by natural exfoliation. Four restorations failed by secondary caries and two failed by marginal adaptation discrepancies. For all evaluation there was difference between the baseline, 6, 12 and 18 months ( p < 0.05) but there were no statistically significant difference in G1 and G2 for any criteria evaluated ( p > 0.05) at any period of the study. The visible plaque index was correlated to secondary caries. Conclusion Bevel cavity design preparations did not improve the success of composite restorations in primary molars over 18 months.

Topography of Atraumatic Restorative Treatment (ART) Restorations: An In Vivo Pilot Study

Objetivo: Avaliar in vivo a topografia de restauracoes executadas atraves do Tratamento Restaurador Atraumatico (ART) em molares deciduos, apos 30, 90 e 180 dias. Metodo: A amostra constou de 26 molares deciduos com lesao de carie oclusal de diâmetro maior que 3mm, os quais foram tratados pela tecnica do ART, sendo restaurados com cimento de ionomero de vidro (Fuji IX®). Apos a confeccao das restauracoes e em consultas de revisao seguintes, foram realizadas moldagens para obtencao de replicas em resina epoxidica, as quais foram fotografadas com o uso de uma câmera digital (Pixera®) acoplada a um microscopio esteroscopio. As imagens obtidas foram entao usadas para o calculo da area da restauracao, em diferentes intervalos de tempo, com o auxilio do Programa AutoCad® (versao 14). As diferencas proporcionais encontradas entre os valores obtidos permitiram o calculo da integridade marginal ao longo do estudo. Resultados: Os resultados demonstraram uma diminuicao media de area de 0,109 ± 0,143mm2 para todas as restauracoes, nao havendo diferenca estatisticamente significante ao longo do tempo (ANOVA; p>0,05). Conclusao: As restauracoes atraumaticas demonstraram boa durabilidade e baixo grau de deterioracao topografica em dentes deciduos.

Clinical evaluation of glass-ionomer tunnel restorations in primary molars: 36 months results

The purpose of this study was to clinically examine the efficacy of tunnel preparations in primary molars restored with glass-ionomer cement during a 36-month observation period. A total of 233 tunnel restorations were placed in primary molars of 203 patients aged 6-10 years. Restorations were evaluated after 12, 24 and 36 months using the modified USPHS criteria for secondary caries, marginal discolouration, marginal adaptation and anatomic form. The Alpha+Bravo score (except for caries) and absence of clinical signs of endodontic complications was considered as a clinical success. At the end of the 36-month experimental period, the cumulative survival rate of tunnel restorations in primary molars was 72 per cent. The main reasons for failure were endodontic complications (46 per cent of the failures), secondary caries (31 per cent of the failures) and marginal ridge fractures (19 per cent of the failures). The tunnel preparation filled with reinforced restorative glass-ionomer cement is a suitable treatment for minimal proximal caries lesions in primary molars.

The Hall Technique; a randomized controlled clinical trial of a novel method of managing carious primary molars in general dental practice: acceptability of the technique and outcomes at 23 months

BackgroundScotland has high levels of untreated dental caries in primary teeth. The Hall Technique is a simplified method of managing carious primary molars using preformed metal crowns (PMCs) cemented with no local anaesthesia, caries removal or tooth preparation. This study compared the acceptability of the Hall Technique for children, their carers, and dentists, and clinical outcomes for the technique, with conventional restorations.MethodsGeneral dental practice based, split mouth, randomized controlled trial (132 children, aged 3–10). General dental practitioners (GDPs, n = 17) in Tayside, Scotland (dmft 2.7) placed conventional (Control) restorations in carious primary molars, and Hall Technique PMCs on the contralateral molar (matched clinically and radiographically). Dentists ranked the degree of discomfort they felt the child experienced for each procedure; then children, their carers and dentists stated which technique they preferred. The teeth were followed up clinically and radiographically.Results128 conventional restorations were placed on 132 control teeth, and 128 PMCs on 132 intervention teeth. Using a 5 point scale, 118 Hall PMCs (89%) were rated as no apparent discomfort up to mild, not significant; for Control restorations the figure was 103 (78%). Significant, unacceptable discomfort was recorded for two Hall PMCs (1.5%) and six Control restorations (4.5%). 77% of children, 83% of carers and 81% of dentists who expressed a preference, preferred the Hall technique, and this was significant (Chi square, p < 0.0001). There were 124 children (94% of the initial sample) with a minimum follow-up of 23 months. The Hall PMCs outperformed the Control restorations:a) 'Major' failures (signs and symptoms of irreversible pulpal disease): 19 Control restorations (15%); three Hall PMCs (2%) (P < 0.000);b) 'Minor' failures (loss of restoration, caries progression): 57 Control restorations (46%); six Hall PMCs (5%) (P < 0.000)c) Pain: 13 Control restorations (11%); two Hall PMCs (2%) (P = 0.003).ConclusionThe Hall Technique was preferred to conventional restorations by the majority of children, carers and GDPs. After two years, Hall PMCs showed more favourable outcomes for pulpal health and restoration longevity than conventional restorations. The Hall Technique appears to offer an effective treatment option for carious primary molar teeth.Trial registration numberCurrent Controlled Trials ISRCTN47267892 – A randomized controlled trial in primary care of a novel method of using preformed metal crowns to manage decay in primary molar teeth: the Hall technique.

Indirect Composite Onlay Restorations in Primary Molars: a clinical report

The authors describe a clinical case of oral rehabilitation, in a 4-year-old patient, using indirect composite onlay restorations. Eight severely decayed primnary molars were restored. The clinical findings after 4 years demonstrated the efficiency of the technique as well as its indication in extensive restorations in Pediatric Dentistry, reestablishing function and aesthetics of these primary teeth. The indirect composite onlay restorations seem to wear at rate compatible with primary tooth wear and maintain a smooth, continuous anatomic form.

Residual caries and marginal integrity in relation to class II glass ionomer restorations in primary molars

To assess the effectiveness of three treatment methods (ART, Carisolv(TM) and rotary instruments) in caries removal and sealing capability of hand-mixed glass ionomer in the management of proximal caries in deciduous molars. In a clinical study 217 dentally naïve children (age 7.5, SD 0.57) were randomly divided in three treatment groups and among 4 operators. Each child received one class II glass ionomer restoration. Immediately after restoration bitewings were made. The dependent variables were: residual caries and marginal adaptation. Independent variables were operator effect, child's behaviour and time to remove caries. There was no statistical significant difference in residual caries between the three treatment methods (p < 0.05). In 33% of the cases a clear radiolucency underneath the restoration was visible on the bitewings. In 26% doubt existed on the presence of residual caries. A clear cervical gap was seen in 16% of the restorations, while in 18% signs of cervical gaps were less obvious. Between the four operators a significant difference in relation to residual caries (p = 0.015) was found as well as a significant difference between the operators for the preparation time in the three treatment methods (p < 0.05). The child's behaviour seems to have no influence on residual caries and marginal gaps. This study indicates that there is no preparation method superior to another, though the treatment methods seem to be sensitive for operator effects. Using hand-mixed glass ionomer cement resulted in considerable number of cervical gaps found.

Preformed metal crowns for carious primary molars

Background There is a high level of untreated dental decay in primary teeth in Scotland. Despite evidence for the efficacy of preformed metal crowns (PMCs) for the restoration of primary molars, few are placed in general practice, possibly due to the interventive nature of the clinical procedure. There is, however, a novel way of placing PMCs involving no local anaesthesia, no caries removal and no preparation of the tooth: the Hall technique. Aim To investigate the survival of carious primary teeth treated with PMCs placed using a novel, simplified method — the Hall technique. Setting General dental practice, in Scotland. Methods A retrospective analysis of practice records from one general practitioner, from 1988 to 2001. The majority of the 978 PMCs fitted on 259 children, using the Hall technique, were placed when there was clinical evidence of approximal caries into dentine. The Kaplan-Meier approach was used to analyse survival times and the Mantel-Haenszel Log rank test for comparison between tooth types. Results For all tooth types, the probability of surviving three years without being extracted or the PMC being lost, was 73.4% (95% confidence interval 70.1% to 76.4%), and for five years was 67.6% (95% confidence interval 63.3% to 71.5%). The probability of surviving without extraction alone for three years was 86.0% (95% confidence interval 83.2% to 88.4%), and for five years was 80.5% (95% confidence interval 76.5% to 83.9%). Conclusion Hall technique restorations placed on primary molars with decay clinically into dentine, by a single operator in general dental practice, have a similar success rate to some other, more conventional, restorative techniques. The technique requires further evaluation through a prospective randomised control clinical trial before its use could be generally recommended.

A novel technique using preformed metal crowns for managing carious primary molars in general practice — A retrospective analysis

There is a high level of untreated dental decay in primary teeth in Scotland. Despite evidence for the efficacy of preformed metal crowns (PMCs) for the restoration of primary molars, few are placed in general practice, possibly due to the interventive nature of the clinical procedure. There is, however, a novel way of placing PMCs involving no local anaesthesia, no caries removal and no preparation of the tooth: the Hall technique. To investigate the survival of carious primary teeth treated with PMCs placed using a novel, simplified method - the Hall technique. General dental practice, in Scotland. A retrospective analysis of practice records from one general practitioner, from 1988 to 2001. The majority of the 978 PMCs fitted on 259 children, using the Hall technique, were placed when there was clinical evidence of approximal caries into dentine. The Kaplan-Meier approach was used to analyse survival times and the Mantel-Haenszel Log rank test for comparison between tooth types. For all tooth types, the probability of surviving three years without being extracted or the PMC being lost, was 73.4% (95% confidence interval 70.1% to 76.4%), and for five years was 67.6% (95% confidence interval 63.3% to 71.5%). The probability of surviving without extraction alone for three years was 86.0% (95% confidence interval 83.2% to 88.4%), and for five years was 80.5% (95% confidence interval 76.5% to 83.9%). Hall technique restorations placed on primary molars with decay clinically into dentine, by a single operator in general dental practice, have a similar success rate to some other, more conventional, restorative techniques. The technique requires further evaluation through a prospective randomised control clinical trial before its use could be generally recommended.

Restorative Treatment on Class I and II Restorations in Primary Molars: A Survey of Brazilian Dental Schools

A survey was sent to 70 Brazilian dental schools evaluating techniques and restorative materials being taught for Class I and II preparation in posterior primary teeth by Pediatric Dentistry courses. After a 54% response rate, marked teaching diversity was found among Brazilian dental schools. Amalgam continues to be taught, but a tendency of preference towards more esthetic-like materials was observed.

The treatment of primary molar teeth presenting with two surface caries—A review of care delivered by the Personal Dental Services in Bradford

Objective To identify the outcomes of primary molars treated for two surface dental caries. Design A review was undertaken using clinical notes from two Personal Dental Service (PDS) clinics in Bradford. Data was abstracted from the notes of children deemed eligible for inclusion in the study. Results The majority of primary molar teeth considered in the study were restored with amalgam (45.7%). One in six teeth (15%) was restored with glass ionomer and 7.2 per cent of teeth were restored with stainless steel crowns. Overall, half of the primary molar teeth restored with amalgam (50%) required further treatment following initial placement of the restoration and one in four of these teeth (25%) went on to be extracted. A similar picture emerged when teeth restored with glass ionomer were considered. For the small number of teeth restored with stainless steel crowns, there was a 90 per cent success rate, with only two teeth requiring extraction. Conclusions Amalgam remains the most commonly used material for the restoration of primary molars presenting with two surface caries. Glass ionomer is less popular and stainless steel crowns are infrequently selected as the initial treatment of choice for such teeth. When the outcomes were considered for teeth restored with the different materials, the audit showed that stainless steel crowns were more effective than plastic restorative materials.

Clinical evaluation of composite and compomer restorations in primary teeth: 24-month results

This split-mouth, blind study evaluated the clinical performance of Dyract AP, F2000, and Heliomolar placed in primary molars of 30 children (mean age, 6 years and 2 months). From a total of 79 restorations accomplished, 27 were built with Heliomolar (18 Class I, and 9 Class II), 30 were with F2000 (21 Class I and 9 Class II), and 22 were built with Dyract AP (14 Class I and 8 Class II). All of teeth restored had primary caries lesions. At 6, 12, 18 and 24 months, 60 restorations (75%) were evaluated using USPHS criteria for: color match (CM), marginal adaptation (MA), marginal discoloration (MD), anatomic form (AF) and secondary caries (SC) by three calibrated operators. The Alpha+Bravo score percentage was considered as clinical success. The data were subjected to statistical analysis by Mann-Whitney and Kruskal-Wallis tests (p<0.05). Heliomolar showed the smallest success clinical at 12 months for marginal adaptation and secondary caries, and at 18 months for marginal discoloration. Regarding color match and anatomic form, no significant differences were found among the groups at each evaluation period. When materials were compared, Heliomolar did not show a significant difference among the evaluated periods for any criteria, remaining with the lowest scores. Significant differences were observed at 12 months for F2000 (marginal adaptation), and at 24 months for Dyract AP (marginal discoloration and secondary caries) and for F2000 (color match and marginal discoloration). It was concluded that Dyract AP and F2000 showed the best clinical performance over 24 month-evaluations for marginal discoloration and secondary caries, and color match and marginal adaptation, respectively. The use of the resin composite Heliomolar in Class I/II restorations in primary molars should be carefully considered.

Chlorhexidine Arrests Subclinical Degradation of Dentin Hybrid Layers in vivo

The recent paradigm that endogenous collagenolytic and gelatinolytic activities derived from acid-etched dentin result in degradation of hybrid layers requires in vivo validation. This study tested the null hypothesis that there is no difference between the degradation of dentin bonded with an etch-and-rinse adhesive and that in conjunction with chlorhexidine, an MMP inhibitor, applied after phosphoric-acid-etching. Contralateral pairs of bonded Class I restorations in primary molars of clinical subjects were retrieved after a six-month period of intra-oral functioning and processed for transmission electron microscopy. Hybrid layers from the chlorhexidine-treated teeth exhibited normal structural integrity of the collagen network. Conversely, abnormal hybrid layers were seen in the control teeth, with progressive disintegration of the fibrillar network, to the extent that it was beyond detection by collagen staining. Self-destruction of collagen matrices occurs rapidly in resin-infiltrated dentin in vivo and may be arrested with the use of chlorhexidine as an MMP inhibitor.