High-viscosity glass-ionomer vs. composite resin restorations in persons with disability: Five-year follow-up of clinical trial

Abstract

The aim of this clinical trial was to compare the 5-year cumulative survival of atraumatic restorative treatment restorations using high-viscosity glass-ionomer restorations (ART/HVGIC) and conventional resin composite restorations (CRT) placed in patients with intellectual and/or physical disability. Patients referred for restorative care to a special care service in Córdoba, Argentina, were recruited. Patients and/or caregivers were provided with written and verbal information regarding treatment options and selected the alternative they preferred. The treatment protocols were ART (hand instruments/HVGIC) in the clinic or CRT (rotary instrumentation/resin composite) in the clinic or under general anaesthesia (GA). Two independent, trained and calibrated examiners evaluated restoration survival using established ART codes after 6, 12, 24, 36 and 60 months. The proportional hazard model with frailty corrections provided survival estimates. Jackknife errors were used to test 5-year results. Sixty-six patients (13.6 ± 7.8 years) with 16 different medical conditions participated. CRT in the clinic proved feasible for five patients (13%), and 14 patients received CRT under GA (21%). ART was provided for 47 patients (71.2%). A total number of 298 dentine carious lesions were restored in primary and permanent teeth (182 ART; 116 CRT). Four patients died between the 3 and 5-year follow up. Percentage survival and jackknife standard error were calculated and were significantly higher for all ART/HVGIC restorations (90.2% ± 2.6) than for all CRT restorations (82.8% ± 5.3), 5 years after placement (p=0.044). These 5-year follow-up results confirm that ART/HVGIC is an effective treatment protocol for patients with disability, equal to that of conventional resin composite restoration. The results of this clinical trial support the use of ART as an evidence-based treatment resource contributing to the reduction of inequalities in access to oral health care among people with disability.

Could SARS‐CoV‐2 burst the use of Non‐Invasive and Minimally Invasive treatments in paediatric dentistry?

“…Restorations’ survival rates after more than 2 years in primary teeth is reported to be 94.3% (±1.5) for restorations at one surface and 64.5% (± 3.9) for those at multiple surfaces 19 . ART was recently assessed as an effective treatment for special needs patients, contributing in the reduction of inequalities in access to oral care 20 . In addition to caries treatment, the minimally invasive treatment especially ART technique has proven to be an effective approach to preserving first permanent molars affected by severe form of MIH 21 …”

“…19 ART was recently assessed as an effective treatment for special needs patients, contributing in the reduction of inequalities in access to oral care. 20 In addition to caries treatment, the minimally invasive treatment especially ART technique has proven to be an effective approach to preserving first permanent molars affected by severe form of MIH. 21 Halfway through the minimally invasive and the non-invasive treatment, the Hall technique (HT) is a mixed caries treatment modality: a caries removal approach consisting in the cementation of a stainless-steel crown with GIC on primary molars with severe caries lesions.…”

A prospective and randomized clinical trial evaluating the effectiveness of ART restorations with high-viscosity glass-ionomer cement versus conventional restorations with resin composite in Class II cavities of permanent teeth: two-year follow-up

“…Few studies have investigated the clinical performance of multiplesurface restorations using GICs and resin composites in permanent teeth. [12][13][14] Evaluating restorations performed with HVGICs under the ART approach would provide important data considering three aspects: testing a substitute for dental amalgam, the ART approach being a more socially available technique due to the non-use of electrical equipment, and ART might be an important approach in COVID era as it does not generate aerosols. 1,8,[15][16][17] Therefore, the objective of the present study was to compare ART restorations with HVGIC versus conventional restorations with resin composite in Class II cavities of permanent teeth over a period of 2 years.…”

Survival of direct composite restorations placed under general anesthesia in adult patients with intellectual and/or physical disabilities

“…In children and adults with intellectual and/or physical disability, the 5-year survival of single- and multiple-surface composite restorations amounted to 100% and 66.9%, respectively. Composite restorations placed under general anesthesia showed a better survival than restorations placed conventionally [ 8 ]. In another study, 77.3% of composite restorations placed under general anesthesia in children and adults with special needs survived after 2 years [ 9 ].…”