title: The longevity of different restorations in primary teeth. Clinical performance and caries inhibition of resin-modified glass ionomer cement and amalgam restorations. Is high-viscosity glass-ionomer-cement a successor to amalgam for treating primary molars? Eroded dentin does not jeopardize the bond strength of adhesive restorative materials. Risk factors for secondary caries in direct composite restorations in primary teeth. The longevity of amalgam versus compomer/composite restorations in posterior primary and permanent teeth: findings From the New England Children's Amalgam Trial. Cariostatic effect of fluoride-containing restorative systems associated with dentifrices on root dentin. A randomized trial of resin-based restorations in class I and class II beveled preparations in primary molars: 24-month results. Effectiveness of Glass-Ionomer (ART) and Amalgam Restorations in the Deciduous Dentition: Results after 3 Years A clinical evaluation of resin-based composite and glass ionomer cement restorations placed in primary teeth using the ART approach: results at 24 months. Silver amalgam versus resin modified GIC class-II restorations in primary molars: twelve month clinical evaluation. Effects of oral hygiene, residual caries and cervical Marginal-gaps on the survival of proximal atraumatic restorative treatment approach restorations Flowable resin composite as a class II restorative in primary molars: A two-year clinical evaluation Prevalence of Approximal Caries in Posterior Teeth in 15-Year-Old Swedish Teenagers in Relation to Their Caries Experience at 3 Years of Age Randomized clinical trial of adhesive restorations in primary molars. 18-month results.
abstract: BACKGROUND AND AIM This paper review s three published papers and adds results from a fourth study which aim ed to determine which restorative material would be the best alternative(s ) to amalgam ( AM )  in primary teeth . DESIGN All studies had a practice -based design and were part of the routine treatment of children and adolescents . The clinicians were assigned which material s to use in a r and omised matter in the first three studies which lasted for 7 - 8 years . In the fourth study conducted 4 years after the initial studies , the clinicians were free to select the restorative material s. RESULTS AND CONCLUSIONS Resin modified glass ionomer ( RMGI ) and compomer ( COM ) restorations showed similar longevity compared with AM , whereas conventional GI restorations showed significantly shorter longevity . The studies indicated that the ' new and improved ' material s based on in vitro tests did not always show enhanced clinical properties . In the last study , where clinicians freely selected the restorative material s they used in their practice s , seven used COM , one used conventional GI material s and one used a combination of the two types of material BACKGROUND The authors clinical ly examined two restorative material s to evaluate their effectiveness in Class II restorations in primary molars and their ability to inhibit recurrent caries . METHODS Forty subjects , each in need of two Class II restorations in primary molars , took part in this study . Each patient received one  Class II restoration of resin-modified glass ionomer cement and one of amalgam . The authors evaluated the restorations at six-month , one-year , two-year and three-year recall appointments . On exfoliation , teeth with experimental restorations were retrieved and microscopically examined for inhibition of demineralization at restoration margins . RESULTS The results of the clinical evaluation demonstrated no significant differences between the resin-modified glass ionomer cement restorations and the amalgam restorations ( P < .05 ) . Polarized light microscopic examination of the returned teeth that were restored as a part of this study indicated that the resin-modified glass ionomer cement had significantly less enamel demineralization at restoration margins than did amalgam ( P < .0001 ) . CONCLUSIONS The resin-modified glass ionomer cement functioned clinical ly as well as amalgam for Class II restorations in primary molars . However , the resin-modified glass ionomer exhibited significantly less enamel demineralization at restoration margins than did amalgam . CLINICAL IMPLICATION S Resin-modified glass ionomer cement restorative material functions well for Class II restorations in primary molars and exhibits less recurrent caries at restoration margins than does amalgam OBJECTIVES To assess and compare the cumulative survival rate of amalgam and atraumatic restorative treatment ( ART ) restorations in primary molars over 3 years . METHODS 280 children aged 6 - 7 years old were enrolled in a cluster r and omized controlled clinical trial using a parallel group design covering two treatment groups : conventional restorative treatment with amalgam ( CRT ) and atraumatic restorative treatment ( ART ) using a high-viscosity glass-ionomer ( HVGIC ) Ketac Molar Easymix . Three pedodontists placed 750 restorations ( 364 amalgam and 386 ART in 126 and 154 children , respectively ) which were evaluated at 0.5 , 1 , 2 and 3 years . The proportional hazard rate regression model with frailty correction , ANOVA and Wald tests , and the Jackknife procedure were applied in analysing the data . RESULTS The cumulative survival rates over 3 years for all , single- and multiple-surface CRT/amalgam restorations ( 72.6 % , 93.4 % , 64.7 % , respectively ) were no different from those of comparable ART/HVGIC restorations ( 66.8 % ; 90.1 % and 56.4 % , respectively ) ( p=0.10 ) . Single-surface restorations had higher survival rates than multiple-surface restorations for the both treatment procedures ( p<0.0001 ) . A higher proportion of restorations failed because of mechanical reasons ( 94.8 % ) than of secondary caries ( 5.2 % ) . No difference in reasons for restoration failures between all types of amalgam and ART/HVGIC restorations were observed ( p=0.24 ) . SIGNIFICANCE The high-viscosity glass-ionomer used in this study in conjunction with the ART is a viable option for restoring carious dentin lesions in single surfaces in vital primary molars This in vitro study evaluated the bond strength of adhesive restorative material s to sound and eroded dentin . Thirty-six bovine incisors were embedded in acrylic resin and ground to obtain flat buccal dentin surfaces . Specimens were r and omly allocated in 2 groups : sound dentin ( immersion in artificial saliva ) and eroded dentin ( pH cycling model - 3 × / cola drink for 7 days ) . Specimens were then reassigned according to restorative material : glass ionomer cement ( KetacTM Molar Easy Mix ) , resin-modified glass ionomer cement ( VitremerTM ) or adhesive system with resin composite ( Adper Single Bond 2 + Filtek Z250 ) . Polyethylene tubes with an internal diameter of 0.76 mm were placed over the dentin and filled with the material . The microshear bond test was performed after 24 h of water storage at 37ºC. The failure mode was evaluated using a stereomicroscope ( 400 × ) . Bond strength data were analyzed with two-way ANOVA and Tukey 's post hoc tests ( α = 0.05 ) . Eroded dentin showed bond strength values similar to those for sound dentin for all material s. The adhesive system showed the highest bond strength values , regardless of the substrate ( p < 0.0001 ) . For all groups , the adhesive/mixed failure prevailed . In conclusion , adhesive material s may be used in eroded dentin without jeopardizing the bonding quality . It is preferable to use an etch- and -rinse adhesive system because it shows the highest bond strength values compared with the glass ionomer cements tested BACKGROUND Secondary caries or caries adjacent to restorations is the most frequent reason for replacement of dental restorations . Though , limited data is available on variables influencing the development of secondary caries in primary teeth . AIM To investigate risk factors for the development of secondary caries adjacent to direct composite restorations in primary teeth . DESIGN For this retrospective study , data of 2417 composite restorations , which were placed due to primary carious lesions , were considered . A total of 212 restorations failed due to secondary caries within a maximum observation period of 8 years . A control group was r and omly selected . Mann-Whitney U-test , binomial logistic regression with backward elimination and Cox regression with frailty model were performed ( P < 0.05 ) . RESULTS The overall caries experience amounted to 6.3 dmft and 13.3 dmfs . 72.5 % of restorations failed within the first 2 years . Older children and children from families with a higher socio-economic status showed a lower risk for secondary caries . Further , the dentist and the adhesive had a significant influence on the longevity . Posterior restorations had a higher risk to fail in comparison with anterior restorations . CONCLUSIONS Within the limitation of this study , it is concluded that the development of secondary caries is influenced by several factors . Nevertheless , the secondary caries rate was found to be relatively low in this high-risk population BACKGROUND Limited information is available from r and omized clinical trials comparing the longevity of  amalgam and resin-based compomer/composite restorations . The authors compared replacement rates of these types of restorations in posterior teeth during the five-year follow-up of the New Engl and Children 's Amalgam Trial . METHODS The authors r and omized children aged 6 to 10 years who had two or more posterior occlusal carious lesions into groups that received amalgam ( n=267 ) or compomer ( primary teeth)/composite ( permanent teeth ) ( n=267 ) restorations  and followed them up semiannually . They compared the longevity of restorations placed on all posterior surfaces using r and om effects survival analysis . RESULTS The average+/-st and ard deviation follow-up was 2.8+/-1.4 years for primary tooth restorations and 3.4+/-1.9 years for permanent tooth restorations . In primary teeth , the replacement rate was 5.8 percent of compomers versus 4.0 percent of amalgams ( P=.10 ) , with 3.0 percent versus 0.5 percent ( P=.002 ) , respectively , due to recurrent caries . In permanent teeth , the replacement rate was 14.9 percent of composites versus 10.8 percent of amalgams ( P=.45 ) , and the repair rate was 2.8 percent of composites versus 0.4 percent of amalgams ( P=.02 ) . CONCLUSION Although the overall difference in longevity was not statistically significant , compomer was replaced significantly more frequently owing to recurrent caries , and composite restorations required seven times as many repairs as did amalgam restorations . CLINICAL IMPLICATION S Compomer/composite restorations on posterior tooth surfaces in children may require replacement or repair at higher rates than amalgam restorations , even within five years of placement OBJECTIVE The aim of this in vitro study was to evaluate the interaction between two sources of fluoride ( restorative systems and dentifrices ) in inhibiting artificial root caries development . METHODS One hundred and eighty tooth segments were embedded in polyester resin , and s and ed flat . Cylindrical cavities 1.0mm-deep and 1.5mm-diameter were prepared in root dentin and r and omly restored by fluoride-containing restorative systems : Ketac-fil/Espe ( Ke ) , Fuji II LC/GC Corp ( Fj ) , F2000/3 M ( F2 ) , Surefil/Dentsply ( Su ) or a control : Filtek Z250/3 M ( Z2 ) . Ten experimental groups were made to test the association among the five restorative systems and two dentifrices : with F(- ) ( Sensodyne Baking Soda ) or without F(- ) ( Sensodyne Original ) ( n=18 ) . After surface polishing , a 1mm-wide margin around the restorations was demarcated and initial dentin surface Knoop microhardness values ( KHN(i ) ) were obtained . The specimens were su bmi tted to a pH-cycling model , and to applications of slurries of dentifrice . Afterwards the final dentin surface Knoop microhardness values ( KHN(f ) ) were measured . RESULTS The differences between KHN(i ) and KHN(f ) , and the covariate KHN(i ) were considered by the ANCOVA and Tukey 's test ( alpha=0.05 ) . The interaction between restorative system and dentifrice was statistically significant ( p=0.0026 ) . All restorative systems provided some protection against artificial caries challenge when associated with the fluoride-containing dentifrice treatment . The means ( st and ard deviation ) of reductions in Knoop hardness values for systems associated with the fluoride-containing dentifrice were : Ke : 40.0(1.02)(a ) , Fj : 41.9(1.02)(b ) , F2 : 43.3(1.04)(c ) , Su : 43.5(1.00)(c ) , Z2 : 44.0(1.02)(c ) ; and with the non-fluoride-containing dentifrice were : Ke : 42.9(1.02)(a ) , Fj : 44.7(1.01)(b ) , F2 : 45.2(1.09)(bc ) , Su : 46.0(0.99)(c ) , Z2 : 46.6(0.99)(c ) ( statistical differences were expressed by different letters ) . CONCLUSION The cariostatic effect shown by the fluoride-containing dentifrice could enhance that shown by Ketac-fil and Fuji II LC , and could mask that shown by F2000 PURPOSE The authors conducted a r and omized clinical trial to evaluate the survival rate of esthetic restorations in Class I and Class II beveled preparations in primary molars 24 months after placement . The null hypothesis was that there is no difference among survival rates of the restorative material s used . METHODS Forty-eight children ( mean age , 5 years 9 months ) received 141 restorations in beveled cavosurface margins in primary molars r and omly assigned by lottery method : 46 received treatment with Vitremer Tri-Cure Glass Ionomer System ( 3 M ESPE Dental Products , St. Paul , Minn. ) ( 33 Class I and 13 Class II restorations ) , 51 received treatment with Freedom ( SDI , Bayswater , Victoria , Australia ) ( 36 Class I and 15 Class II restorations ) ; 44 received treatment with TPH Spectrum ( Dentsply , Petropolis , Rio de Janeiro , Brazil ) ( 30 Class I and 14 Class II restorations ) . Two examiners whose technique had been calibrated ( weight kappa > 0.85 ) evaluated the restorations using modified U.S. Public Health Service criteria and Visible Plaque Index score at baseline and at 12 , 18 and 24 months . RESULTS After two years , the authors censored data for 17 restorations , considered 101 restorations to be clinical ly successful and deemed 23 restorations failed because of loss of marginal integrity , anatomical form discrepancies and secondary caries . For Class I and Class II restorations , the cumulative survival rates were higher than 80 percent and 55 percent , respectively , for all material s ( life table , Gehan-Wilcoxon Test , P > .05 ; P > .05 ) . CONCLUSIONS At the 24-month clinical recall , the authors found no differences among material s in Class I ( P > .05 ) or Class II beveled preparations ( P > .05 ) in primary molars , but all material s showed higher survival rates in Class I than in Class II restorations This study compared the survival of restorations produced through the atraumatic restorative treatment ( ART ) approach using glass-ionomer with those produced through the traditional approach using amalgam ( MTA ) in deciduous dentitions over a period of 3 years . Using a parallel group design , 835 grade 1 children , aged 6–7 years , participated . A total of 482 children were treated through the ART and 353 children through the MTA approach .  Eight dentists produced a total of 1,891 single- and multiple-surface restorations . After 3 years , 22.1 % of the restorations were lost for evaluation . There was a statistically significant difference in the combined survival of all single- and multiple-surface restorations between the two approaches in favour of the ART approach ( p = 0.04 ) . The study revealed a 3-year cumulative survival percentage of single-surface ART and MTA restorations of 86.1 and 79.6 % , respectively . The difference was statistically significant ( p = 0.03 ) . The main reasons for both single-surface ART and MTA restorations to fail was ‘ restoration missing ’ followed by ‘ gross marginal defect ’ . The 3-year cumulative survival percentages of multiple-surface ART and MTA restorations were 48.7 and 42.9 % , respectively . The difference was not statistically significant ( p > 0.05 ) . The 3-year survival percentages of single- and multiple- surface ART and MTA restorations varied widely amongst the 8 operators with an operator effect ( p = 0.001 ) for multiple-surface MTA restorations . It can be concluded that the ART approach using glass-ionomer yielded better results in treating dentinal lesions in deciduous teeth than did the traditional approach using amalgam after 3 years . It is recommended to select the ART approach to complement the other activities of the school oral health programme BACKGROUND The authors evaluated the 24-month performance of a packable resin-based composite/dentin bonding system and a high-viscosity glass ionomer cement ( GIC ) in restorations placed in primary molars with the atraumatic restorative treatment ( ART )  approach . METHODS Three dentists placed 419 restorations in 219 children aged 6 through 10 years who had bilateral matched pairs of carious posterior Class I and II primary teeth . They used a split-mouth design to place the two material s , which were assigned r and omly to contralateral sides . The authors evaluated the restorations according to U.S. Public Health Service Ryge criteria . RESULTS After 24 months , 96.7 percent of the Class I GIC restorations and 91 percent of the resin-based composite restorations survived , while the success rates for the Class II restorations were 76.1 percent and 82 percent for the GIC and resin-based composite restorations , respectively . The survival rate of the Class II resin-based composite restorations was 5.9 percent higher than that of the GIC restorations at the 24-month evaluation , but this difference was not statistically significant . However , the study results showed a statistically significant difference in survival rates between Class I and II restorations for both material s. CONCLUSION AND CLINICAL IMPLICATION S The two-year clinical performance of both material s was satisfactory for the restoration of Class I and II primary molars using the ART approach The purpose of this study was to compare the clinical efficacy of  resin modified GIC with amalgam as a restorative material , in Class-II cavities of primary molars . Restorations were evaluated at four , eight , and twelve months for their marginal integrity , anatomic form and development of recurrent caries . When each parameter was considered separately , there was no difference in the success rate between the two groups , except development of recurrent caries significantly less ( p<0.05 ) in RMGIC group(4.7 % ) compared to amalgam group ( 12.5 % ) at twelve month follow up . However , the cumulative success rate at 12 month was found to be significantly higher ( p<0.05 ) in RMGIC ( Fuji II LC ) group(83.1 % ) compared to amalgam(72 % ) Background : Although Atraumatic restorative treatment ( ART ) approach has been in existence for a while , the reasons for the poor performance of multisurface ART restorations are not very clear . Aim : The aim of this study is to investigate the effects of oral hygiene , residual caries and cervical marginal-gaps on survival of proximal ART restorations . Setting s : Two rural divisions in Kenya were selected for the study . Design : A r and omized clinical trial . Material and Methods : The 804 children in the study had their baseline- and 2-year dental plaque levels documented . Each child received one proximal restoration in a primary molar using ART approach , together with trained and pre-tested operators/assistants , three glass ionomer cements (GIC)-br and s and two tooth-isolation methods . The restorations were clinical ly evaluated soon after placement and after 2 years . Post-restorative bite-wing radiographs taken soon after restoration were also evaluated . Statistical analysis : Statistical Package for Social Sciences ( SPSS ) version 14 computer programme was used and results tested using Pearson 's correlation , Cox Proportional Hazards regression analysis and Multiple Logistic regression models tests . Results : At baseline and after 2 years , the mean cumulative survival and plaque index changed from 94.4 % to 30.8 % and 2.34 ( St and ard Deviation , or SD of 0.46 ) to 1.92 ( SD 2.1 ) respectively , with higher plaque indices associated with higher restoration failures . Of the 507 radiographs evaluated , 48 ( 9.5 % ) , 63 ( 12.4 % ) and 9 ( 1.8 % ) restorations had residual caries ( RC ) , cervical marginal-gaps ( CMG ) and both RC/CMG respectively . Survival of the restorations with RC/CMG was significantly lower ( p = 0.003 ) compared to those with RC or without RC . Conclusion : Low survival of proximal restorations in the study was associated with the presence of cervical marginal-gaps Objective . To evaluate the clinical durability of flowable resin composite and resin-modified glass ionomer cement when used as class II restoratives in primary molars . Material and Methods . A total of 190 restorations were placed in 61 children , age in the range of 5–11 years . The restoratives , Tetric Flow , in combination with the adhesives , Excite or Prompt-L-Pop and Vitremer , were used in class II cavities in primary molars . An intra-individual study design was used and the restorations were evaluated by modified USPHS criteria over a 2-year period . Results . 146 of the restorations could be evaluated at 2 years . The cumulative failure rate was 10.6 % for Vitremer and 13.6 % for Tetric Flow . No statistically significant differences were found in failure rates between different material s or between bonding systems . The main cause of failure for Tetric Flow was secondary caries and for  Vitremer wear and dissolution . Conclusions . Vitremer and Tetric Flow showed no significant difference concerning clinical durability at 2 years when used as class II restoratives in primary molars . Both material s demonstrated acceptable clinical results The aim of the present investigation was to study the prevalence of approximal caries lesions and fillings in posterior teeth at 15 years of age in a prospect ively followed Swedish population ( n = 568 ) , with special reference to their caries experience at the age of 3 years . Only approximal surfaces were recorded , since all children in the Community of Jönköping have had fissure sealing performed on all caries-free permanent molars . At 15 years of age , the mean number of approximal tooth surfaces with initial caries lesions ( Dia ) , manifest caries lesions and fillings ( DmFa ) and total caries experience and fillings ( Di + mFa ) – recorded on bitewing radiographs – was 2.78 , 0.45 and 3.23 , respectively . One third of the adolescents had no approximal caries or fillings ; the Dia constituted 86 % of the Di + mFa . Children with manifest caries at 3 years of age had a higher risk of developing approximal caries in their permanent teeth than caries-free children at the same age ( 41 vs. 17 % ) . Furthermore , children who were caries-free at 3 years of age were more likely to remain caries-free at 15 years of age compared to children with manifest caries ( 37 vs. 17 % ) . All these differences were statistically significant ( p < 0.001 ) . Additionally , early childhood caries experience ( developed before 3 years of age ) had a greater predictive value than late childhood caries experience ( developed between 3 and 6 years of age ) concerning approximal caries at 15 years of age PURPOSE To evaluate the clinical performance of adhesive restorations of resin composite and resin-modified glass-ionomer cements in primary molars . METHODS This r and omized clinical trial included subjects ( 5 - 9 year-old children ) selected at two university centers ( UFRGS and UNIFRA ) . The sample consisted of 132 primary molars presenting active cavitated carious lesions ( with radiographic involvement of the inner half of the dentin ) , located on the occlusal and occlusal-proximal surface . The sample was r and omly divided into three groups , according to the restorative material : ( G1 ) universal restorative system ( Adper Single Bond 2 system and Filtek Z350 ) ; ( G2 ) : Resin-modified glass-ionomer cement ( Vitremer ) ; and ( G3 ) : Low shrink restorative system ( Filtek P90 ) . The restorations were clinical ly and radiographically followed every 6 months for up to 18 months using the USPHS modified criteria for clinical evaluation . Survival estimates for restoration longevity were evaluated using the Kaplan-Meier method . Log-rank test ( P < 0.05 ) was used to compare the differences in the success rate according to the type of the restorative material . RESULTS The type of restorative material used did not influence the longevity of the restorations . After clinical follow-up , there was no statistical difference in the rates of success for the three material s used to restore active cavitated carious lesions in primary molars . The survival rates for the follow-up were similar regarding the number of restored surfaces and the caries removal technique ( partial or complete ) . Mean estimated time of survival was 17.2 months ( 95 % CI : 16.7 - 17.7 ) . Estimated survival rates of the restorations were 100 % , 98 % , 88 % and 65 % at 1 , 6 , 12 and 18 months of clinical evaluations , respectively
target: AND PRACTICAL IMPLICATION S Because new caries lesions in the margins of restorations are the main reason for failure and replacement of restorations in primary teeth , it is important to know whether there is a benefit in using GICs in both occlusal and occlusoproximal cavities
background: BACKGROUND Fluoride released from glass ionomer cements ( GICs ) is capable of preventing caries lesions .
  However , the preventive effect in margins of occlusal and occlusoproximal restorations have not been proved .