Does ART have a place in preservative dentistry?

Comparative Evaluation of the Survival Rates of Atraumatic Restorative Treatment Restorations Using Bilayer Technique along with Nanofilled Coating in Primary Molars: A Clinical Study

Objective

To enhance the survival rate of atraumatic restorative treatment (ART) restorations using (class I and class II) bilayer technique of placing glass ionomer cement (GIC) along with nanofilled coating (NC) over the restorations, thereby improving longevity.

Study design

A total of 178 primary molars in 67 children were selected and randomly divided into four groups. Group IA was treated with a single layer of GIC, followed by a protective layer of petroleum jelly in class I restoration. Group IB was treated with a single layer of GIC, followed by a protective layer of petroleum jelly in class II restoration. Group IIA was treated with bilayer GIC restoration followed by NC of GC-Coat Plus in class I, whereas group IIB was treated with bilayer GIC restoration followed by GC-Coat Plus in class II. Clinical analysis of all three groups was performed at 1, 3, 6, 9, and 12 months to evaluate the success of treatment procedures using predetermined criteria. Pearson's Chi-square and Kaplan-Meier estimates were utilized to evaluate the success of all four treatment procedures (p < 0.05).

Results

Out of 178 teeth, 33 teeth were in group IA, 36 teeth were in group IB, 43 teeth were in group IIA, and 40 teeth were available for evaluation at the end of the 12-month follow-up period. The overall success was determined to be 81% for group IA, 79.2% for group IB, 79.5% for group IIA, and 88.6% for IIB. At 6th-month follow-up, one clinical failure was observed in groups IA and IB. At 9 months follow-up, two clinical failures were observed in both group IA and group IB and three failures were observed in group IIB. At 12 months follow-up, four clinical failures were observed in group IA, three in group IB and one clinical failure was observed in group IIB. There was no statistically significant difference observed between the success of the four groups, suggesting that either of the techniques can be utilized for ART.

Conclusion

No statistically significant difference was observed between the survival of class I and class II restorations of both the groups, indicating that either single-layer or bilayer technique along with NC can be adopted for the management of dental caries in primary molars using the ART approach.

How to cite this article

Khan N, Garg N, Garg N, et al. Comparative Evaluation of the Survival Rates of Atraumatic Restorative Treatment Restorations Using Bilayer Technique along with Nanofilled Coating in Primary Molars: A Clinical Study. Int J Clin Pediatr Dent 2024;17(S-1):S55-S60.

Expert consensus on early childhood caries management

Early childhood caries (ECC) is a significant chronic disease of childhood and a rising public health burden worldwide. ECC may cause a higher risk of new caries lesions in both primary and permanent dentition, affecting lifelong oral health. The occurrence of ECC has been closely related to the core microbiome change in the oral cavity, which may be influenced by diet habits, oral health management, fluoride use, and dental manipulations. So, it is essential to improve parental oral health and awareness of health care, to establish a dental home at the early stage of childhood, and make an individualized caries management plan. Dental interventions according to the minimally invasive concept should be carried out to treat dental caries. This expert consensus mainly discusses the etiology of ECC, caries-risk assessment of children, prevention and treatment plan of ECC, aiming to achieve lifelong oral health.

Survival Rate and Cost-Effectiveness of Conventional and Atraumatic Restorative Treatment Restorations among Anganwadi Preschool Children in Bengaluru City: A Follow-up Study

Background

Atraumatic restorative treatment (ART) approach helps reduce barriers to restorative care for the patients. This study was done to compare the survival rate and cost-effectiveness of conventional and ART restorations at time-intervals of 6, 12, and 18 months among anganwadi preschool children in Bengaluru city.

Materials and Methods

133 children aged 3-5 years attending anganwadi centers in Bengaluru city based on inclusion and exclusion criteria were recruited for the present study. A split-mouth technique was used in which the participants received two types of carious cavity excavation techniques (conventional and ART) followed by restoration using glass ionomer cement. Comparison and evaluation were made at the end of 6 months, 12 months and 18 months intervals to check for the survival rate and cost-effectiveness.

Results

The survival rates of ART when compared to conventional restorations were higher at 6 months and 12 months 97.7% and 93.07%, respectively, and at 18 months survival rate of conventional restorations were higher. The cost-effectiveness ratio (CER) of the ART restoration was lower when compared to conventional restorations.

Conclusion

The carious cavities restored using ART techniques had a better survival rate at 12 months and lower CER when compared to the conventional technique.

Survival analysis of ART restorations in primary molars of preschool children: 1 year follow-up

Abstract Among the minimally invasive approaches available today, the atraumatic restorative treatment (ART) has demonstrated promising results both in the primary and permanent dentition. Objective To evaluate the survival of Class I ART restorations in preschoolers with two Brazilian brands of glass ionomer cements (GIC) in comparison with a reference GIC. Material and method The cavities of 49 preschool children (three to five years) with carious lesions in the posterior teeth (N=81) were filled by two experienced pediatric dentists according to the ART technique. The Brazilian GICs Maxxion-R (MR) and Vitro-Fil LC (VF), and the reference GIC Ketac-Molar (KM) were placed in a randomly pre-established sequence. Restorations were evaluated after 6 and 12 months by another investigator. Scores 0 and 1 were considered successful, while scores 3-9 were classified as failures. Kaplan-Meier survival analysis and the log-rank test were performed (p<0.05). Result No statistically significant differences in survival rates of the tested GIC were observed after 12 months. Conclusion The clinical performance the low-cost Brazilian GICs MR and VF observed after 12 months suggests that they may be an alternative for Class I ART restorations to safeguard the natural exfoliation of primary teeth. However, until further studies involving a larger number of restorations and longer follow-up periods are conducted, reference GIC such as KM should continue to be the material of choice for ART restorations.

Atraumatic restorative treatment versus conventional restorative treatment for managing dental caries

BACKGROUND

Dental caries is a sugar-dependent disease that damages tooth structure and, due to loss of mineral components, may eventually lead to cavitation. Dental caries is the most prevalent disease worldwide and is considered the most important burden of oral health. Conventional treatment methods (drill and fill) involve the use of rotary burs under local anaesthesia. The need for an electricity supply, expensive handpieces and highly trained dental health personnel may limit access to dental treatment, especially in underdeveloped regions.To overcome the limitations of conventional restorative treatment, the Atraumatic Restorative Treatment (ART) was developed, mainly for treating caries in children living in under-served areas of the world where resources and facilities such as electricity and trained manpower are limited. ART is a minimally invasive approach which involves removal of decayed tissue using hand instruments alone, usually without use of anaesthesia and electrically driven equipment, and restoration of the dental cavity with an adhesive material (glass ionomer cement (GIC), composite resins, resin-modified glass-ionomer cement (RM-GICs) and compomers).

OBJECTIVES

To assess the effects of Atraumatic Restorative Treatment (ART) compared with conventional treatment for managing dental caries lesions in the primary and permanent teeth of children and adults.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 22 February 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 1), MEDLINE Ovid (1946 to 22 February 2017), Embase Ovid (1980 to 22 February 2017), LILACS BIREME Virtual Health Library (Latin American and Caribbean Health Science Information database; 1982 to 22 February 2017) and BBO BIREME Virtual Health Library (Bibliografia Brasileira de Odontologia; 1986 to 22 February 2017). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) with at least six months' follow-up that compared the effects of ART with a conventional restorative approach using the same or different restorative dental materials to treat caries lesions.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened search results, extracted data from included studies and assessed the risk of bias in those studies. We used standard methodological procedures expected by Cochrane to evaluate risk of bias and synthesise data. Where pooling was appropriate we conducted meta-analyses using the random-effects model. We assessed the quality of the evidence using GRADE criteria.

MAIN RESULTS

We included a total of 15 eligible studies randomising 3760 participants in this review. The age of participants across the studies ranged from 3 to 101 years, with a mean of 25.42 years. 48% of participants were male. All included studies were published between 2002 and 2016. Two of the 15 studies declared that the financial support was from companies that manufacture restorative material. Five studies were individually randomised parallel-group studies; six were cluster-randomised parallel-group studies; and four were randomised studies that used a split-mouth design. Eleven studies evaluated the effects of ART on primary teeth only, and four on permanent teeth. The follow-up period of the included studies ranged from 6 months to 36 months. We judged all studies to be at high risk of bias.For the main comparison of ART compared to conventional treatment using the same material: all but two studies used high-viscosity glass ionomer (H-GIC) as the restorative material; one study used a composite material; and one study used resin-modified glass ionomer cement (RM-GIC)).Compared to conventional treatment using H-GIC, ART may increase the risk of restoration failure in the primary dentition, over a follow-up period from 12 to 24 months (OR 1.60, 95% CI 1.13 to 2.27, five studies; 643 participants analysed; low-quality evidence). Our confidence in this effect estimate is limited due to serious concerns over risk of performance and attrition bias. For this comparison, ART may reduce pain during procedure compared with conventional treatment (MD -0.65, 95% CI -1.38 to 0.07; 40 participants analysed; low-quality evidence)Comparisons of ART to conventional treatment using composite or RM-GIC were downgraded to very low quality due to indirectness, imprecision and high risk of performance and attrition bias. Given the very low quality of the evidence from single studies, we are uncertain about the restoration failure of ART compared with conventional treatment using composite over a 24-month follow-up period (OR 1.11, 95% CI 0.54 to 2.29; one study; 57 participants) and ART using RM-GIC in the permanent teeth of older adults with root caries lesions over a six-month follow-up period (OR 2.71, 95% CI 0.94 to 7.81; one study; 64 participants).No studies reported on adverse events or costs.

AUTHORS' CONCLUSIONS

Low-quality evidence suggests that ART using H-GIC may have a higher risk of restoration failure than conventional treatment for caries lesions in primary teeth. The effects of ART using composite and RM-GIC are uncertain due to the very low quality of the evidence and we cannot rely on the findings. Most studies evaluated the effects of ART on the primary dentition.Well-designed RCTs are required that report on restoration failure at clinically meaningful time points, as well as participant-reported outcomes such as pain and discomfort. Due to the potential confounding effects from the use of different dental materials, a robust body of evidence on the effects of ART compared with conventional treatment using the same restoration material is necessary. We identified four ongoing trials that could provide further insights into this area.

Remineralizing amorphous calcium phosphate based composite resins: the influence of inert fillers on monomer conversion, polymerization shrinkage, and microhardness

Aim

To determine if the addition of inert fillers to a bioactive dental restorative composite material affects its degree of conversion (DC), polymerization shrinkage (PS), and microhardness (HV).

Methods

Three amorphous calcium phosphate (ACP)-based composite resins: without added fillers (0-ACP), with 10% of barium-glass fillers (Ba-ACP), and with 10% of silica fillers (Si-ACP), as well as commercial control (Ceram•X, Dentsply DeTrey) were tested in laboratory conditions. The amount of ACP (40%) and the composition of the resin mixture (based on ethoxylated bisphenol A dimethacrylate) was the same for all ACP materials. Fourier transform infrared spectroscopy was used to determine the DC (n = 40), 20 min and 72 h after polymerization. Linear PS and Vickers microhardness (n = 40) were also evaluated. The results were analyzed by paired samples t test, ANOVA, and one-way repeated measures ANOVA with Student-Newman-Keuls or Tukey’s post-hoc test (P = 0.05).

Results

The addition of barium fillers significantly increased the DC (20 min) (75.84 ± 0.62%) in comparison to 0-ACP (73.92 ± 3.08%), but the addition of silica fillers lowered the DC (71.00 ± 0.57%). Ceram•X had the lowest DC (54.93 ± 1.00%) and linear PS (1.01 ± 0.24%) but the highest HV (20.73 ± 2.09). PS was significantly reduced (P < 0.010) in both Ba-ACP (1.13 ± 0.25%) and Si-ACP (1.17 ± 0.19%) compared to 0-ACP (1.43 ± 0.21%). HV was significantly higher in Si-ACP (12.82 ± 1.30) than in 0-ACP (10.54 ± 0.86) and Ba-ACP (10.75 ± 0.62) (P < 0.010).

Conclusion

Incorporation of inert fillers to bioactive remineralizing composites enhanced their physical-mechanical performance in laboratory conditions. Both added fillers reduced the PS while maintaining high levels of the DC. Silica fillers additionally moderately improved the HV of ACP composites.

Six-month evaluation of ART one-surface restorations in a community with high caries experience in Brazil

The aim of this study to evaluate the success rate in one-surface ART restorations placed in permanent molars using a glass ionomer cement especially developed for ART in a community with high caries experience; to evaluate the operator influence on its success, post-operative sensitivity and technique acceptance by patients. Prior to placement of the restorations, the Gingival Bleeding Index, Visible Plaque Index, DMFT, dmft indices and treatment needed were assessed. One hundred and fifty five one-surface restorations were placed in permanent molars of school children, according to the WHO ART manual, 1997. After 6 months, the success rate was verified clinically and by slides. At baseline, the mean DMFT was 2.56 (±1.08) and the mean dmft, 2.53 (±2.33). Operators A and B have placed 102 and 53 ART restorations respectively. The mean time of placement was 16 minutes and 25 seconds to operator A and 14 minutes and 43 seconds to operator B. At 6-month follow up, 152 ART restorations were evaluated and 97.3% were assessed to be successful. Two restorations were excluded from the sample because the ART restorations were replaced by amalgam fillings. Only 4 restorations have failed, in which 2 due to caries, 1 due to fistula presence and the other because the restoration was lost. Four patients reported postoperative sensitivity. At this study period, ART treatment seems to be suitable for its purpose. Further evaluations are necessary to the new glass ionomer cements especially developed for ART technique provided good results at 6-month follow up in a community with high DMFT and dmft indices. The success rate for one-surface cavities in permanent molars was 97.3%, and the studied indices seemed to have no influence in this early evolution period.

Two-year evaluation of the atraumatic restorative treatment approach in primary molars class I and II restorations

BACKGROUND

Atraumatic restorative treatment (ART) has the advantages of reducing pain and fear and of being more cost-effective than the traditional approach.

AIM

The aim of this study was to investigate the survival of ART class I and II restorations in primary molars at 2 years.

DESIGN

The sample consisted of 190 restorations and placed in 155 children 6-7 years old of both genders. The treatment was performed by two final-year dental students. All patients were treated in a completely supine position on tables available in the schools. The restorations were evaluated at 1, 12, and 24 months.

RESULTS

The best results were found for class I in each period of follow-up. After 1 month, the success of class I restorations was 94.6% and class II restorations 70.1%. After 12 months, the success rate was 50.6% for class I and 15.2% for class II. The most frequent failure characteristics were totally or partially lost and gross marginal defect.

CONCLUSIONS

The rate of success of restorations using the ART approach was significantly lower for class II.

A clinical evaluation of two glass ionomer cements in primary molars using atraumatic restorative treatment technique in India: 1 year follow up

AIM

To compare the clinical performance of two glass ionomer cements, Amalgomer CR and Fuji IX in small and medium cavities prepared using Atraumatic restorative treatment approach in India.

STUDY DESIGN

One hundred school children in the age group of 4-9 years who had bilateral matched pair of carious lesions in primary posterior teeth were included. A split mouth design was used in which two materials were randomly placed in contralateral sides. The performance of the restorations was assessed after 1 year using Frenken's criteria (1996). Survival analysis of restoration was done using chi-square test.

RESULTS

The survival rate of Amalgomer CR and Fuji IX class I restorations were 97.4% and 94.9%, respectively. In class II cavities 95.1% and 88.5% of Amalgomer CR and Fuji IX restorations were successful. Amalgomer CR and Fuji IX showed a success of 94.2% and 92.3% in small sized class II cavities. Amalgomer CR showed a 100% success for medium sized class I and II restorations. Whereas Fuji IX showed a 100% and 66.7% success in medium sized class I and II cavities.

CONCLUSION

The clinical performances of both materials were satisfactory at the end of 1 year and ART is suitable procedure to be done in a dental clinic for children.

Physical-mechanical properties of glass ionomer cements indicated for atraumatic restorative treatment

BACKGROUND

This study evaluated mechanical properties of glass ionomer cements (GICs) used for atraumatic restorative treatment. Wear resistance, Knoop hardness (Kh), flexural (F(s)) and compressive strength (C(s)) were evaluated. The GICs used were Riva Self Cure (RVA), Fuji IX (FIX), Hi Dense (HD), Vitro Molar (VM), Maxxion R (MXR) and Ketac Molar Easymix (KME).

METHODS

Wear was evaluated after 1, 4, 63 and 365 days. Two-way ANOVA and Tukey post hoc tests (P = 0.05) analysed differences in wear of the GICs and the time effect. F(s), C(s), and Kh were analysed with one-way ANOVA.

RESULTS

The type of cement (p < 0.001) and the time (p < 0.001) had a significant effect on wear. In early-term wear and Kh, KME and FIX presented the best performance. In long-term wear, F(s) and C(s), KME, FIX and HD had the best performance. Strong explanatory power between F(s) and the Kh (r(2) = 0.85), C(s) and the Kh (r(2) = 0.82), long-term wear and F(s) of 24 h (r(2) = 0.79) were observed.

CONCLUSIONS

The data suggested that KME and FIX presented the best in vitro performance. HD showed good results except for early-term wear.

Assessing patients' caries risk

BACKGROUND

Caries management historically has focused on the removal of cavitated carious tissue and restoration of the tooth.

OVERVIEW

Assessing a patient's risk of developing caries is a vital component of caries management. A comprehensive caries assessment should consider factors such as past and current caries experience, diet, fluoride exposure, presence of cariogenic bacteria, salivary status, general medical history, behavioral and physical factors, and medical and demographic characteristics that may affect caries development. A caries risk assessment also should consider factors that may challenge the patient's ability to maintain good oral hygiene (for example, crowded dentition, deep fissures, wide open restorative margins or placement of oral appliances).

CONCLUSIONS

and Practical Implications. The authors review the importance of caries risk assessment as a prerequisite for appropriate preventive and treatment intervention decisions and provide some practical information on how general practitioners can incorporate caries risk assessment into the management of caries.

Compressive and diametral tensile strength of glass ionomer cements

The aim of this study was to compare, in different periods of time, the compressive and diametral tensile strength of a traditional high viscous glass ionomer cement: Fuji IX (GC Corporation), with two new Brazilian GIC's: Vitro-Molar (DFL) and Bioglass R (Biodinamica), all indicated for the Atraumatic Restorative Treatment (ART) technique. Fifteen disk specimens (6.0mm diameter x 3.0mm height) for the diametral tensile strength (DTS) test and fifteen cylindrical specimens (6.0mm diameter x 12.0mm height) for the compressive strength (CS) test were made of each GIC. Specimens were stored in deionized water at 37º C and 100% of humidity in a stove until testing. Five specimens of each GIC were submitted to CS and DTS test in each period, namely 1 hour, 24 hours and 7 days. The specimens were tested in a testing machine (Emic) at a crosshead speed of 1.0mm/min for CS and 0.5mm/min for the DTS test until failure occurred. The data were submitted to two-way ANOVA and Tukey tests (alpha=0.05). The mean CS values ranged from 42.03 to 155.47MPa and means DTS from 5.54 to 13.72 MPa, with test periods from 1h to 7 days. The CS and DTS tests showed no statistically significant difference between Fuji IX and Vitro Molar, except for CS test at 1-hour period. Bioglass R had lowest mean value for CS of the cements tested. In DTS test Bioglass R presented no statistically significant differences when compared with all others tested GICs at 1-hour period and Bioglass R presented no difference at 24-hour and 7-day periods when compared to Vitro-Molar. Further studies to investigate other physical properties such as fracture toughness and wear resistance, as well as chemical composition and biocompatibility, are now needed to better understand the properties of these new Brazilian GIC's.

Clinical evaluation of three restorative materials applied in a minimal intervention caries treatment approach

OBJECTIVES

This paper reports on a longitudinal evaluation of three materials (glass ionomer, zinc oxide-eugenol cement, and composite) employed in a minimal restorative intervention approach of 81 high caries-active pregnant women selected for a preventive oral health program in Brazil. The aim of the study was to evaluate the clinical behavior of the glass ionomer cement, currently indicated in programs for control of carious lesions.

METHODS

The patients were randomly divided into two groups. Both groups were engaged in an oral health promotion approach. In Group 1, 417 glass ionomer restorations were placed in 43 individuals, involving all types and sizes of cavities. In the second group, 213 posterior zinc oxide-eugenol (ZOE) restorations and 127 anterior composite restorations were placed in 38 patients. Minimal cavity preparations were made, in which only soft or infected dentin was removed, on the basis of clinical judgment.

RESULTS

After two years, the restorations were clinically evaluated by two examiners for marginal integrity, amount of wear, presence of fracture, carious lesions, and lost restorations. Statistical analysis (chi-square test) identified statistically significant difference between glass ionomer and ZOE (90.6% vs 9.2%). Comparing glass ionomer and composite, similar survival rates were observed. The success rate observed for the glass ionomer cement ranged from 77.1 percent to 92.5 percent, depending on the type and size of cavity in which it was applied. Four teeth restored with glass ionomer cement and one tooth restored with composite showed caries signs. Regarding the ZOE restorations, caries was always associated with other causes of failure such as excessive wear, restoration loss, or marginal defects, with no possibility of separate evaluation. Despite the preventive and therapeutic measurements employed, a mean increase of 2.15 new surfaces with cavities was observed in Group 1, as well as 2.83 surfaces presenting the same status in Group 2.

CONCLUSIONS

This study demonstrated that highly viscous glass ionomer cement applied in a minimal intervention approach provided high-quality preventive and restorative care after two years to a population at high risk for caries. The composite was employed in cavities exposed to lower stress, such as in the anterior teeth, and its behavior was comparable to that of the glass ionomer cement. The reinforced ZOE presented a high failure rate, thus contraindicating its use for such purpose.

Assessment of manual restorative treatment (MRT) with amalgam in high-caries Filipino children: results after 2 years

BACKGROUND

The atraumatic restorative treatment (ART), using only hand instruments and glass-ionomer cement as adhesive material is recommended for restorative dental treatment in disadvantaged communities lacking electricity and sophisticated dental equipment. Research is required on more durable restorative materials appropriate for populations with high-caries experience.

OBJECTIVES

The aim of the study was to evaluate, under field conditions, the applicability and effectiveness of an encapsulated amalgam as restorative material in ART prepared cavities in permanent teeth of children with high-caries rates. As the definition of ART restricts the manual treatment to adhesive materials the approach used is called the manual restorative treatment (MRT).

METHODS

Two dentists and two trained healthcare workers, using hand instruments and an encapsulated amalgam that was mixed with a manually driven triturator, placed a total of 934 restorations in the permanent dentition in 466 children. Due to irregular school attendance of Filipino children only 611 restorations could be evaluated by one independent dentist. The average age at reassessment of restorations was 27 +/- 4.5 months.

RESULTS

93.3% of the restorations were acceptable. The failure rate of occlusal surface restorations was 5.6% compared with 13.6% of buccal surface fillings. The survival rate of large occlusal restorations was 95.1% compared with 93.7% for small restorations. The survival of MRT restorations was not influenced by the experience and professional level of the operator.

CONCLUSIONS

Amalgam is a suitable MRT material, especially for extensive occlusal lesions in high-caries populations. Studies of longer duration are needed to confirm this finding.

The effects of two cavity preparation methods on the longevity of glass ionomer cement restorations: an evaluation after 12 months

BACKGROUND

The authors undertook a study to evaluate the effect of two cavity preparation methods on the initial survival of two more-viscous glass ionomer cements, or GICs, placed in the occlusal surfaces of permanent molar teeth.

METHODS

Three dentists placed 149 restorations in 68 adult patients in a hospital clinic. They used either atraumatic restorative treatment, or ART, or conventional cavity preparation methods to place two encapsulated esthetic conventional GICs: Fuji IX GP (GC International Corp., Tokyo) and Ketac-Molar Aplicap (3M ESPE, Seefeld, Germany). For comparison, they used high-copper-content GK Amalgam Alloy (Advanced Technology & Materials Co. Ltd., Beijing) in conventional preparations. They evaluated the restorations using both direct and indirect observation methods.

RESULTS

Cavity preparations for which the authors used ART hand instruments took approximately twice as long to complete as did those for which they used conventional rotary instruments. After 12 months, no restorations had failed, but restorations comprising both GICs showed early losses of adjacent sealant material. Both GICs also showed relatively high restoration wear. At 12 months, the mean cumulative net occlusal wear for Fuji IX GP was 77 +/- 47 micrometers, and for Ketac-Molar 83 +/- 51 microm, without statistical significance (P > .05). Color matching improved significantly with time (P < .001), without significant differences in color between the two GICs by 12 months (P = .09). The amalgam alloy had minor surface tarnishing and marginal discrepancies increased with time (P < .00 1).

CONCLUSIONS

All of the occlusal restorations were rated as satisfactory after 12 months. The method of cavity preparation did not affect the restoration performance of the GICs. However, their deterioration requires long-term monitoring. Clinical Implications. The more viscous GICs appear initially suitable for restricted use in clinical practice when placed using either of two cavity preparation methods in the occlusal surfaces of permanent molar teeth in adults.