Application of SDF versus ART restoration in treating dentine caries lesions in primary teeth

Abstract

Objectives: This study aimed to compare the clinical outcomes of placing atraumatic restorative treatment (ART) restorations with those of semi-annual application of silver diamine fluoride (SDF) solution in treating decayed primary teeth in preschool children. Methods: This randomized clinical trial was conducted in 23 kindergartens in Hong Kong. After obtaining written parental consent, children aged 3-4 years who had cavitated dentin caries lesions in their primary teeth were randomly assigned to receive either ART restorations (Ketac Molar, 3MESPE, Germany) or semi-annual application of 38% SDF solution (Saforide, Toyo Chemical, Japan). All treatments were carried out in the kindergartens using hand instruments only. The treated teeth were examined by an independent blinded examiner every 6 months using ball-ended probes and disposable dental mirrors attached to a handle with an intra-oral LED light source. Clinical success was defined as the treated tooth having no active caries, other signs (e.g. abscess) or symptoms; and for teeth in the ART group, the restoration being retained and without major defect Results: A total of 412 children received treatment at baseline, with 208 and 204 in the SDF and ART groups, respectively. There was no significant difference between the baseline mean (±SD) dft scores of children in the SDF (5.0±3.5) and the ART (4.9±3.5) groups. So far, 160 and 154 treated lesions in the SDF and ART groups, respectively, were assessed after 24 months. In 81% of the SDF treated lesions, the surface was hard and there were no signs of active caries or discomfort. No significant differences in the caries arrest rates of different classes of lesions were found (Chi-square test, p>0.05). About one-third (32%) of the ART restorations were present and had no or only minor defect. The success rates of ART restorations ranged from 0% in Class III to 40% in Class I restorations. Conclusions: So far in this clinical trial, the 24-month clinical success rate of SDF treatment was higher than that of ART restorations. This study is still ongoing and more findings will be reported later.