Effectiveness of ART and traditional amalgam approach in restoring single-surface cavities in posterior teeth of permanent dentitions in school children after 6.3 years

Objectives: The Atraumatic Restorative Treatment (ART) approach was compared with the traditional amalgam (TA) approach in order to test their appropriateness to complement a preventive and educational school oral health programme in Syria. Methods: Using a parallel group design, 370 and 311 grade 2 children were randomly assigned to the ART and the TA group respectively. Eight dentists placed 1117 single- and multiple-surface restorations. A modified actuarial method was used to estimate survival curves. The jackknife method was applied to calculate the standard error in the cumulative survival percentages. Results: A statistically significant difference in cumulative survival percentages between single-surface non-occlusal ART and comparable amalgam restorations was observed after 4.3, 5.3 and 6.3 years. The survival of single-surface non-occlusal ART posterior restorations (80.2 +/- 4.9%) was statistically significantly higher than that of occlusal posterior ART restorations (64.8 +/- 3.9%) at evaluation year 6.3. There was no statistically significant difference observed between survival percentages of large (55.8 +/- 10%) and that of small (69.2 +/- 4.6%) single-surface posterior ART restorations after 6.3 years. There was an operator effect observed for single-surface ART and comparable amalgam restorations. Secondary caries was observed in 2.3% of single-surface ART restorations and in 3.7% of single-surface amalgam restorations during the 6.3 year observation period. Conclusion: The ART approach provided higher survival percentages for single-surface restorations than the TA approach over 6.3 years and is therefore appropriate for use in school oral health programmes. Secondary caries was only a minor reason for ART restorations to fail. An operator effect was observed for both treatment approaches.