Three-year Survival of ART and CRT Restorations in Patients With Disability

Objectives: To assess the cumulative survival rate of atraumatic restorative treatment (ART) and conventional restorations (CRT) after three years in people with disability referred for special care dentistry.
Methods: Patients were referred for restorative care to a university service for special care dentistry and treated by one of two specialists. Patients and/or their caregivers were provided with written and verbal information regarding the treatment options, and selected the alternative they considered most suitable according to their expectations. Treatment was provided as selected but if this option proved clinically unfeasible another alternative technique was subsequently proposed. Two treatment protocols were distinguished: ART (hand instruments/high-viscosity glass-ionomer) and CRT (rotary instrumentation/resin composite) in the clinic and under general anaesthesia (GA). After 6, 12, 24 and 36 months, two independent trained and calibrated examiners evaluated survival of the restorations using established ART restoration assessment codes. The Proportional Hazard model with frailty corrections was applied to calculate survival estimates over a three years period.
Results: 66 patients (13.6±7.8 years) with 16 different medical disorders participated. CRT in clinic proved feasible for 5 patients (13%) and 14 patients received CRT under GA (21%). The ART approach was applied to 47 patients (71.2%). In all, 298 dentine carious lesions were restored in primary and permanent teeth, 182 (ART) and 116 (CRT). The 2-years survival rates and jackknife standard error of ART and CRT restorations were 94.8±2.1% and 82.8±5.3%, respectively (p=0.01).
Conclusions: The three-years follow up results confirm that ART appears to be an effective treatment protocol for treating patients with disability restoratively, many of whom have difficulty coping with the conventional restorative treatment.