ART Versus Hall Technique in Primary Molars: 1-yr Survival Results

Objectives: Occluso-proximal, cavitated carious lesions in primary molars are common. They are notoriously difficult to manage using less invasive techniques, preferred by children, yet still obtain high quality restorations with predictable results. The aim of this two-arm, parallel group, patient-randomized controlled, superiority trial with treatment provided in school setting, was to compare survival rates of occluso-proximal restorations using Atraumatic Restorative Treatment (ART) with the Hall Technique (HT).
Methods: After obtaining local Ethics Committee approval (#1.293.935) and ClinicalTrials.gov registration (NCT02569047), children from 5 to 10 years old (n=131), presenting an occluso-proximal carious lesion in a primary molar were recruited from schools in the city of Tietê, Brazil. One tooth per child, fitting the inclusion criteria, was randomly allocated to receive either: an ART restoration using high viscosity glass ionomer cement (Equia Forte - GC Corp.) or a stainless steel crown placed using the HT. The primary outcome was the treatment survival, a composite measure of absence of Minor Failure (restoration/crown defect but not interfering with tooth health) or Major Failure (signs or symptoms of irreversible pulp damage, fistula/abscess, tooth fracture or failures that cannot be repaired). Restorations were evaluated after 1, 6 and 12 months. Kaplan-Meier survival analysis and log rank tests were carried out. Cox regression test investigated associations between the primary outcome and other variables (α= 5%).
Results: After twelve months of follow-up, the overall restoration survival rate was 78.6% (HT = 98.5% and ART = 58.5%). There was a statistically significant difference between the interventions’ survival rates with the HT being higher than ART (HR = 29.6; p = 0.001, CI = 4.01 to 218.9). Cox regression found no association between child's age, restoration surface (mesial or distal) or operator (with or without experience).
Conclusions: Occluso-proximal cavitated carious lesions restored using crowns placed with the Hall Technique show better survival rates than Atraumatic Restorative Treatment after 1 year.