Five-year Follow-up Of ART And CRT In Patients With Disability

Objectives: To assess the 5-year cumulative survival percentage of atraumatic restorative treatment (ART) and conventional resin composite restorations (CRT) placed in persons with disability.
Methods: Patients referred for restorative care to a special care service in Córdoba, Argentina, were treated by one of two specialists. Patients and/or caregivers were provided with written and verbal information regarding treatment options and selected the alternative they preferred. The treatment protocols were ART (hand instruments/high-viscosity glass-ionomer, either EQUIA system GC America or Chemfil Rock, Dentsply Germany) in the clinic or CRT (rotary instrumentation/resin composite with adhesive system, Single Bond and Filtek Z-350 3M Espe) in the clinic or under general anaesthesia (GA). Two independent, trained and calibrated examiners evaluated restoration survival using established ART codes after 6, 12, 24, 36 and 60 months. The proportional hazard model with frailty corrections provided survival estimates over 5 years.
Results: Sixty-six patients (13.6 ± 7.8 years) with 16 different medical conditions participated in the initial study, of whom four died in the last two years of the 5 year follow up. CRT in the clinic proved feasible for five patients (13%), and 14 patients received CRT under GA (21%). ART was used for 47 patients (71.2%). A total number of 298 dentine carious lesions were restored in primary and permanent teeth (182 ART; 116 CRT). Some observations are censored because of loss to follow up. Survival probability percentages and standard errors were calculated significantly higher for ART-GIC restorations (90.2±2.4%) than for CRT-Composite restorations (82.8±3.8%) 5 years after placement (p=0.01).
Conclusions: The 5-year follow-up results confirm that ART is an effective treatment protocol for patients with disability, many of whom have difficulty coping with CRT.