Cost-efficacy of ART and Conventional Treatment in Primary Molars: RCT

Objectives: The aim of the present study was to compare the 18-months cost-efficacy of ART and conventional restorative treatment with composite resin under rubber dam isolation (CT) in occlusal and occlusoproximal cavities of primary molars.
Methods: This cluster-randomized non-inferiority clinical trial was approved by the local Ethics Committee and registered on the Clinicaltrials.gov database (NCT02562456). A number of 117 children presenting 211 occlusal and 298 occlusoproximal cavities were randomly assigned to treatment groups. The restorations were performed in a dental trailer parked at a public school in Barueri - Brazil and evaluated after 6, 12 and 18 months. Professional and procedural costs were considered to estimate the price of each treatment. All repairs were considered in the final cost which included dental restoration using the previous randomized technique, endodontic treatment or extraction. The restorative treatment efficacy was assessed by Kaplan-Meier survival and Cox regression with shared fragility. The relationship between treatments’ cost and associated variables was analyzed with linear bootstrapping regression. A cost-efficacy plan was plotted to explore uncertainty.
Results: The survival of occlusal and occlusoproximal restorations after 18 months was 73.61% and 40.0% for CT, and 73.9% and 27.0% for ART. No significant statistical difference was found between treatments regarding the survival of occlusal restorations. However for occlusoproximal treatments, CT performed better than ART. CT cost was significantly higher for occlusal and occlusoproximal restorations (US$ 19.76 and US$ 30.70) in comparison with ART (US$ 8.85 and US$ 19.05) even considering all repairs throughout 18 months. The uncertainty analysis showed a tendency of ART to be more cost-effective than CT in occlusal cavities and less cost-effective in the occlusoproximal ones.
Conclusions: The most-effective treatment for occlusal and occlusoproximal cavities in primary teeth is ART and CT respectively.