Effectiveness of Caries Removal with Atraumatic-Restorative-Treatment on Multiple Surface Cavities

Success of Atraumatic Restorative Treatment (ART) on multiple surface caries lesions is a pertinent research question and critics of ART maintain that hand instruments cannot remove all carious dentine. Objective: Comparison of in vitro effectiveness of caries removal on class I, II and V cavities using ART and conventional technique (CT). Effectiveness was measured in terms of caries remaining and time to prepare cavities. Methods: Extracted permanent molars with class I, II and V cavities, clinically suitable for ART were selected. Caries were removed alternating between ART and CT. Special care was taken to prevent dentine drying. Spoon excavators were used for ART and a round bur for CT. Cavity preparation ceased when hard dentine were reached. Six teeth were prepared in each group. Time needed for cavity preparation was recorded. Four slices of each prepared cavity (500µm thick) were cut on an Isomet Low Speed Saw. Slices were stained in aqueous glycol-based caries-detector-dye (20s) and rinsed in sterile distilled water (5s). Stained slices were photographed and stained areas were quantified (Remaining Caries Index (RCI)) with an image analysis software package, where stained surface area was expressed relative to size of the cavity. Results: Timing of cavity preparation showed preparation of classes I (p>0.05) and V (p<0.05) cavities took longer with the ART technique. No difference between times needed for preparation of class II cavities with either ART or CT were found. RCI indicated no significant difference (p>0.05) between caries remaining in both classes I and II cavities. Significant more caries remained behind in class V cavities prepared with ART compared to CT. Conclusion: No significant difference was found in caries removal using ART and CT for class I and II cavities, but the ART technique is not suitable for preparation of class V cavities.