Comparative study on the outcomes of restoring SDF-treated and untreated dentine caries lesions with ART approach

Abstract

This thesis consists of two systematic reviews, a laboratory study and a clinical trial, which are all related to the use of atraumatic restorative treatment (ART) to restore dentine caries lesions of young children.

Objective: The laboratory study aimed to investigate the influence of silver diamine fluoride (SDF) application on the micro-tensile bond strength (mTBS) of glass ionomer cement (GIC) to sound and carious dentine. Methods: Thirty dentine blocks were randomly allocated into either sound (Gp1) or carious (Gp2) dentine groups. A microbiological method was adopted to create artificial caries lesions in the Gp2 specimens. Each dentine block was sectioned into two halves and each pair of block halves was randomly assigned to two subgroups to receive topical application of SDF or water (control). Two weeks later, GIC was bonded to the dentine surface. After immersion for 7 days in artificial saliva, the GIC-dentine specimens were sectioned into beams for mTBS testing. Results: There was no significant difference in the mean mTBS values between the SDF and the control subgroups (Gp1-SDF vs. Gp1-water: 10.6±1.6 vs. 10.2±1.8 Mpa; Gp2-SDF vs. Gp2-water: 6.1±2.2 vs 6.0±2.3 Mpa, p>0.05). However, the mean mTBS value of the sound dentine group was significantly higher than that of the carious dentine group irrespective of SDF application prior to GIC bonding. Conclusions: SDF application does not significantly affect the mTBS of GIC to dentine. Compared with sound dentine, carious dentine has lower mTBS to GIC.

Objective: The clinical trial was to compare the clinical outcomes and subjective evaluations, i.e. parental satisfaction and children’s oral health-related quality of life (OHRQoL), of restoring SDF-treated and untreated dentine caries lesions in primary teeth of preschool children with the ART approach. Methods: Children with cavitated dentine caries lesions were randomly allocated into two groups to receive application of either SDF or placebo 10 weeks before the provision of ART restorations. Parental questionnaires were used to obtain information on parental satisfaction and children’s OHRQoL. Status of ART restorations was assessed every 6 months after placement. Results: A total of 194 children (SDF group, 101; control group, 93) participated in this study, with 260 and 249 restorations placed in the SDF and the control groups, respectively. There were no significant differences in the success rate of ART restorations between the two study groups. At 24-month follow-up, Class I restorations had the highest success rate (~50%), followed by Class V (~35%), Class II (~15%) and Class III (<10%). Compared with baseline, at the 6-month follow-up, higher mean parental satisfaction scores with their child’s dental health status (2.8 vs. 2.2, p<0.001) and esthetics (2.9 vs. 2.6, p<0.001) were obtained, while the children’s OHRQoL did not change much (mean ECOHIS score: 7.1 vs. 6.5, p>0.05). Conclusion: Prior treatment of dentine caries lesions with SDF does not significantly affect the success rate of ART restorations placed in primary teeth. Restoring the caries cavities with the ART approach, irrespective of prior SDF application, can increase parental satisfaction but not influence children’s OHRQoL.