Application of SDF versus ART in treating primary tooth caries

Abstract

Objectives: This study aimed to compare the clinical outcomes of placing atraumatic restorative treatment (ART) restorations with those of semi-annual application of silver diamine fluoride (SDF) solution in treating decayed primary teeth in preschool children. Methods: This randomized clinical trial was conducted in 23 kindergartens in Hong Kong. After obtaining written parental consent, children aged 3-4 years who had cavitated dentin caries lesions in their primary teeth were randomly assigned to receive either ART restorations (Ketac Molar, 3MESPE, Germany) or semi-annual application of 38% SDF solution (Saforide, Toyo Chemical, Japan). All treatments were carried out in the kindergartens using hand instruments only. The treated teeth were examined by an independent blinded examiner every 6 months using ball-ended probes and disposable dental mirrors attached to a handle with an intra-oral LED light source. Results: A total of 412 children received treatment at baseline, with 208 and 204 in the SDF and ART groups, respectively. There was no significant difference between the mean (±SD) dft scores of children in the SDF (5.0±3.5) and the ART (4.9±3.5) groups. So far, 187 and 160 treated lesions in the SDF and ART groups, respectively, were assessed after 12 months. In 79% of the SDF treated lesions, the surface was hard and there were no signs of active caries or discomfort. No significant differences in the caries arrest rates of different classes of lesions were found (Chi-square test, p>0.05). Nearly half (47%) of the ART restorations were present and had no or only minor defect. The success rates of ART restorations ranged from 9% in Class III to 59% in Class I restorations. Conclusions: So far in this clinical trial, the 12-month clinical success rate of SDF treatment was higher than that of ART restorations. This study is still ongoing and more findings will be reported later.