Comparison between restorations in the permanent dentition produced by hand and rotary instrumentation - survival after 3 years

Objectives: In the early 1990s, the Ministry of Education in Syria introduced a school oral health programme based on preventive and educational activities only. A restorative component was missing at that time. A few years later, the Atraumatic Restorative Treatment (ART) approach was considered an option to complement the oral health programme but little was known about the longevity of ART restorations in permanent teeth. The null hypothesis which was researched in this trial was: there is no difference between the survival of restorations placed through the ART approach using glass ionomer and those produced through the traditional approach using amalgam (MTA) in permanent dentitions after 3 years. Methods: Using a parallel group design, 679 grade 2 children, with a mean age of 7.5 years, participated. A total of 369 children were treated through the ART and 310 children through the MTA approach. Eight dentists produced a total of 1118 single- and multiple-surface restorations. Results: The 3-year dropout of the single-surface restorations was 15.3%. Testing the null hypothesis for all single- and multiple-surface restorations revealed a statistically significant difference between the two approaches in favour of the ART approach (P = 0.04). The study showed a 3-year cumulative survival percentage of single-surface ART and MTA restorations of 82.1 (SE = 1.9%) and 76.9% (SE = 2.3%), respectively. The difference was not statistically significant. The number of 3-year surviving multiple-surface restorations was too low for further analyses. The main failure characteristics for both single-surface ART and MTA restorations were restoration missing and gross marginal defect. The 3-year survival percentage of both single-surface ART and MTA restorations varied widely among the eight operators resulting in an operator effect (P = 0.01). Conclusions: The null hypothesis was rejected in favour of the ART approach. It is recommended to select the ART approach to complement the educational and preventive activities of the school oral health programme in Syria.