The dilemma of selecting suitable proximal carious lesions in primary molars for restoration using the atraumatic restorative treatment (ART) approach

Citation:
Kemoli AM, van Amerongen WE. "The dilemma of selecting suitable proximal carious lesions in primary molars for restoration using the atraumatic restorative treatment (ART) approach." Community Dent Health J. 2011;28(1):12-16.

Abstract:

Objective: To determine the examiner’s accuracy in selecting proximal carious lesions in primary molars for restoration using the atraumatic restorative treatment (ART)
approach.
Basic research design: Intervention study.
Clinical setting and participants: A total of 804 six to eight year-olds from 30 rural
schools in Kenya participated in the study.
Intervention: Three examiners selected a total of 1,560 suitable proximal carious
lesions in the primary molars after examining 6,002 children from 30 schools randomly
selected out of 142 schools in two divisions. Seven operators randomly paired on a daily
basis to eight assistants restored the lesions. An explanation was provided for any cavity
that was not restored. Pre-and post-operative radiographs of the cavities were also taken
for evaluation.
Main outcome measures: The examiner’s choice of suitable proximal cavities
restorable using the ART approach was related to the decision made to either restore or
not to restore. The radiographic findings of the selected cavities were also compared to
the decision made by the examiner. The results obtained were used to determine the
examiner’s accuracy in selecting suitable proximal cavities for restoration using the ART approach.
Results: The majority of the subjects were excluded due to absenteeism, pulpalexposure or anxiety during the operative stage. Only 804 children received one restoration in their primary molars. The examiner’s accuracy in selecting suitable ART restorable cavities was 79.9% based on clinical parameters. The examiners’ judgment that the cavities had not progressed into the pulp was 94.9% based on preoperative radiographic analysis and based on postoperative radiographic analysis, 91.7% that the pulp would not be involved after treatment.
Conclusions: A trained and diligent examiner has a very good chance of selecting
proximal carious lesions restorable using the ART approach, without the threat of dental
pulpal-involvement during the excavation of caries.

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