With a rapidly increasing elderly population with more retained teeth, there is likely to be an increasing demand for treatment of caries in this group.
Conventional dental care might not be acceptable or accessible to older (frailer) patients, so providing suitable and cost-effective dental treatment to this population could be challenging. The use of the atraumatic restorative treatment (ART) approach could be an option for this population.
The aim of this study was to compare the 2-year survival of restorations placed according to the principles of ART compared to conventional restorations in partially dentate older patients.
Patients ≥ 65 yeas of age with ≥ 1 carious lesion into dentine and able to perform usual daily dental care activities such as toothbrushing were included. They were randomised to receive either ART or conventional treatment (CT). ART involved tooth preparation with hand instruments conditioning with polyacrylic acid for 20 seconds, washing and drying with cotton pellets and restoration with high-strength glass-ionomer cement. Cavity preparation for the CT involved the use of rotary instruments under local anaesthesia prior to placement of resin-modified glass- ionomer. Moisture control techniques were the same in both cases.
A calibrated dentist who was not involved in restoration placement and who was blinded to treatment group reviewed patients at 6 months, 1 year and 2 years.
- 99 patients were recruited (51 ART; 48 CT)
- 300 restorations were placed (142 ART; 158 CT). The majority were single surface restorations.
- Mean DMFT at baseline was 25.74 in the ART group and 28.54 in the CT group.
- 77 patients (71.2%) were available at 2 years (34 ART; 37 CT)
- 96 restorations (67.6%) were assessed in the ART group and 121 (76.6%) were assessed in CT group.
- No statistically significant between group differences were detected.
|Atraumatic restorative treatment (ART)||Conventional treatment (CT)|
|Restorations at base line||142||158|
|Restoration as 2 years||96 (67.6%)||121 (77.2%)|
|Present in good condition||74 (77%)||97 (80.1%)|
|Total failures||14/96 (14.6%)||11/121 (9.1%)|
|Cumulative survival proportions||85.4%||90.9%|
The authors concluded: –
This study illustrated that in terms of restoration survival after 2 years there were no statistically significant differences between ART and conventional caries removal for partially dentate older adults. An ART based approach to caries management appears to be a suitable approach to treat older patients with high levels of survival of restorations after 2 years. This technique could represent an effective, easy to administer and less costly alternative to treat carious lesions in the elderly and, together with preventive measures might be an aid to stop caries progression, which could result in tooth loss.
Previously (Dental Elf – 9th Sept 2014) we have looked at cost effectiveness data derived from this study. That study found ART to be more cost-effective. This study found no statistically significant differences between ART and CT suggesting that it may present an alternative approach to managing caries in this population.
Original Trial Registration – ISRCTN76299321
da Mata C, Allen PF, McKenna G, Cronin M, O’Mahony D, Woods N. Two-year survival of ART restorations placed in elderly patients: A randomised controlled clinical trial. J Dent. 2015 Jan 15. pii: S0300-5712(15)00016-0. doi: 10.1016/j.jdent.2015.01.003. [Epub ahead of print] PubMed PMID: 25597266.
Dental Elf – 9th Sept 2014 – Atraumatic restorative treatment had good 1-year survival and cost effectiveness in older adults
Don’t miss – Atraumatic restorative treatment for older adults http://t.co/ltAFtyEHa0 #EBP
It is certainly very interesting to see alternative restorative approaches showing positive results when used in elderly patients. ART could be an alternative to treat older individuals routinely, especially those who do not have easy access to dental treatment, such as nursing home residents. More studies are necessary though, especially to assess the feasibility of bringing this type of treatment to non-clinical settings.
Cristiane da Mata