Sealing on Carious Tissue (SoCT) in Primary Molars by Zinc-Reinforced Glass Ionomer Cement (ZRGIC) using Finger Pressure Technique: A Preliminary Study

Main Article Content

Sunil Babu Kotha
Noura Khalid Alwatban
Hissah Abdulaziz almuhrij
Hanadi Abdullah Alwafi
Azhar Abbas Alabbad
Wejdan Melfi Mohammed Alotaibi
Abdulrahman Al-Saffan
Sreekanth Kumar Mallineni

Keywords

Carious lesion; Glass ionomer cement; Primary teeth; Retention rate

Abstract

Regardless of the numerous causes, children fear the dentist for a variety of reasons, including parental unpreparedness, community influences, previous medical or dental experiences, previous dental settings, injections, dental materials, drill sounds, dental staff, and socioeconomic concerns. Conventionally, the carious tissue is removed using a local anesthetic, rubber dams, and rotational handpieces and it is preferred by the majority of dentists. Traditionally, the dental procedures are unpleasant for youngsters, therefore they avoid them. To evaluate the retention of zinc-reinforced glass ionomer cement (ZRGIC) in primary molars by sealing the carious tissue (SoCT) using the finger pressure technique in uncooperative children. Only healthy, uncooperative children with occlusal carious lesions on primary molars were involved in the study. The study did not include any children who had symptoms from a primary molar carious lesion. The ZRGIC was used by finger pressure technique to seal the occlusal carious lesion in the primary molars. The children were called back for assessments semiannually (6 months) and annually (12 months). Success and failure rates were compared based on molar tooth type and arch type. The SPSS (21.0) was used for the analysis, and the significance level was set at a 5% level of probability with a 95% confidence interval. A total of 108 children aged 5.3±0.6 years with 265 primary molars and no signs or symptoms were available for evaluation in the study. After 6-month and 1-year follow-ups, the ZRGIC-created finger pressure approach for sealing carious tissues showed a high retention rate of 98.5% and 95.5%, respectively. Among primary first molars, the ZRGIC failure rate was 2.1%, but it was only 1.2% among primary second molars, and retention was 97% among the latter rather than 92.7% among the former. There was a statistically significant difference between the retention rates for semiannual (p=0.001) and annual visits (p=0.005). At six months, the retention rate for maxillary molars was significantly (p = 0.001) higher than that for the mandibular arch. Similarly, a statistically significant difference (p=0.035) was found in the percentage of ZRGIC failures in mandibular and maxillary molars after 12 months. The sealing the carious tissue by ZRGIC using the finger pressure method has shown statistically significant success rates at the semiannual (98.5%) and annual (95.5%) follow-up visits. The sealing carious lesions with ZRGIC by using the finger pressure technique can be used in uncooperative children with occlusal carious lesions.

Abstract 188 | PDF Downloads 179

References

1. Mallineni S.K., Yiu C. A Retrospective Audit of Dental Treatment Provided to Special Needs Patients under General Anesthesia During a Ten-Year Period. J. Clin. Pediatric Dent. 2018;42:155–160. doi: 10.17796/1053-4628-42.2.13.
2. Wright, G. Z. and Alpern, G. D. (1971) ‘Variables influencing children’s cooperative behavior at the first dental visit.’, ASDC journal of dentistry for children, 38(2), pp. 124–128
3. Wright GZ, Feasby WH. The physical aspects of behaviour management. Ont Dent. 1977 Feb;54(2):8-10.
4. Weisenberg M, Aviram O, Wolf Y, Raphaeli N. Relevant and irrelevant anxiety in the reaction to pain. Pain. 1984 Dec;20(4):371-383. doi: 10.1016/0304-3959(84)90114-3.
5. Al Absi M, Rokke PD. Can anxiety help us tolerate pain? Pain. 1991 Jul;46(1):43-51. doi: 10.1016/0304-3959(91)90032-S.
6. Simon AK, Bhumika TV, Nair NS. Does atraumatic restorative treatment reduce dental anxiety in children? A systematic review and meta-analysis. Eur J Dent. 2015 Apr-Jun;9(2):304-309. doi: 10.4103/1305-7456.156841.
7. Walsh, L. J. Anxiety prevention: implementing the 4 S principle in conservative dentistry’, Auxilliary, 17(5),2007; pp. 24–26.
8. Walsh, L. J. and Brostek, A. M. (2013) ‘Minimum intervention dentistry principles and objectives’, Australian Dental Journal, 58(SUPPL.1), pp. 3–16. doi: 10.1111/adj.12045.
9. Muppa R, Bhupatiraju P, Duddu M, Penumatsa NV, Dandempally A, Panthula P. Comparison of anxiety levels associated with noise in the dental clinic among children of age group 6-15 years. Noise Health. 2013 May-Jun;15(64):190-3.
10. Smales RJ, Yip HK. The atraumatic restorative treatment (ART) approach for primary teeth: Review of literature. Pediatr Dent. 2000 Jul-Aug;22(4):294-8.
11. Chen KJ, Gao SS, Duangthip D, Lo ECM, Chu CH. Managing Early Childhood Caries for Young Children in China. Healthcare (Basel). 2018 Jan 30;6(1):11. doi: 10.3390/healthcare6010011.
12. Innes NP, Evans DJ, Stirrups DR. Sealing caries in primary molars: randomized control trial, 5-year results. J Dent Res. 2011 Dec;90(12):1405-10. doi: 10.1177/0022034511422064.
13. de Amorim RG, Leal SC, Frencken JE. Survival of atraumatic restorative treatment (ART) sealants and restorations: a meta-analysis. Clin Oral Investig. 2012 Apr;16(2):429-41. doi: 10.1007/s00784-011-0513-3.
14. Schwendicke F, Frencken JE, Bjørndal L, Maltz M, Manton DJ, Ricketts D, Van Landuyt K, Banerjee A, Campus G, Doméjean S, Fontana M, Leal S, Lo E, Machiulskiene V, Schulte A, Splieth C, Zandona AF, Innes NP. Managing Carious Lesions: Consensus Recommendations on Carious Tissue Removal. Adv Dent Res. 2016 May;28(2):58-67. doi: 10.1177/0022034516639271.
15. AAPD. Guideline on restorative dentistry. Pediatr. Dent. 2016, 38, 250–262.
16. Holmgren CJ, Roux D, Doméjean S. Minimal intervention dentistry: part 5. Atraumatic restorative treatment (ART)--a minimum intervention and minimally invasive approach for the management of dental caries. Br Dent J. 2013 Jan;214(1):11-8. doi: 10.1038/sj.bdj.2012.1175.
17. Holmgren CJ, Frencken JE. Conclusions from the symposium: two decades of ART: success through research. J Appl Oral Sci. 2009;17:134–136. doi: 10.1590/S1678-77572009000700021
18. Frencken JE, Holmgren CJ. Caries management through the Atraumatic Restorative Treatment (ART) approach and glass-ionomers: update 2013. Braz Oral Res. 2014;28:5-8. doi: 10.1590/S1806-83242013000600001.
19. Kidd EA. How 'clean' must a cavity be before restoration? Caries Res. 2004 May-Jun;38(3):305-13. doi: 10.1159/000077770.
20. Lo EC, Luo Y, Fan MW, Wei SH. Clinical investigation of two glass-ionomer restoratives used with the atraumatic restorative treatment approach in China: two-years results. Caries Res. 2001 Nov-Dec;35(6):458-63. doi: 10.1159/000047490.
21. Duangthip D, Chen KJ, Gao SS, Lo ECM, Chu CH. Managing Early Childhood Caries with Atraumatic Restorative Treatment and Topical Silver and Fluoride Agents. Int J Environ Res Public Health. 2017 Oct 10;14(10):1204. doi: 10.3390/ijerph14101204.
22. Song, F.V.; Yang, B.; Di Tommaso, D.; Donnan, R.S.; Chass, G.A.; Yada, R.Y.; Farrar, D.H.; Tian, K.V. Resolving Nanoscopic Structuring and Interfacial THz Dynamics in Setting Cements. Mater. Adv. 2022, 3, 4982–4990.
23. Ong SH, Yoo SH. Surface roughness and chemical composition changes of resin-modified glass ionomer immersed in 0.2% sodium fluoride solution. J Dent Sci. 2021 Jan;16(1):389-396. doi: 10.1016/j.jds.2020.07.002
24. Al-Nahedh HN. Effects of Resin-modified Glass Ionomer Cement and Flowable Bulk-fill Base on the Fracture Resistance of Class II Restorations: An Original Laboratory Experimental Study. J Contemp Dent Pract. 2021 Apr 1;22(4):342-348.
25. Kumar A, Raj A, Singh DK, Donthagani S, Kumar M, Ramesh K. A New Zinc Reinforced Glass Ionomer Cement: A Boon in Dentistry. J Pharm Bioallied Sci. 2021 Jun;13(Suppl 1):S272-S275. doi: 10.4103/jpbs.JPBS_730_20.
26. Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, Poole C, Schlesselman JJ, Egger M; STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLoS Med. 2007 Oct 16;4(10):e297. doi: 10.1371/journal.pmed.0040297.
27. Frankl SN (1962) Should the parent remain with the child in the dental operatory? J Dent Child 29: 150-163.
28. Frencken JE. The state-of-the-art of ART sealants. Dent Update 2014;41:119-20, 122-4
29. Cole BO, Welbury RR. The atraumatic restorative treatment (ART) technique: does it have a place in everyday practice? Dent Update. 2000 Apr;27(3):118-20, 122-3. doi: 10.12968/denu.2000.27.3.118.
30. Holmgren CJ, Lo EC, Hu D. Glass ionomer ART sealants in Chinese school children-6-year results. J Dent. 2013 Sep;41(9):764-70. doi: 10.1016/j.jdent.2013.06.013.
31. Holmgren C, Gaucher C, Decerle N, Doméjean S. Minimal intervention dentistry II: part 3. Management of non-cavitated (initial) occlusal caries lesions--non-invasive approaches through remineralisation and therapeutic sealants. Br Dent J. 2014 Mar;216(5):237-43. doi: 10.1038/sj.bdj.2014.147
32. Alkhalaf R, Neves AA, Banerjee A, Hosey MT. Minimally invasive judgement calls: managing compromised first permanent molars in children. Br Dent J. 2020 Oct;229(7):459-465. doi: 10.1038/s41415-020-2154-x.
33. Leal SC. Minimal intervention dentistry in the management of the paediatric patient. Br Dent J. 2014 Jun 13;216(11):623-7. doi: 10.1038/sj.bdj.2014.449.
34. Surendranath P, Krishnappa S, Srinath S. Silver Diamine Fluoride in Preventing Caries: A Review of Current Trends. Int J Clin Pediatr Dent. 2022;15(Suppl 2):S247-S251. doi: 10.5005/jp-journals-10005-2167.
35. Araujo MP, Innes NP, Bonifácio CC, Hesse D, Olegário IC, Mendes FM, Raggio DP. Atraumatic restorative treatment compared to the Hall Technique for occluso-proximal carious lesions in primary molars; 36-month follow-up of a randomised control trial in a school setting. BMC Oral Health. 2020 Nov 11;20(1):318. doi: 10.1186/s12903-020-01298-x.
36. Frencken JE, Holmgren CJ. Caries management through the Atraumatic Restorative Treatment (ART) approach and glass-ionomers: update 2013. Braz Oral Res. 2014;28:5-8.
37. Lam PPY, Chua H, Ekambaram M, Lo ECM, Yiu CKY. Risk predictors of early childhood caries increment-a systematic review and meta-analysis. J Evid Based Dent Pract. 2022 Sep;22(3):101732. doi: 10.1016/j.jebdp.2022.101732
38. Abreu-Placeres N, Martinez-Mier EA. Stabilized stannous fluoride (snf2) toothpastes may be effective in the management of hypersensitivity, while more research is needed for its effectiveness in dental caries and erosion prevention. J Evid Based Dent Pract. 2021 Dec;21(4):101651. doi: 10.1016/j.jebdp.2021.101651.
39. Moores CJ, Kelly SAM, Moynihan PJ. Systematic Review of the Effect on Caries of Sugars Intake: Ten-Year Update. J Dent Res. 2022 Aug;101(9):1034-1045. doi: 10.1177/00220345221082918
40. Sulyanto RM, Kang M, Srirangapatanam S, Berger M, Candamo F, Wang Y, Dickson JR, Ng MW, Ho SP. Biomineralization of Dental Tissues Treated with Silver Diamine Fluoride. J Dent Res. 2021 Sep;100(10):1099-1108. doi: 10.1177/00220345211026838.
41. Ha DH, Spencer AJ, Moynihan P, Thomson WM, Do LG. Excess Risk of Dental Caries from Higher Free Sugars Intake Combined with Low Exposure to Water Fluoridation. J Dent Res. 2021 Oct;100(11):1243-1250. doi: 10.1177/00220345211007747.
42. Grier A, Myers JA, O'Connor TG, Quivey RG, Gill SR, Kopycka-Kedzierawski DT. Oral Microbiota Composition Predicts Early Childhood Caries Onset. J Dent Res. 2021 Jun;100(6):599-607. doi: 10.1177/0022034520979926.
43. James P, Harding M, Beecher T, Browne D, Cronin M, Guiney H, O'Mullane D, Whelton H. Impact of Reducing Water Fluoride on Dental Caries and Fluorosis. J Dent Res. 2021 May;100(5):507-514. doi: 10.1177/0022034520978777.
44. Urquhart O, Tampi MP, Pilcher L, Slayton RL, Araujo MWB, Fontana M, Guzmán-Armstrong S, Nascimento MM, Nový BB, Tinanoff N, Weyant RJ, Wolff MS, Young DA, Zero DT, Brignardello-Petersen R, Banfield L, Parikh A, Joshi G, Carrasco-Labra A. Nonrestorative Treatments for Caries: Systematic Review and Network Meta-analysis. J Dent Res. 2019 Jan;98(1):14-26. doi: 10.1177/0022034518800014.
45. Twetman S, Dhar V. Evidence of Effectiveness of Current Therapies to Prevent and Treat Early Childhood Caries. Pediatr Dent. 2015 May-Jun;37(3):246-53. PMID: 26063553.
46. Ruff RR, Barry-Godín T, Niederman R. Effect of Silver Diamine Fluoride on Caries Arrest and Prevention: The CariedAway School-Based Randomized Clinical Trial. JAMA Netw Open. 2023 Feb 1;6(2):e2255458. doi: 10.1001/jamanetworkopen.2022.55458.
47. Bourouni S, Dritsas K, Kloukos D, Wierichs RJ. Efficacy of resin infiltration to mask post-orthodontic or non-post-orthodontic white spot lesions or fluorosis - a systematic review and meta-analysis. Clin Oral Investig. 2021 Aug;25(8):4711-4719. doi: 10.1007/s00784-021-03931-7.
48. Wierichs RJ, Wolf TG, Campus G, Carvalho TS. Efficacy of nano-hydroxyapatite on caries prevention-a systematic review and meta-analysis. Clin Oral Investig. 2022 Apr;26(4):3373-3381. doi: 10.1007/s00784-022-04390-4.
49. Slayton RL, Urquhart O, Araujo MWB, Fontana M, Guzmán-Armstrong S, Nascimento MM, Nový BB, Tinanoff N, Weyant RJ, Wolff MS, Young DA, Zero DT, Tampi MP, Pilcher L, Banfield L, Carrasco-Labra A. Evidence-based clinical practice guideline on nonrestorative treatments for carious lesions: A report from the American Dental Association. J Am Dent Assoc. 2018 Oct;149(10):837-849.e19. doi: 10.1016/j.adaj.2018.07.002.
50. Opydo-Szymaczek, J.; Borysewicz-Lewicka, M.; Andrysiak, K.; Witkowska, Z.; Hoffmann-Przybylska, A.; Przybylski, P.; Walicka, E.; Gerreth, K. Clinical Consequences of Dental Caries, Parents’ Perception of Child’s Oral Health and Attitudes towards Dental Visits in a Population of 7-Year-Old Children. Int. J. Environ. Res. Public Health 2021, 18, 5844. https://doi.org/10.3390/ijerph18115844
51. Mika, A.; Mitus-Kenig, M.; Zeglen, A.; Drapella-Gasior, D.; Rutkowska, K.; Josko-Ochojska, J. The child’s first dental visit. Age, reasons, oral health status and dental treatment needs among children in Southern Poland. Eur. J. Paediatr. Dent. 2018, 19, 265–270
52. Ramazani, N. Child dental neglect: A short review. Int. J. High Risk Behav. Addict. 2014, 3, e21861
53. Saatchi M, Abtahi M, Mohammadi G, Mirdamadi M, Binandeh ES. The prevalence of dental anxiety and fear in patients referred to Isfahan Dental School, Iran. Dent Res J (Isfahan). 2015 May-Jun;12(3):248-53
54. Nunna M, Dasaraju RK, Kamatham R, Mallineni SK, Nuvvula S. Comparative evaluation of virtual reality distraction and counter-stimulation on dental anxiety and pain perception in children. J Dent Anesth Pain Med. 2019 Oct;19(5):277-288. doi: 10.17245/jdapm.2019.19.5.277.
55. Clark W, Geneser M, Owais A, Kanellis M, Qian F. Success rates of Hall technique crowns in primary molars: a retrospective pilot study. Gen Dent. 2017 Sep-Oct;65(5):32-35. PMID: 28862586.
56. Innes NP, Evans DJ, Stirrups DR. The Hall Technique; a randomized controlled clinical trial of a novel method of managing carious primary molars in general dental practice: acceptability of the technique and outcomes at 23 months. BMC Oral Health. 2007 Dec 20;7:18. doi: 10.1186/1472-6831-7-18.
57. Duangthip D, Chen KJ, Gao SS, Lo ECM, Chu CH. Managing Early Childhood Caries with Atraumatic Restorative Treatment and Topical Silver and Fluoride Agents. Int J Environ Res Public Health. 2017 Oct 10;14(10):1204. doi: 10.3390/ijerph14101204.
58. Alkhalaf R, Neves AA, Banerjee A, Hosey MT. Minimally invasive judgement calls: managing compromised first permanent molars in children. Br Dent J. 2020 Oct;229(7):459-465. doi: 10.1038/s41415-020-2154-x.
59. Mobarak EH, Shabayek MM, El-Deeb HA, Mulder J, Hassan FM, Van der Sanden WJM, Frencken JE. Survival of occlusal ART restorations using high-viscosity glass-ionomer with and without chlorhexidine: A 2-year split-mouth quadruple-blind randomized controlled clinical trial. J Adv Res. 2019 Jan 31;17:117-123. doi: 10.1016/j.jare.2019.01.015.
60. Zoergiebel J, Ilie N. Evaluation of a conventional glass ionomer cement with new zinc formulation: effect of coating, aging and storage agents. Clin Oral Investig. 2013 Mar;17(2):619-26. doi: 10.1007/s00784-012-0733-1.
61. Al-Angari SS, Hara AT, Chu TM, Platt J, Eckert G, Cook NB. Physicomechanical properties of a zinc-reinforced glass ionomer restorative material. J Oral Sci. 2014 Mar;56(1):11-6. doi: 10.2334/josnusd.56.11.
62. Kumar A, Raj A, Singh DK, Donthagani S, Kumar M, Ramesh K. A New Zinc Reinforced Glass Ionomer Cement: A Boon in Dentistry. J Pharm Bioallied Sci. 2021 Jun;13(Suppl 1):S272-S275. doi: 10.4103/jpbs.JPBS_730_20.
63. Hermosillo VH, Quintero LE, Guerrero ND, Suarez DD, Hernandez MJ, Holmgren CJ. The implementation and preliminary evaluation of an ART strategy in Mexico: a country example. J Appl Oral Sci. 2009;17:114–121. doi: 10.1590/S1678-77572009000700019.
64. Braga MM, Mendes FM, De Benedetto MS, Imparato JC. Effect of silver diammine fluoride on incipient caries lesions in erupting permanent first molars: a pilot study. J Dent Child (Chic). 2009 Jan-Apr;76(1):28-33.
65. Nuvvula S, Mallineni SK. Silver Diamine Fluoride in Pediatric Dentistry. J. South asian Assoc. Pediatric Dent. 2019;2:73–80.
66. Banerjee A, Frencken JE, Schwendicke F, Innes NPT. Contemporary operative caries management: consensus recommendations on minimally invasive caries removal. Br Dent J. 2017;223(3):215-222. doi:10.1038/sj.bdj.2017.672
67. Mickenautsch S, Yengopal V. Absence of carious lesions at margins of glass-ionomer cement and amalgam restorations: An update of systematic review evidence. BMC Res Notes. 2011 Mar 11;4:58. doi: 10.1186/1756-0500-4-58.
68. Said, F.; Moeen, F.; Khan, M.T.; Mansoor, A.; Uzbek, U.H.; Alam, M.K.; Siddiqui, A.A. Cytotoxicity, Morphology and Chemical Composition of Two Luting Cements: An in Vitro Study. Pesqui. Bras. Odontopediatria Clínica Integr. 2020, 20, 5434.
69. Mickenautsch S, Yengopal V, Leal SC, Oliveira LB, Bezerra AC, Bönecker M. Absence of carious lesions at margins of glass-ionomer and amalgam restorations: a meta- analysis. Eur J Paediatr Dent. 2009 Mar;10(1):41-6.
70. Czarnecka B, Nicholson JW. Ion release by resin-modified glass-ionomer cements into water and lactic acid solutions. J Dent 2006; 34: 539-543.
71. Krämer N, Schmidt M, Lücker S, Domann E, Frankenberger R. Glass ionomer cement inhibits secondary caries in an in vitro biofilm model. Clin Oral Investig 2018; 22: 1019-1031.
72. Hasegawa T., Takenaka S., Ohsumi T., Ida T., Ohshima H., Terao Y., Naksagoon T., Maeda T., Noiri Y. Effect of a Novel Glass Ionomer Cement Containing Fluoro-Zinc-Silicate Fillers on Biofilm Formation and Dentin Ion Incorporation. Clin. Oral Investig. 2020;24:963–970. doi: 10.1007/s00784-019-02991-0.
73. Naksagoon T., Ohsumi T., Takenaka S., Nagata R., Hasegawa T., Maeda T., Noiri Y. Effect of Water Aging on the Anti-Biofilm Properties of Glass Ionomer Cement Containing Fluoro-Zinc-Silicate Fillers. Biofouling. 2020;36:1090–1099. doi: 10.1080/08927014.2020.1856371.
74. Liu Y., Kohno T., Tsuboi R., Kitagawa H., Imazato S. Acidity-Induced Release of Zinc Ion From BioUnionTM Filler and Its Inhibitory Effects Against Streptococcus mutans. Dent. Mater. J. 2020;39:547–553. doi: 10.4012/dmj.2019-061.
75. AlJefri, G.H.; Kotha, S.B.; Murad, M.H.; Aljudaibi, R.M.; Almotawah, F.N.; Mallineni, S.K. Penetration and Adaptation of the Highly Viscous Zinc-Reinforced Glass Ionomer Cement on Contaminated Fissures: An In Vitro Study with SEM Analysis. Int. J. Environ. Res. Public Health 2022, 19, 6291. https://doi.org/10.3390/ijerph19106291
76. Drachev SN, Galieva AS, Yushmanova TN, et al. Restorative treatment decisions for carious lesions: Do Russian dentists and dental students apply minimal intervention dentistry?. BMC Oral Health. 2021;21(1):638. Published 2021 Dec 15. doi:10.1186/s12903-021-01978-2
77. Qvist V, Laurberg L, Poulsen A, Teglers PT. Eight-year study on conventional glass ionomer and amalgam restorations in primary teeth. Acta Odontol Scand. 2004 Feb;62(1):37-45. doi: 10.1080/00016350310008689.
78. Pawlaczyk-Kamieńska, T.; Torlińska-Walkowiak, N.; Borysewicz-Lewicka, M. The relationship between oral hygiene level and gingivitis in children. Adv. Clin. Exp. Med. 2018, 27, 1397–1401.
79. Mickenautsch S, Yengopal V, Banerjee A (2010) Atraumatic restorative treatment versus amalgam restoration longevity: a systematic review. Clin Oral Investig 201014,233–240. https://doi.org/10.1007/ s00784-009-0335-8
80. Mallineni, S.K.; Alassaf, A.; Almulhim, B.; Alghamdi, S. Influence of Tooth Brushing and Previous Dental Visits on Dental Caries Status among Saudi Arabian Children. Children 2023, 10, 471. https://doi.org/10.3390/children10030471
81. Ersin N, Candan U, Aykut A, Önçag Ö, Eronat C, Kose T. A clinical evaluation of resin-based composite and glass ionomer cement restorations placed in primary teeth using the ART approach – results at 24 months. Am Dent Assoc 2006, 137,1529–1536
82. van Den Dungen GM, Huddleston Slater AE, van Amerongen WE. ART or conventional restorations? A final examination of proximal restorations in deciduous molars. Ned Tijdschr Tandheelkd 2004, 111,345–349
83. Lo E, Holmgren C. Provision of atraumatic restorative treatment (ART) restorations to Chinese pre-school children at 30 month evaluation. Int J Paed Dent 2001,11,3–10
84. Honkala E, Behbehani J, Ibricevic H, Kerosuo E, Al-Jame G .The atraumatic restorative treatment (ART) approach to restoring primary teeth in a standard dental clinic. Int J Pediatr Dent, 2003, 13,172–179 \
85. van Gemert-Schriks MCM, van Amerongen WE, Ten Cate JM, Aartman IHA (2007) Three-year survival of single- and two-surface ART restorations in a high-caries child population. Clin Oral Investig 11:337–343. https://doi.org/10.1007/s00784-007-0138-8

Most read articles by the same author(s)