Two-Year Clinical Evaluation of Three Restorative Materials in Primary Molars

A variety of alternatives to amalgam are now available for use in Class I and Class II restorations in primary teeth, including glass ionomer cements, compomers and resin modified glass ionomer cements(RMGIC). Objectives: This study evaluated the two-year clinical performance of three restorative dental materials: A resin modified glass ionomer cement (Fuji IILC), a compomer (Dyract AP) and a high viscosity glass ionomer cement (Fuji IX), in primary molars of pediatric patients with high caries risk activity and compared these results to those reported for amalgam restorations. Study design: One hundred and forty nine Class I and Class II cavities in 45 patients aged 6 to 8 years were restored with compomer, glass ionomer cements and amalgam. Restorations were evaluated according to modified Ryge criteria by two examiners at baseline, and after 6, 12, 18 and 24 months of oral function. The data was submitted to statistical analysis (binomial and hyper geometric tests, p<0.05). Results: Two-year recall rate was 62.42%. Class I performed better than class II restorations. The difference in marginal discoloration between compomer and amalgam restorations was statistically significant (p=0.014). No other significant differences were found between GIC, compomer and amalgam restorations. The clinical performance of the three restorative materials compared to amalgam in Class I and Class II cavities at two-year recall was acceptable.Conclusions: The results, even in a population with high caries risk activity, suggest that these materials are suitable alternatives to amalgam in Class I and Class II restorations in primary teeth.

Amalgam, glass ionomer cement, compomer, USPHS criteria, primary molars, clinical evaluation, restorations

1. Croll T.P. Alternatives to silver amalgam and resin composite in pedi-atric dentistry. Quint Int, 29: 697–703, 1998.

2. Qvist V., Laurberg L., Poulsen A., Teglers P.T. Longevity and cariosta-tic effects of everyday conventional glass ionomer and amalgam restorations in primary teeth: three years results: J Dent Res, 76: 1387–13, 1997.

3. Marks L.A.M., Weerheijm K.L., Van Amerongen W.E., Groen H.J., Martens L.C. Dyract versus Tytin Class II restorations in primary molars: 36 months evaluation. Caries Res, 33: 387–392, 1999.

4. Wilson A.D., Kent B.E. New translucent cement for dentistry. The glass ionomer cement. Br Dent J, 132: 133–135, 1972.

5. Qvist V., Manscher E., Teglers P.T. Resin-modified and conventional glass ionomer restorations in primary teeth: 8-year results. J Dent, 32: 285–294, 2004.

6. Gross L, Griffen A, Casamassimo P. Compomers as class II restorations in primary molars. Pediatr Dent, 23(1): 24–27, 2001.

7. Mass E, Gordon M, Fuks AB. Assessment of compomer proximal restorations in primary molars: a retrospective study in children.ASDC J Dent Child, 66 (2): 93–97: 1999.

8. Papagiannoulis L, Kakaboura A, Pantaleon F, Kavvadia K. Clinical evaluation of a polyacid-modified resin composite (compomer) in class II restorations of primary teeth: a two-year follow-up study. Pediatr Dent, 21(4): 231–4, 1999.

9 Yu C, Gao XJ, Deng DM, Yip HK, Smales RJ. Survival of glass ionomer restorations placed in primary molars using atraumatic restorative treatment ( ART) and conventional cavity preparations: 2-year results. Int Dent J, 54(1): 42–6, 2004.

10 Ruttar J., McAllan L., Tyas M.J. Three-year clinical performance of glass ionomer cement in primary molars. Int J Pediatr Dent, 12: 146–147, 2002.

11 Hickel R, Kaaden C, Pascos E, Buerkle V, Garcia-Godoy F, Manhart J. Longevity of occlusally-stressed restorations in posterior primary teeth. Am J Dent, 18(3): 198–211, 2005.

12 Christensen GJ. Restorative dentistry for pediatric teeth: state of the art 2001. J Am Dent Assoc, 132: 379–381, 2001.

13 Lee Pail R, Udin R, Tanbonliong T. Materials used to restore class II lesions in primary molars: A survey of California pediatric dentists. Pediatr Dent, 26(6): 501–7, 2004.

14 American Academy of Pediatric Dentistry. Clinical guideline on pediatric restorative dentistry. 26(7): 106–114, 2004.

15 American Academy of Pediatric Dentistry. Policy on use of a caries-risk assessment tool (CAT) for infants, children and adolescents.Pediatric Dentistry, 30(7), 29–33, 2008.

16 Ryge G. Clinical criteria. Int Dent J, 30: 347–358, 1980.

17 Riordan P.J., Fitzgerald P.E. Outcome measures in split mouth caries trials and their statistical evaluation. Community Dent Oral Epidemiol, 22: 192–197, 1994.

18 Smales R.J., Yip H.K. The atraumatic restorative treatment (ART) approach for primary teeth: review of literature. Pediatric Dent, 22: 294–298, 2000.

19 Lo E.C.M., Holmgren C.J. Provision of atraumatic restorative treatment (ART) restorations to Chinese preschool children—a 30 month evaluation. Int J Pediatr Dent, 11: 3–10, 2001.

20 Rahimtoola S., Van Amerongen E. Comparison of two tooth-saving preparation techniques for one-surface cavities. J Dent Child, 69: 16–26, 2002.

21 Kramer N., Frankenberger R. Clinical performance of a condensable metal-reinforced glass ionomer cement in primary molars. Br Dent J, 190: 317–321, 2001.

22 Perry R, Kugel G, Kunzelmann K.H, Flessa H.P, Estefan D. Composite restoration wear analysis: conventional methods vs. three dimensional laser digitizer. J Am Dent Assoc, 131: 1472–1477, 2000.

23 Qvist V., Manscher E. and Teglers P.T. Resin-modified and conventional glass ionomer restorations in primary teeth: 8-year results. J Dent, 32: 285–294, 2004.

24 Kavvadia K, KakabouraA, VanderasA, Papagiannoulis L. Clinical evaluation of a compomer and an amalgam in primary teeth class II restorations: A two-year comparative study. Pediatr Dent, 26(3): 245–50, 2004.