Comparative Long-Term Clinical Performance of Atraumatic Restorative Treatment Versus Conventional Composite Restorations in Carious Primary Molars: A Prospective Observational Cohort Study

Abstract

INTRODUCTION Dental caries are highly prevalent in children, and restoring carious primary molars presents challenges due to limited cooperation and resource constraints in this age group. Atraumatic restorative treatment (ART) may offer a minimally invasive alternative to conventional restorative techniques; however, long-term comparative evidence in primary dentition remains limited. This study aimed to evaluate and compare the success rates and clinical performance of ART using high-viscosity glass ionomer cement with conventional composite restorations in carious primary molars over 24 months. MATERIALS AND METHODS A prospective observational cohort study was conducted on children aged five to nine years with dentin caries in vital primary molars. Participants were consecutively recruited from pediatric dental clinics, and the treatment modality (ART or conventional composite restoration) was determined by routine clinical decision-making without randomization. Baseline characteristics, including age, sex, oral hygiene status, cavity classification, and DMFT (decayed, missing, filled teeth) scores, were recorded. Restorations were placed following standard protocols: hand instruments and high-viscosity glass ionomer cement for ART, and rotary instruments with composite resin under moisture control for conventional treatment. Clinical performance was assessed at baseline, six, 12, and 24 months by calibrated, blinded examiners using predefined success criteria (retention, marginal integrity, absence of secondary caries, and no pulpal pathology). Kaplan-Meier survival analysis with log-rank and chi-square tests was used for statistical comparisons. RESULTS The baseline characteristics were well balanced between the groups. Over 24 months, ART restorations demonstrated significantly higher survival rates than conventional composite restorations. The survival advantage of ART became more pronounced over time and was consistent across subgroups, including single- and multi-surface cavities, varying oral hygiene levels, and patient sex. Conventional restorations showed significantly lower survival rates in Class II cavities. CONCLUSION ART using high-viscosity glass ionomer cement provided superior long-term clinical performance compared to conventional composite restoration in primary molars. Its minimally invasive nature, reliability across diverse clinical conditions, and independence from advanced equipment make ART a preferred option in pediatric dentistry, especially for young children and in resource-limited settings.