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| Name | Class |
|---|---|
| University of Dundee | OTHER |
| Academic Centre for Dentistry in Amsterdam | OTHER |
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The aim of this, two-arm, parallel group, patient-randomised controlled, superiority trial is to evaluate the survival rate of approximal Atraumatic Restorative Treatment (ART) restorations compared to the Hall Technique (HT) placed in a school setting. The investigators will recruit 120 schoolchildren (5-10 years) with at least one occlusal-proximal carious lesion in primary molar. They will be randomized and treated following best-practice protocols to either receive an ART restoration using the high-viscosity glass ionomer cement (EQUIA Forte, capsules, GC Corp.) or a preformed metal crown placed using the HT (3M ESPE) cemented with glass ionomer luting cement (Fuji I Capsules, GC Corp.). Baseline measures and outcome data (at reviews over a three year period) will be assessed through participant report, clinical examination and parent report/ questionnaires.
The selected children will be randomly allocated into 2 groups. The control group will comprise cavities treated by ART, following the protocol proposed by Frencken and Holmgren (1999), while the experimental group will comprise cavities treated by HT, according to the guideline published by Innes and Evans (2011). The allocation of patients in each group will be carried out by a random list generated by a specific computer program. To ensure the allocation concealment, the sequence generated by randomization will be distributed in opaque, sealed envelopes, which will be opened by the operator during the treatment, only after the patient is ready to receive treatment.
Operators will be two undergraduate students in dentistry and one experienced specialist in pediatric dentistry that will be trained on how to prepare and fill the cavities according to the original procedures of ART (Frencken and Holmgren, 1999) and also according to HT (Innes and Evans, 2011). The training will include a lecture about the techniques used in this study, as well as a workshop held in the laboratory for students to train handling and application of treatments to be tested. They will also undergo a week of training with patients, to apply the different techniques before starting the study, the latter phase held at the Faculty of Dentistry, University of São Paulo, under the supervision of an experienced dentist in ART and HT.
Each child will be allocated for one of the operators with the aid of a random list. All treatments will be performed on the school premises, in field conditions without the use of dental chair or other facilities from a clinical environment.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Atraumatic Restorative Treatment | Active Comparator | The cavity will be prepared according to the ART (Atraumatic Restorative Treatments) steps and filled with the dental material Glass Ionomer Cement without local anesthesia. |
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| Hall Technique | Experimental | The cavity will not receive any preparation. A stainless crown will be placed and cemented with the dental material Glass Ionomer Cement without local anesthesia. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Atraumatic Restorative Treatment | Procedure | No local anaesthesia will be used. Infected carious tissue will be removed with hand instruments, and the cavities restored with Glass Ionomer Cement (GIC).The cavity will be filled with GIC. After the press-finger technique, the excess of material will be removed. |
| Measure | Description | Time Frame |
|---|---|---|
| The restoration survival (changes from baseline up to 36 months) | The treatments will be classified "success" when they present clinical satisfactory aspect, and the failures will be scored as "minor failures" and "major failures" (adapted from Innes et al., 2007). The minor failures will be those in which there is a defect in the restoration / crown, but it does not interfere with the tooth health. The major failures will be considered when there signs or symptoms of irreversible pulp damage, such as dental fistula / abscess, tooth fracture or failures that cannot be repaired .The ART-restorations and HT scored as satisfactory will be considered as "successful", while those presented minor and major failures will be considered as "failure". | The treatments will be evaluated after 1 week up to 36 months |
| Measure | Description | Time Frame |
|---|---|---|
| Child self-reported discomfort | For the assessment of discomfort, the Wong-Baker FACES pain rating scale will be used (Wong; Baker, 1988), which is an ordinal six-point scale ranging from 0 to 5. A score of 0 shows a smiling face, indicating no discomfort, whereas a score of 5 shows a crying and sad face, indicating great discomfort. This method was previously validated for the assessment of pain and discomfort in children (Wong; Baker, 1988; Luffy; Grove, 2003; Novaes et al., 2010) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Daniela P Raggio, Professor | University of Sao Paulo | Principal Investigator |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 19450254 | Background | Barbosa TS, Tureli MC, Gaviao MB. Validity and reliability of the Child Perceptions Questionnaires applied in Brazilian children. BMC Oral Health. 2009 May 18;9:13. doi: 10.1186/1472-6831-9-13. | |
| 22994794 | Background | Barbosa Tde S, Gaviao MB. Validation of the Parental-Caregiver Perceptions Questionnaire: agreement between parental and child reports. J Public Health Dent. 2015 Fall;75(4):255-64. doi: 10.1111/j.1752-7325.2012.00371.x. Epub 2012 Sep 21. |
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| ID | Term |
|---|---|
| D003731 | Dental Caries |
| ID | Term |
|---|---|
| D017001 | Tooth Demineralization |
| D014076 | Tooth Diseases |
| D009057 | Stomatognathic Diseases |
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| ID | Term |
|---|---|
| D057087 | Dental Atraumatic Restorative Treatment |
| ID | Term |
|---|---|
| D003813 | Dentistry |
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| Hall Technique | Procedure | It employs the cementation of preformed metal crowns (PMC) without the need of any prior teeth preparation or caries removal. No local anesthesia is used neither tooth preparation.Different sizes of PMCs will be tested until the smallest size that perfectly fit the tooth is achieved. The PMC will be loaded with the dental material glass ionomer cement (GIC) and placed. Child will asked to bite firmly on it, until it is fitted. The excess of GIC will be removed with hand instruments and dental floss. |
|
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| Baseline |
| Perception and concerns related to tooth appearance. | The Child's and Parent's Questionnaire about Teeth Appearance will be applied as interview to children in the school as well as being filled out by their parents / caregivers at home (Furtado et al., 2012). This instrument has a version for kids and a version for their parents, including questions related to physical, psychological and social order, beyond the perceptions of color change and other aesthetic conditions related to the child´s teeth. | baseline up to 6 months |
| Acceptance of children in relation to treatments performed. | The questionnaire for the evaluation of acceptance in relation to treatment performed will be applied as interview to children in the school. The questionnaire for the children contains 6 items and employs a 5-point pictorial Likert scale. The response possibilities were: strongly agree, agree, indifferent, disagree and strongly disagree. The questionnaires were based on questionnaires used by Bell et al. (2010) They were rewritten in order to be useful for both the ART and the HT. The questionnaires will be translated from English to Portuguese by a Brazilian dentist who is fluent in both languages. The first and last question for the children was identical to control the reliability of answering. | Immediately after treatment (in the same appointment) |
| Acceptance of parents in relation to treatments performed. | The questionnaire for the evaluation of acceptance in relation to treatment performed will be filled out by their parents / caregivers at home. The questionnaire for the children contains 6 items and employs a 5-point pictorial Likert scale. The response possibilities were: strongly agree, agree, indifferent, disagree and strongly disagree. The questionnaires were based on questionnaires used by Bell et al. (2010) They were rewritten in order to be useful for both the ART and the HT. The questionnaires will be translated from English to Portuguese by a Brazilian dentist who is fluent in both languages. The first and last question for the children was identical to control the reliability of answering. | Immediately after treatment (in the same appointment) |
| Occlusal vertical dimension assessment | The distance between the most coronal points of the primary canines at the treatment side will be used as determination of the Occlusal vertical dimension assessment (OVD - van der Zee, van Amerongen, 2011). The most coronal point of the upper canine will be marked on the lower canine when biting in maximal occlusion using a pencil. Subsequently the distance between the marked point and the most coronal point of the lower canine will be measured using a digital calliper (GT-DC-02, Globotronics, Meer, BE). If measuring the OVD score on the treatment side is impossible because of tooth loss, the contralateral side will be used to measure the OVD score. | The measurements will be done before treatment, immediately after treatment (in the same appointment) and at each check-up appointment (1, 2 and 3 weeks and 1, 6, 12, 18, 24, 30 and 36 months) |
| Cost-effectiveness assessment | The cost of treatments will be calculated then taking into account: Capital cost: Fixed cost of equipment and instruments such as the cost of autoclave, examination kits; Materials cost or cost of expendable supplies such as gloves, masks, articulating paper, restorative material and PMCs; Labor costs will include salaries of personnel such as a dentist and a dental nurse per day using the maximum levels of the Brazilian Public Health Service salary scales for these professionals in the city treatments will be performed and Time taken to do each procedure of restorative treatments using a stopwatch that will be started when the patient has his/her mouth open and the operator is about to start the restorative intervention and will be stopped when the child stands up from the treatment table. | Up 36 months |
| Oral Health Quality of life (OHRQoL) assessment | The perceptions of parents and children regarding the OHRQoL will be evaluated. For that, the Child Perceptions Questionnaire validated for Brazilian children which takes into account the cognitive abilities and lifestyles in an age ranging from 8 to 10 years (CPQ8-10) will be used (Barbosa et al., 2009). The instrument consists of 14 questions, distributed into four domains (child symptoms, function, psychological, and self-image/social interaction domains) and in a family impact section (oral symptoms, functional limitations, emotional well-being and social well-being). | Before the treatment and during the 6 months recall |
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| 40830451 | Derived | de Araujo MP, Garbim JR, Innes NP, Hesse D, Bonifacio CC, Olegario IC, Braga MM, Mendes FM, Raggio DP. Economic Evaluation of ART and Hall in Primary Molars. BMC Oral Health. 2025 Aug 19;25(1):1336. doi: 10.1186/s12903-025-06528-8. |
| 33176756 | Derived | Araujo MP, Innes NP, Bonifacio CC, Hesse D, Olegario 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. |
| 27029801 | Derived | Hesse D, de Araujo MP, Olegario IC, Innes N, Raggio DP, Bonifacio CC. Atraumatic Restorative Treatment compared to the Hall Technique for occluso-proximal cavities in primary molars: study protocol for a randomized controlled trial. Trials. 2016 Mar 31;17:169. doi: 10.1186/s13063-016-1270-z. |