Microbiological and Microscopic Evaluation of Atraumatic Restorative Treatment in Adult Dentition
Condition: Dentin Caries; Infection
Study type: Interventional

Summary: 
      Atraumatic Restorative Treatment (ART) was proposed as a new and effective method in the
      1990s to provide conservative dental treatment to the people living in economically
      underdeveloped countries, due to lack of dental treatment facilities. In the technique, after
      the carious dentin is removed by excavation with hand instruments, the powder-liquid system
      conventional glass ionomer cement (GIC) which does not require special devices for mixing and
      hardening is used as a filling material. Because of these advantages of the treatment, the
      usage fields of ART have been expanded considering that it can be applied in the cases that
      working with rotary instruments is difficult or even impossible. But only a few research has
      been conducted on ART in adults and it must be investigated in terms of the clinical safety
      of ART by the studies focused on the counts and activities of the microorganisms in carious
      dentin left on the cavity floor. The purpose of this study is to investigate the reliability
      of ART in adult individuals related to the marginal adaptation of the restorations and the
      microbiological changes in the left carious dentin using in vitro and in vivo methods. In the
      in vivo part of the study, occlusal dentin carious of 25 participants at high risk of caries
      were removed with hand instruments and microorganisms of the last removed carious dentin were
      evaluated quantitatively concerning the bacterias playing a major role in caries lesions. The
      restorations of the teeth were carried out using ART technique with a GIC which has been
      proven its effectiveness in preventing the caries progression and recurrent caries in the
      practice of dentistry for many years. After six months, the microbiological assessment was
      repeated such as baseline. Marginal adaptation and the presence of the gaps in the ART
      restorations on the replicas created with the impression materials at the baseline and sixth
      month were investigated under scanning electron microscope. At the end of the study, the
      teeth were restored by the conventional methods and using composite material.
    


Intervention name(s): Atraumatic restorative treatment
Intervention type(s): Procedure
Intervention model: Single Group Assignment
Intervention model description: The clinical studies were carried out in the occlusal dentin caries of 25 permanent molar teeth in participants with high caries risk and between 19-35 years of age. The caries tissue were removed with hand instruments in accordance procedure of atraumatic restorative treatment. Then the total counts of bacteria, facultative anaerobe bacteria, Mutans Streptococci, and Lactobacilli supp. counts in the affected dentin were evaluated quantitatively. The weights of samples were measured with an electronic balance (Shimadzu, Type AX200, Japan). The cavities were restored with a glass ionomer cement (KetacTM Molar Easymix, ESPE Dental AG, Seefeld, Germany). Twenty replicas of randomly selected ART restorations were prepared and marginal adaptation was evaluated by scanning electron microscopy. After 6 months, the same protocols were repeated. Data were analyzed with Paired Sample and Wilcoxon Paired t-tests, Pearson, Spearman correlation, and Chi-Square tests (p< 0.05).
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Atraumatic restorative treatment; Glass ionomer cement; Marginal adaptation