Influence of residual caries and cervical gaps on the survival rate of class II glass ionomer restorations

  • A. C. Roeleveld
  • W. E. van Amerongen
  • G. Mandari


Aim: To assess the influence of different variables on the survival of class II glass ionomer cements (GIC) in a clinical study among 6–7 year old schoolchildren in and around Dar es Salaam, Tanzania. Methods: 217 children were randomly divided into three groups. In the conventional group, Class-II cavities were excavated with burs, in the ART group they were excavated with hand instruments and in the Carisolv™ group excavation took place with a chemical solution and special blunt hand instruments. The preparations in all groups were restored with hand mixed GIC (Fuji IX) by 4 operators. After restoration, residual caries and cervical gaps were assessed on bite-wing radiographs. The quality of the restorations was established and the survival rate determined in two subsequent evaluations. Results: 195 children (90%) were present at the first evaluation which took place after 7 months and 194 (89%) were present at the second evaluation, after one year. At the first evaluation the survival rate of the ART-restorations was 38%, of the conventional restorations 50%, and of the Carisolv™ restorations 35%. Survival rates at the time of the second evaluation were 30%, 42% and 28% respectively. The differences between the three treatment groups were, however, not significant (p=0.200 at t=1and p=0.247 at t=2). In the first evaluation 161 bitewings were available of the 195 restorations, while for the second evaluation 130. There was no significant relation between residual caries and the success/failure rate (p=0.140 at t=1 and p=0.201 at t=2). Also, cervical gaps appeared to have no relation with the failure rate (p=0.057 at t=1 and p=0.833 at t=2) However, together those variables have a significant influence on the survival rate (p = 0.025). Conclusion: The combination of two variables (residual caries and cervical gaps) has considerable influence on the survival rate of class II GIC restorations compared to each variable alone.

Key words

cervical gap residual caries ART Carisolv 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Aartman IHA, Everdingen van T. Self-report measurements of dental anxiety and fear in children: A critical assessment. J Dent Child 1998;65:252–258.Google Scholar
  2. Bannerjee A, Kidd EAM, Watson TF. In vitro Evaluation of Five Alternative Methods of Carious Dentine Excavation Caries Res 2000;34:144–150.CrossRefGoogle Scholar
  3. Berge M, Hoogstraten J. The dental subscale of the children’s fear survey schedule: A factor analytic study in the Netherlands. Commun Dent Oral Epidemiol 1998;26:340–343.CrossRefGoogle Scholar
  4. Brännström M, Coli P, Blixt M. Effect of tooth storage and cavity cleansing on cervical gap formation in Class II glass-ionomer/composite restorations. Dent Materials 1992;8:327–331.CrossRefGoogle Scholar
  5. Dammaschke T, Stratmann U. Reaction of sound and demineralised dentine to Carisolv in vivo and in vitro. J Dent 2002;30:59–65.PubMedCrossRefGoogle Scholar
  6. den Dungen G, Huddleston Slater A, van Amerongen WE. ART of Conventioneel? Onderzoeksresultaten van proximale restauraties in tijdelijke molaren. Ned Tijdschr Tandheelkd 2004; 111:345–348.PubMedGoogle Scholar
  7. Ericson D, Zimmerman M. Clinical Evaluation of Efficacy and Safety of a New Method for Chemo-Mechanical Removal of Caries. Caries Res 1999;33:171–177.PubMedCrossRefGoogle Scholar
  8. Frencken JE, Holmgren C. Atraumatic Restorative Treatment for dental caries ISBN: 906759024X (1999). Publ: J. Frencken, Nijmegen, the Netherlands. Frencken JE. ART met glasionomeer als adhesief materiaal. Ned Tandartsenblad 2000; 13:611–613.Google Scholar
  9. Hak-Kong Yip, Smales RJ. Comparison of atraumatic restorative treatment and conventional cavity preparations for glass ionomer restorations in primary molars: One-year results. Quintessence Int 2002;33:17–21.Google Scholar
  10. Hak-Kong Yip, Smales RJ. Selection of restorative materials for the atraumatic restorative treatment (ART) approach: a review. Spec Care Dent 2001;21:216–221CrossRefGoogle Scholar
  11. Kleinknecht RA, Klepac RK. Origins and characteristics of fear of dentistry.J Am Dent Assoc 1973;86:842–848PubMedGoogle Scholar
  12. van Luijk A. De nieuwste manier van caries verwijderen. Nederlands Tandartsenblad 2000; 18:829–831.Google Scholar
  13. McCabe JF, Walls AWG. Applied dental materials 8th edition. Blackwell Science Ltd 1998; 202–211.Google Scholar
  14. Medi Team. Carisolv gel singlemix (uncoloured), users manual and product information. 15-04-2002.Google Scholar
  15. Mhaville RJA, van Amerongen WE,, Mandari GJ. Residual caries and marginal integrity in relation to class II glass ionomer restorations in primary molars. Europ Archs Paediatric Dentistry. 2006; 7(2):37–40.Google Scholar
  16. Mickenautsch S, Frencken JE. The impact of the ART approach on the treatment profile in a Mobile Dental System (MDS) in South Africa. Int Dent J 1999;49:132–138.PubMedCrossRefGoogle Scholar
  17. Mjör IA, Gordan VV. A review of atraumatic restorative treatment(ART). Int. Dent J 1999;49:127–131.Google Scholar
  18. Munshi AK, Hegde AM, Shetty PK. Clinical evaluation of Carisolv in the chemo-mechanical removal of carious dentin. J Clinic Pediatr Dent 2001;26:49–54.Google Scholar
  19. Pilot T, Frencken JE. Caries behandeling zonder de boor. Het tandheelkundig jaar 1997; 47–58Google Scholar
  20. Rahimtoola S, ai]van Amerongen WE. Pain related to different ways of minimal intervention in the treatment of small caries lesions. J Dent Child 2000;76:123–127.Google Scholar
  21. Schriks MCM, van Amerongen WE. Atraumatic perspectives and physiological aspects of treatment with and without rotary instruments. Commun Dent Oral Epidemiol 2003;31:15–20CrossRefGoogle Scholar
  22. Smales RJ, Fang DTS. In vitro Effectiveness of Hand Excavation of Caries with the ART Technique. Caries Res 1999;33:437–440.PubMedCrossRefGoogle Scholar
  23. Smales RJ, Hak-Kong Yip. The atraumatic treatment (ART) approach for primary teeth: review of literature. Pediatr Dent 2000;22:294–297.PubMedGoogle Scholar
  24. Smales RJ, Hak-Kong Yip. The atraumatic restorative treatment(ART) approach for the management of dental caries. Quintessence Int 2002;33:427–432.PubMedGoogle Scholar
  25. Splieth C, Rosin M. Gellissen B. Determination of residual dentine caries after conventional mechanical and chemo-mechanical caries removal with Carisolv. Clinical Oral Invest 2001;5:250–253.CrossRefGoogle Scholar
  26. Taifour MD. Effectiveness of the ART approach in a child population in Syria. Thesis; Katholieke Universiteit Nijmegen. December 2002.Google Scholar
  27. van Amerongen WE. Opleidingen en werkzaamheden van kindertandverzorgenden. Thesis, University of Amsterdam, 1980.Google Scholar
  28. van Amerongen WE. Dental Caries under Glass Ionomer Restorations Journal of Public Health Dentistry 1996;56:150–154.PubMedCrossRefGoogle Scholar
  29. van Amerongen WE, Rahimtoola S. Is ART really atraumatic? Commun Dent Oral Epidemiol 1999;27:431–435.CrossRefGoogle Scholar
  30. van Bochove J, van Amerongen WE. The influence of restorative treatment approaches and the use of local anaesthesia on the child’s discomfort. Europ Archs Paediatr Dentist. 2006;7:11–16.Google Scholar
  31. van Duinen RNB. Het gebruik van glasionomeercement in molaren en premolaren. Het tandheelkundig jaar 1997; 139–150.Google Scholar
  32. Veerkamp J.S.J. Gruythuysen R.J.M. Dentist’s ratings of child dental patients’ anxiety. Commun Dent Oral Epidemiol 1995;23:356–359.CrossRefGoogle Scholar
  33. Weerheijm KL, Groen HJ. The residual caries dilemma. Commun Dent Oral Epidemiol 1999;27:436–441.CrossRefGoogle Scholar
  34. Yazici AR, ÷zgnaltay G. A Scanning Electron Microscopic Study of Different Caries Removal Techniques on Human Dentin. Operat Dent 2002;27: 360–366.Google Scholar

Copyright information

© European Academy of Paediatric Dentistry 2006

Authors and Affiliations

  • A. C. Roeleveld
    • 1
  • W. E. van Amerongen
    • 1
  • G. Mandari
    • 2
  1. 1.Department of Cariology Endodontology PedodontologyAcademic Centre for Dentistry Amsterdam (ACTA)Amsterdamthe Netherlands
  2. 2.Dept Restorative Dentistry, School of DentistryMuhimbili University College of Health Sciences (MUCHS)Dar es-SalaamTanzania

Personalised recommendations