title: Effects of oral hygiene, residual caries and cervical Marginal-gaps on the survival of proximal atraumatic restorative treatment approach restorations.
abstract: BACKGROUND
  Although Atraumatic restorative treatment (ART) approach has been in existence for a while, the reasons for the poor performance of multisurface ART restorations are not very clear.
  
  
  OBJECTIVE
  The aim of this study is to investigate the effects of oral hygiene, residual caries and cervical marginal-gaps on survival of proximal ART restorations.
  
  
  METHODS
  Two rural divisions in Kenya were selected for the study.
  
  
  METHODS
  A randomized clinical trial.
  
  
  METHODS
  The 804 children in the study had their baseline- and 2-year dental plaque levels documented. Each child received one proximal restoration in a primary molar using ART approach, together with trained and pre-tested operators/assistants, three glass ionomer cements (GIC)-brands and two tooth-isolation methods. The restorations were clinically evaluated soon after placement and after 2 years. Post-restorative bite-wing radiographs taken soon after restoration were also evaluated.
  
  
  METHODS
  Statistical Package for Social Sciences (SPSS) version 14 computer programme was used and results tested using Pearson's correlation, Cox Proportional Hazards regression analysis and Multiple Logistic regression models tests.
  
  
  RESULTS
  At baseline and after 2 years, the mean cumulative survival and plaque index changed from 94.4% to 30.8% and 2.34 (Standard Deviation, or SD of 0.46) to 1.92 (SD 2.1) respectively, with higher plaque indices associated with higher restoration failures. Of the 507 radiographs evaluated, 48 (9.5%), 63 (12.4%) and 9 (1.8%) restorations had residual caries (RC), cervical marginal-gaps (CMG) and both RC/CMG respectively. Survival of the restorations with RC/CMG was significantly lower (p = 0.003) compared to those with RC or without RC.
  
  
  CONCLUSIONS
  Low survival of proximal restorations in the study was associated with the presence of cervical marginal-gaps.
authors.affiliation: Department of Paediatric Dentistry/Orthodontics, University of Nairobi, Nairobi, Kenya.
authors.forename: Arthur M
authors.initials: AM
authors.lastname: Kemoli
authors.forename: Willem E Van
authors.initials: WE
authors.lastname: Amerongen