title: Survival Rate of Atraumatic Restorative Treatment (ART) Restorations Using a Glass Ionomer Bilayer Technique with a Nanofilled Coating: A Bi-center Randomized Clinical Trial.
abstract: OBJECTIVE
  The high-viscosity consistency of glass ionomer cement (GIC) contributes to its inappropriate adaptation, while the material's premature exposure to humidity decreases its mechanical properties. This study's purposes were to: (1) investigate approximal atraumatic restorative treatment (ART) restorations' survival in primary molars using two different insertion techniques and two surface protection materials; and (2) compare the results of cities where treatments were performed.
  
  
  METHODS
  A total of 389 six- to seven-year-olds were selected from two cities in Brazil and randomly assigned into four groups: (1) ART restorations plus petroleum jelly (PJ); (2) bilayer-ART restorations plus PJ; (3) ART restorations plus nanofilled coating for GIC (NC); (4) bilayer-ART restorations plus NC. Restorations were evaluated after one, six, 12, 18, and 24 months. Kaplan-Meier survival analysis, log-rank test, and Cox regression analysis were performed.
  
  
  RESULTS
  Restorations' cumulative survival was 46.4 percent. There was a higher survival of bilayer-ART restorations (P=0.03). No difference was observed between surface protection materials (P=0.57). Restorations made in Barueri were almost 2.5-fold more likely to survive than those from Recife (P<0.001).
  
  
  CONCLUSIONS
  The bilayer technique improves approximal ART restorations' survival in primary molars. The nanofilled coating does not influence restorations' survival rate, and the city where treatments were performed influences restoration survival.
authors.affiliation: Department of Conservative Dentistry, Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands. d.hesse@acta.nl.
authors.forename: Daniela
authors.initials: D
authors.lastname: Hesse
authors.affiliation: Department of Conservative Dentistry, Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands.
authors.forename: Clarissa Calil
authors.initials: CC
authors.lastname: Bonifácio
authors.affiliation: Department of Orthodontics and Pediatric Dentistry, Dental School, University of São Paulo, São Paulo, São Paulo, Brazil.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Bönecker
authors.affiliation: Private practice in São Paulo, São Paulo, Brazil.
authors.forename: Camila de Almeida Brandão
authors.initials: Cde A
authors.lastname: Guglielmi
authors.affiliation: Department of Social Dentistry, Dental School, University of Pernambuco; in Recife, Pernambuco, Brazil.
authors.forename: Carolina
authors.initials: C
authors.lastname: da Franca
authors.affiliation: Department of Conservative Dentistry, Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands.
authors.forename: Willem Evert
authors.initials: WE
authors.lastname: van Amerongen
authors.affiliation: Department of Social Dentistry, Dental School, University of Pernambuco; in Recife, Pernambuco, Brazil.
authors.forename: Viviane
authors.initials: V
authors.lastname: Colares
authors.affiliation: Department of Orthodontics and Pediatric Dentistry, Dental School, University of São Paulo, São Paulo, São Paulo, Brazil.
authors.forename: Daniela Prócida
authors.initials: DP
authors.lastname: Raggio
mesh_terms: D001938:Brazil; D057087:Dental Atraumatic Restorative Treatment; D003731:Dental Caries / Q000188:drug therapy; D019232:Dental Restoration Failure; D003793:Dental Restoration, Permanent; D005899:Glass Ionomer Cements / Q000627:therapeutic use; D006801:Humans; D008963:Molar; D015996:Survival Rate
chemical_list: D005899:Glass Ionomer Cements