This preprint is under consideration at BMC Oral Health. Preprints are preliminary reports that have not undergone peer review. They should not be considered conclusive, used to inform clinical practice, or referenced by the media as validated information.
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Background: Atraumatic Restorative Treatment (ART) and the Hall Technique (HT) are both minimally invasive, non-aerosol generating procedures (non-AGPs). They seem to have never been directly compared, nor has the HT been studied in a non-clinical setting. This study compared the HT and ART restorations placed in a school setting after 36 months.
Methods: Children (5-10 yo) who had a primary molar with an occluso-proximal carious lesion were allocated to the ART or HT arms. Primary outcome: restoration survival over 36-months (using Kaplan-Meier survival analysis, log rank test, and Cox regression). Secondary outcomes: 1) occlusal vertical dimension (OVD) (1, 2, 3, 4 weeks) and 2) child self-reported discomfort; 3) treatment acceptability (immediately following interventions); 4) Child Oral Health Related Quality of Life (OHRQoL), before treatment and after 6 months and 5) a post-hoc analysis of time to tooth exfoliation (1, 6, 12, 18, 24, 30, 36 months).
Results: One-hundred and thirty-one children (ART=65; HT=66) were included (mean age=8.1±1.2). At 36 months, 112 (85.5%) children were followed-up. Primary outcome: restoration survival rates ART=32.7% (SE=0.08; 95%CI=0.17-0.47); HT=93.4% (0.05; 0.72-0.99), p<0.001; Secondary outcomes: 1) OVD returned to pre-treatment state within 4 weeks; 2) treatment discomfort was higher for the HT (p=0.018); 3) over 70% of children and parents showed a high acceptability for treatments, with crown aesthetics being a concern for around 23% of parents; 4) Child OHRQoL improved after six months; and 5) teeth treated with the HT exfoliated earlier than those in the ART group (p=0.007).
Conclusions: Both ART and the HT were acceptable to child participants and their parents and all parents thought both restorations protected their child’s tooth. However, the crown appearance concerned almost a quarter of parents in the HT arm. Children experienced less discomfort in the ART group. Although both treatments can be performed in a non-clinical setting and have the advantage of being non-aerosol generating procedures (non-AGPs), the HT had almost three times higher survival rates (93.4%) for restoring primary molar occluso-proximal cavities compared to ART (32.7%).