The aim of this 3-year longitudinal study was to analyze caries increment and the caries-preventive effect of sealants in adolescents in the setting of the German national health system. 434 pupils (193 male, 241 female) took part in compulsory school examinations at age 12 (mean 12.3 ± 0.4 years) and 15 (mean 15.6 ± 0.3 years) according to WHO criteria, including the examination of sealants. Mean DMFT increased from 1.78 (± 2.15) to 3.97 (± 3.68), mean DMFS from 2.79 (±4.07) to 6.94 DMFS (± 8.34), respectively. Logistic regression analysis showed that high caries incidence at the individual level was mostly associated with the type of school (’Gymnasium’, RR = 0.3), gender (female, RR = 2.08) and high baseline DMFS (RR = 1.2 per surface), but not with the number of sealants. In an interaction model, adolescents with high baseline DMFS values had an even higher risk of caries increment with an increasing number of sealants compared to adolescents with fewer sealants (p = 0.047). At the tooth level, this effect was detected for first permanent molars, while sealants in premolars and second permanent molars did not result in a statistically significant caries-preventive effect due to the low caries incidence on these surfaces. Thus, sealants on occlusal surfaces of first permanent molars were only protective in individuals with low or moderate caries activity (p = 0.006), which indicates the need for other measures to reduce caries activity in high risk adolescents. In addition, rates of 19% lost sealants and 18% carious or filled surfaces in 3 years suggest a discrepancy between sealant retention under real-life conditions and the results of controlled clinical trials.

ResumoObjetivo: comparar a aceitabilidade da ART e de restaurações convencionais em crianças. Material e métodos: A amostra do presente ensaio clínico randomizado foi composta por 30 crianças de 4 a 7 aanos de idade que tinham pelo menos uma cavidade ativa classe II em um primeiro molar que era acessível a instrumentos manuais. Os grupos de tratamento foram: grupo controle -tratamento com anestesia local, isolamento absoluto, instrumentos rotatórios e resina composta; grupo teste -tratamento de acordo com ART utilizando instrumentos manuais somente, sem anestesia e ionômero de vidro. Em ambos os grupos, somente tecido cariado desmineralizado e esmalte sem suporte foram removidos. A aceitabilidade dos dois grupos foi acessada por mensuração das sensações emocionais usando a Escala de Imagem Facial (EIF) antes e depois do procedimento. Resultados: Não houve diferenças significativas entre os grupos na mudanças dos escores da EIF. 50% das crianças do grupo teste ficaram mais satisfeitas, enquanto 64% das crianças do controle não mudaram seus sentimentos. Conclusão: ART não demonstrou ter melhor aceitabilidade do que o tratamento convencional. Entretanto, o menor tempo utilizado para completar o procedimento parece ser um aspecto válido em crianças muito jovens ou pacientes com problemas de comportamento. AbstractAim: to compare the acceptability of the ART and the conventional restoration approaches in children. Material and methods: The sample of the current randomized clinical trial was 30 children 4 to 7 years old who had at least one class II active cavity in a primary molar that was accessible to hand instruments. The treatment groups were: Control Group-treatment with local anesthesia, rubber dam, rotary instruments and composite resin. Test Group-treatment according to ART approach using only hand instruments, no anesthesia and glass ionomer. In both groups, only the demineralized carious tissue and unsupported enamel were removed. The acceptability of the two groups was assessed by measuring the emotional feelings represented by Face Image Scale (FIS) before and after the procedure. Results: There was no significant difference between the two groups regarding changes in FIS scores. Fifty percent of the children from the Test Group got more satisfied after the procedure, while 64% of the participants from Control Group did not change their feelings. Conclusion: The ART approach had not demonstrated to have a best acceptability then the conventional approach. However the short time taken to complete the procedure seems to be worthy aspects when dealing with very young children or patients with behaviors problems.