Cost-efficacy Between ART and Composite Resin Restorations in Primary Molars
|The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.|
|ClinicalTrials.gov Identifier: NCT02562456|
Recruitment Status : Active, not recruiting
First Posted : September 29, 2015
Last Update Posted : November 27, 2018
|Condition or disease||Intervention/treatment||Phase|
|Dental Caries||Procedure: Atraumatic Restorative Treatment Procedure: Conventional Treatment||Not Applicable|
The study will be performed in a dental care trailer which simulated a regular dental office and it is located inside a public school of the city Barueri (São Paulo, Brazil).
- Inclusion criteria: children 1) aging 3 to 6 years-old; 2) healthy; 3) presenting at least one occlusal or occlusoproximal cavity in primary molar 4) whose parents consent with his/her participation in the research, since 5) the tooth of interest is not associated with fistula, abscess, pulp exposure, history of spontaneous dental pain or mobility; and 6) the cavity of interest allows access using hand instruments only.
- Exclusion criteria: children presenting behavioral problems during clinical examination.
Sample size calculation
For sample size calculation, data regarding longevity of CT in occlusal and occlusoproximal restorations after 2 years were extracted from the literature as 86% for occlusal and 60% for occlusoproximal restorations. A difference of 15% and 20% between the longevity of CT and ART was set as non-inferiority limit. Considering the level of significance as 5%, power as 80% and adding 40% due to the study design (cluster per child), a number of 204 occlusal restorations and 240 occlusoproximal restorations will be needed.
The child will be the unit of randomization which means that all eligible teeth of a participant will be treated according the same restorative approach. Randomization list will be obtained using blocks of 4, 6 and 8 generated by software Sealed Envelope Ltd. Opaque, sealed and sequentially numbered envelopes will be used for randomizing all participants immediately before restorative treatments' beginning.
To assure allocation concealment, the participant will be randomized immediately before the treatment. When two or more cavities is available, preventing the finalization of the treatment in only one session, breach of allocation concealment will be signalized in the participants' record.
Due to differences between the techniques, it will be not possible to blind operators, participants and evaluators.
All operators will be masters or PhD students from the Pediatric Dentistry Department, Faculty of Dentistry, University of São Paulo, previously trained. All procedures will be performed with the assistance of a dental student previously trained to manipulate all restorative materials.
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||428 participants|
|Intervention Model:||Parallel Assignment|
|Masking:||Single (Outcomes Assessor)|
|Official Title:||Difference of Cost-efficacy Between Atraumatic Restoration Treatment (ART) and Composite Resin Restorations in Primary Molars: A Randomized Clinical Trial|
|Actual Study Start Date :||November 1, 2015|
|Actual Primary Completion Date :||June 10, 2018|
|Estimated Study Completion Date :||December 10, 2019|
Active Comparator: Conventional treatment
Occlusal and occlusoproximal composite resin restorations in primary molars using the Scotchbond Multi-purpose adhesive system and the Filtek Z-350 composite resin under rubber dam isolation and local anesthesia.
Procedure: Conventional Treatment
Occlusal and occlusoproximal composite resin restorations in primary molars using the Scotchbond Multi-purpose adhesive system and the Filtek Z-350 composite resin wil be performed. Local anesthesia will be used. Absolute isolation will be performed using rubber dam and clamp. Removal of unsupported enamel will be performed using a round bur. Infected carious tissue will be removed with hand instruments. The cavity will be etched using 37% phosphoric acid for 15 seconds followed by rising and drying for the same amount of time. The cavity will be restored with composite resin. Occlusion will be checked. an adapted matrix strip with a wooden wedge will be used to assure appropriate contour.
Experimental: Atraumatic Restorative Treatment
Occlusal and occlusoproximal ART restorations in primary molars using the high viscosity GIC Fuji IX under relative isolation.
Procedure: Atraumatic Restorative Treatment
Occlusal and occlusoproximal ART restorations in primary molars using the high viscosity GIC Fuji IX will be performed under relative isolation. No local anesthesia will be used. Infected carious tissue will be removed with hand instruments, and the cavities restored with GIC. After the press-finger technique, the excess of material will be removed and occlusion will be checked. For occlusoproximal restoration, an adapted matrix strip with a wooden wedge will be used to assure appropriate contour.
- The restoration survival [ Time Frame: Every 6 months up to 24 months. ]The treatments will be classified as successful when they present a clinical satisfactory aspect. Otherwise, "minor failures" will be analyzed. "Minor failures" are those in which there is a defect in the restoration/crown, but it does not interfere with the tooth health.
- Cost-efficacy assessment [ Time Frame: Through study completion, an average of 24 months ]
Treatment costs = professional costs + procedure costs.
- Professional cost: the time spent in each session will be converted in hours and multiplied not only by the medium income of the dentist per hour added 40% of dangerousness but also by the medium income of a dental assistant added 20% of insalubrity
- Procedure cost: variable cost (equipment & instruments depreciation and electricity) and and materials cost. To calculate the equipments' and instruments' depreciation, we will consider their price, the lifespan of 5 and 3 years respectively and a monthly use of 160 hours. To calculate materials' costs, all materials used in each procedure will have their specifications and quantity registered. Prices will be inferences from the market value converted in US Dollars obtained by the medium of the values from different places that commercialized the referred products.
If the restorative treatment requires repairs, the additional cost of it will also be considered.
- Child self-reported discomfort [ Time Frame: Immediately after treatment ]The acceptability of each type of treatment will be evaluated using the Facial scale of Wong-Baker (Wong; Baker, 1998). This scale indicates the discomfort of an individual who has to choose among six faces, each one expressing different facial countenance. The first image is a smiling happy face, indicating no discomfort, followed by gradually less cheerful expressions, up to the last one which is a very sad face covered by tears, indicating great discomfort. The participant will be asked to choose the face that is more similar to how he or she felt during the treatment. This answer should be given solely by the child, which means, no parental or professional interferences. The facial scale of Wong-Baker will be applied right after the end of each restorative treatment session.
- Cooperation [ Time Frame: Immediately after treatment ]Cooperation will be evaluated by the operator immediately after the end of the treatment using a 5-point scale: 1- Good behaviour, 2- Reasonable behaviour, 3- Indiferent, 4- Bad behaviour, 5- Really bad behaviour.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02562456
|Complexo Educacional Carlos Osmarinho de Lima - Trailer USP|
|Barueri, São Paulo, Brazil|
|Study Chair:||Daniela P Raggio, PhD||University of Sao Paulo|