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Objective: Atraumatic Restorative Treatment (ART) was developed to increase access to restorative dental care and utilizes hand instrumentation and typically glass ionomer (GI) to restore frank carious cavitation. This study examined microleakage in primary molars treated via ART, augmented either with papainenzyme agent for caries removal or silver diamine fluoride (SDF) for caries arrest. Methods: Sixty extracted primary molars with frank, carious proximo-occlusal cavitations were divided into three ART groups (spoon excavator caries removal and GI restoration): 1) control, 2) pre-treatment with papain-enzyme agent and 3) pre-treatment with SDF. Specimens were thermocycled and then immersed in 2% fuchsin dye for 24 hours. After sectioning, microleakage was determined by visual examination of dye penetration at occlusal and gingival margins via stereomicroscope (20x magnification). Data was analyzed with ordinal logistic regression and Fisher’s exact test. Results: No significant differences in microleakage rates were observed between any of the groups for complete dye penetration (p=0.80), at the occlusal margin (p=0.19) or gingival margin (p=0.42); gingival margin above or below the CEJ did not make a difference (p=0.78). A significant effect of microleakage at the gingival margin was detected (p=7.46 x 10-6 ). Conclusions: Neither papain-enzyme or SDF in this study adversely affected microleakage in ART restorations, although case selection may favor occlusal-only restorations. If clinical presentation indicates possible benefit to use of either of these modalities, the practitioner can likely proceed without increasing marginal leakage.

Microleakage in chemomechanical and chemotherapeutic approaches to Atraumatic Restorative Treatment