Durability of restorations in primary molars

Techniques used to restore carious primary molars have changed over the past decade as new adhesive materials have been developed. The most meaningful way of assessing the efficacy of a technique is by clinical trials. This article reviews the information concerning amalgam, composite and glass polyalkenoate (ionomer) cement as well as extracoronal restorations. Stainless steel/nickel chrome crowns provide the most durable restoration, often surviving until the tooth exfoliates. Class II amalgam restorations, whilst being prone to fracture, have been shown to survive about 3 years, a figure that improves with increasing age of the child and the use of local anaesthesia. Over the shorter term resin-based composites appear to be at least as durable as amalgam, particularly with respect to the maintenance of a good anatomical form. In contrast, when assessed at 6 years the failure rate of composite restorations is high, 62%, whereas the failure rate of amalgam restorations at 5 years is as low as 20%. Glass ionomer cements and cermets are alternative materials for use in the primary dentition. The reported success rate of 33% over 5 years for conventional glass ionomer cements is encouraging, however cermets appear to be less successful but have not been evaluated over the longer term. Glass ionomer cements provide a means of restoring primary molars with minimal amount of destruction of sound tooth tissue and reduced treatment time for the young patient, whilst the local fluoride release is also a potential advantage.(ABSTRACT TRUNCATED AT 250 WORDS)