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PURPOSE To compare the clinical failure rate of two resin-modified glass ionomer cements (RMGICs) used for Class II primary molar restorations over a 3-year period. METHODS Healthy, cooperative children aged 4-8 years with carious, asymptomatic primary molars requiring class II restorations received either nano-filled (Ketac Nano, 3 M ESPE) or regular (Vitremer, 3 M ESPE) RMGIC restorations. These were blindly assessed semiannually for 3 years using the modified USPHS criteria with all-cause failure as primary outcome and failure for each criterion as secondary outcome. Data was analysed with Fisher's exact tests and survival analysis with robust standard errors at 5%. RESULTS Outcome assessment included 159 teeth at 12 months, 141 teeth at 24 months, and 98 teeth at 36 months. No difference in all-cause failure was found between regular and nano-filled RMGIC at 12 (8.6% versus 14.1%), 24 (9.0% versus 14.9%) or 36 months (7.4% versus 20.5%) (P > 0.05). The nano-filled RMGIC retained better its anatomical form and the regular RMGIC likewise its marginal integrity (P < 0.05), but only in the acceptable range (Alpha-Bravo). Overall, survival analysis found no significant difference for all-cause failure [hazard ratio (HR) 0.58; 95% confidence interval (CI) 0.25-1.31; P = 0.19] or any secondary outcomes other than contact point integrity. Finally, subgroup analysis by jaw indicated that the regular RMGIC performed better than the nano-filled RMGIC for mandibular molars (HR 0.36; 95% CI 0.13-0.96; P = 0.04), but further data are needed. CONCLUSION Nano-filled RMGIC showed less occlusal wear but more mild marginal defects than regular RMGIC, but these findings were of limited clinical significance and both materials performed favourably for 3 years.

Aim: Aim of this randomised clinical trial was to compare the outcome of direct pulp capping (DPC) versus pulpotomy, both with MTA, for carious primary molars. Methods: Healthy, cooperative children aged 3-9 years with at least one deep carious primary molar requiring vital pulp therapy were included. Data on the primary outcome (all-cause failure) and secondary outcomes (clinical or radiographic failure) were collected blindly semi-annually for a minimum of 1 year up to 3 years and analysed with survival analysis and generalised linear regression at alpha = 5%. Results: A total of 74 children were randomly allocated on 1:1 basis to DPC (35 children; 40 teeth) or pulpotomy (39 children; 57 teeth). Survival from all-cause failure was 79.7% [95% confidence interval (CI) 69.3-86.9%] at 12 months and 66.0% (95% CI 53.4-76.0%) at 24 months which remained stable up to 36 months, with no differences between groups (P > 0.05). No significant difference was found in the survival rate of the two groups for all-cause [hazard ratio (HR) = 0.95; 95% CI 0.45-2.01; P = 0.88], clinical (HR = 0.74; 95% CI 0.0.19-2.92; P = 0.66), or radiographic failure (HR = 0.80; 95% CI 0.0.36-1.82; P = 0.60) throughout the 3-year follow-up. Regression analysis indicated that needing a second attempt for haemorrhage control was associated with higher clinical failure rate. All-case failure was significantly different for class II versus occlusal cavities and in the latter cavities pulpotomy performed better (P < 0.001). Conclusion: The results of the current trial indicate that both DPC and pulpotomy can be reliable options for the treatment of deep carious primary molars in cooperative children, in carefully selected cases. Keywords: Direct pulp capping; MTA; Primary molars; Pulpotomy; Randomised clinical trial.

AIM To compare the 2-year success rates of a Resin Modified Glass Ionomer Cement (RMGIC) with a composite resin in class II primary molar restorations. METHODS Healthy, cooperative children aged 4-7.5 years with at least one carious primary molar requiring a class II restoration were included in this parallel randomised trial and allocated on a 1:1 basis to composite resin (Z250, 3M ESPE) or RMGIC (Vitremer, 3M ESPE). Restorations were assessed semiannually up to 2 years clinically and radiographically using modified United States Public Health Service criteria, with the primary outcome being all-cause failure. Data were analysed per protocol by binomial linear regression with Relative Risks (RR) and their 95% confidence intervals (CI). RESULTS 55 patients were randomly allocated to either group and 44 analysed at 2 years; with 49 teeth in the Z250 and 55 teeth in the Vitremer group. The all-cause failure rate for both materials was 3% after 1 year (4 and 2% for Z250 and Vitremer, respectively) and 16% after 2 years (16% for both Z250 and Vitremer). Overall, no difference between materials could be found at 2 years (RR = 1.4; 95% CI 0.8, 2.4; P = 0.30). However, Vitremer was associated with more favourable gingival health compared to composite (RR = 0.2; 95% CI 0.1, 0.9; P = 0.03), but also occlusal wear, which was observed exclusively for Vitremer. CONCLUSION No significant difference was found in the overall performance of the two materials, making them suitable for class II primary molar restorations, although RMGIC presented more pronounced occlusal wear of limited clinical importance after 2 years.