Journal of Survey in Fisheries Sciences 10(1S) 168-175 2023

Choice Of Restorative Material by Dentists for Class Ii Caries in First

Maxillary Molar In 3- To 6-Year-Old Children- A Retrospective Study

1Tahreem Fathima, 2*Deepa Gurunathan,

1
Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences
(SIMATS), Saveetha University, Chennai- 600077, India.
2*
Professor, Department of Pedodontics and Preventive dentistry Saveetha Dental College and
Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University,
Chennai- 600077, India.

Corresponding Author
Deepa Gurunathan,
Professor, Department of Pedodontics and Preventive dentistry Saveetha Dental College and
Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University,
Chennai- 600077, India.

ABSTRACT
Aim: This study aimed to compare the choice of restorative material by dentists for class II caries in first maxillary
molar in 3 to 6-year-old children
Introduction: Dental caries is the most prevalent disease of childhood which eventually leads to pain and tooth
structure defects. Primary teeth in young children are vital to their development, and every effort should be made
to retain these teeth functionally for as long as it is possible. Dental fillings have been used to restore the tooth
structure integrity, reducing provoked pain in deep dentin lesions and helping in controlling the caries disease
process. Thus, oral health professionals need to make wise decisions about the type of restorative material they
choose to best manage their patients with childhood caries.
Materials and Methods: A retrospective study was conducted using the patient's record from a private dental
college and Hospital who was diagnosed with class II caries in maxillary molar in 3 to 6-year-old children
respectively. Data was collected and then subjected to statistical analysis (SPSS).
Results & Discussion: Primary teeth start to erupt at 6 months of age and complete their eruption by the age of 3
years. The primary dentition in children should ideally be maintained and in case they exhibit caries it should be
filled and taken care of accordingly. Majorly stainless steel crowns (SSCs) were preferred material for the
treatment of cavitated Class II in 3 to 6 year old in maxillary first molar followed by amalgam, glass ionomer
cement, and composite. The study sample consisted of 800 patients, about 25% were 3 years old, 31% were 4
years old, 25% were 5 years old and 19% were 6 years old. Among 800 children, 50% of children were boys and
50% of children were girls
Conclusion: Within the limits of the study, about 90% of the children visiting university dental hospitals among
800 children had class II caries in the first maxillary molar. For children of 3 to 6 years, stainless steel crowns
were used significantly as a restorative material for class II caries in the first maxillary molar. The present study
enlightens the preference regarding the material of choice used for restoring Class II in the first maxillary molar
in 3 to 6 year old. It could be concluded that Stainless steel crown was the most suitable material of choice when
compared to composite, amalgam, and glass ionomer cement. Dentists prefer SSC more due to its cost and
durability in primary molars.
Clinical significance: The usage of choice of restorative material by dentists for class II caries in the first
maxillary molar in 3 to 6-year-old children to evaluate the success rate of the restorative material.

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Deepa Gurunathan.et.al., CHOICE OF RESTORATIVE MATERIAL BY DENTISTS FOR CLASS II
CARIES IN FIRST MAXILLARY MOLAR IN 3- TO 6-YEAR-OLD CHILDREN- A RETROSPECTIVE
STUDY
Keywords: restorative material, caries, children, amalgam, glass ionomer cement, composite, stainless steel
crowns, innovative technique
INTRODUCTION
Dental caries is the most prevalent disease
of childhood which eventually leads to pain
and tooth structure defects. Dental caries is
often observed in developing and
developed countries. Dental caries develop
at a very early age and if not treated cause
various consequences like damage to
present and erupting teeth. The undesirable
effects of early childhood caries can lead to
malnourishment, insomnia, negative
behavioral patterns, unaesthetic
appearance, and deformities in speech
which leads to social and economic issues
faced by the family [1].
Primary teeth in young children are vital to
their development, and every effort should
be made to retain these teeth functionally
for as long as it is possible [2]. There exists
a linear relationship between high levels of
untreated caries and other outcomes such as
height, weight, and body mass index [3].
Dental fillings have been used to restore the
tooth structure integrity, reducing provoked
pain in deep dentin lesions and helping in
controlling the caries disease process [4].
Therefore, oral health professionals make
wise decisions about the type of restorative
material they would choose to manage their
pedo patients with early childhood caries.
It’s not an easy decision due to growing
advances in dental restorative materials that
have widened the market.
The conventional restorative materials that
are required for restoring primary teeth
include amalgam (AMG), conventional
glass-ionomer cement (GIC), resin-
modified glass ionomer cement (RMGIC),
high-viscous glass-ionomer cement
(HVGIC), compomer (CP), and resin
composite (RC) [5]. Although amalgam has
been considered the gold standard in
restorative dentistry [6], its use has
decreased mainly because of the potential
toxicity of mercury and higher health tissue
removal during cavity preparation [7].
Therefore, restorative materials with
adhesive properties are widely used since
they fit with the concept of minimally
invasive dentistry, providing good handling
and functional performance besides
meeting patients’ demands regarding
aesthetics.
The placement of restorations is a common
treatment approach in clinical practice and
it has been indicated that there is no
sufficient scientific evidence about which is
the best filling material for treating caries in
the primary dentition [8]. Thus, in clinical
decision-making, choosing one among
these materials will depend upon the
professional ability, individuality, and
therefore the patient’s wish. Factors that are
to be considered while restoring teeth are
aesthetic requirement, friendly technique,
caries activity, type of substrate, and cavity
to be restored also should be considered for
selecting the restorative material [9].
Composite resin is the most aesthetic
material, adhesive to the tooth structure
with good wear properties and command
set. In pediatric dentistry, a highly-filled
composite resin is recommended for
preventive resin restorations [10].
However, the composite resin is technique-
sensitive, requiring complete moisture
control and careful case selection;
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Journal of Survey in Fisheries Sciences
polymerization shrinkage occurs and
secondary caries may be difficult to
diagnose [11]. Conventional glass ionomer
cement is a biocompatible, adhesive,
aesthetic, and fluoride leaching material
with favorable thermal expansion and
contraction properties [12]. However, it's
brittle, radiolucent, and vulnerable to
erosion and wear and such restorations in
primary dentitions are significantly more
likely to need replacement than amalgam
restorations [13]
Crowns for primary molars are pre-
fabricated and are present in a variety of
sizes and materials to be placed over
decayed or developmentally defective
teeth. They are made completely of
stainless steel (known as “preformed metal
crowns” or PMCs) or, to provide better
aesthetics, may be made of stainless steel
with a white veneer cover or made wholly
of white ceramic material. Crowns are
recommended for restoring primary
maxillary molar teeth that had undergone a
pulp treatment, are very decayed, or are
badly broken down whereas few dental
practitioners use them in clinical practice
[14]. PMCs are cemented, using GIC, over
the carious tooth, without local anesthetic,
carious tissue removal, or tooth
preparation, seals the cariogenic biofilm
under the crown thus, arresting the carious
process [15]. Our team has extensive
knowledge and research experience that
has translate into high quality publications
[16–25]. The purpose of the study is to
choose a particular restorative material that
would best suit class II caries in 3 to 6-year-
old for first maxillary molar and which
could reduce the risk of secondary caries or
reduce the chances of restorative failure and
increase the durability of restorative
material as to protect the dentition.
10(1S) 168-175 2023
MATERIALS AND METHODS
STUDY DESIGN AND SETTING:
The retrospective study examined the
records of 86,000 patients from January
2021 in which 800 patients who had class II
caries underwent treatment for class II
caries who belonged to the age group 3 to 6
years at a university dental hospital in
Chennai were shortlisted based on the
inclusion and exclusion criteria.
ETHICAL APPROVAL:
The ethical approval was obtained from the
institutional ethics committee under the
ethical approval number SDC//.
STUDY POPULATION
The study population included patients who
underwent treatment for class II caries in a
private dental college by the means of
systematic sampling.
● Inclusion criteria- Patients who
underwent treatment for classic
caries
● Exclusion criteria- children below
the age of 3 years were excluded
from the study.
DATA COLLECTION
The data for this study was taken from the
patient records from a private dental college
in Chennai. A total sample of 800 patients
who met the inclusion criteria was included
in the study. These 800 patients belonged to
the age group 3 to 6 years. Repeated patient
records and incomplete data were excluded.
Data were reviewed by an external
reviewer.
STATISTICAL ANALYSIS
Data were recorded in Microsoft Excel
2016 (Microsoft office 10) and later
exported to SPSS statistical package for
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Deepa Gurunathan.et.al., CHOICE OF RESTORATIVE MATERIAL BY DENTISTS FOR CLASS II
CARIES IN FIRST MAXILLARY MOLAR IN 3- TO 6-YEAR-OLD CHILDREN- A RETROSPECTIVE
STUDY
social science for windows versions, 20.0,
SPSS Inc, (Chicago IU, USA) and
subjected to statistical analysis. The Chi-
square test was employed with a level of
significance set at p<0.05.
RESULTS & DISCUSSION:
Primary teeth start to erupt at 6 months of
age and complete their eruption by the age
of 3 years. The primary dentition in
children should ideally be maintained and
in case they exhibit caries it should be filled
and taken care of accordingly. The choice
of restorative material used at 3 to 6 years
of age plays a crucial role. Kilpatrick
conducted a comprehensive review of the
durability of restorations on primary molars
[26]. He concluded short lifespan of
primary teeth, variation in morphology of
primary teeth, age, and patient compliance
affect the choice of restorative material in
the primary dentition. The study sample
consisted of 800 patients, about 25% were
3 years old, 31% were 4 years old, 25%
were 5 years old and 19% were 6 years old
(figure:1). Among 800 children, 50% of
children were boys and 50% of children
were girls (figure:2). Among the restorative
materials used for class II caries, 29%
stainless steel crowns were used, 25%
amalgam was used, 24% Glass ionomer
cement was used and 22% composite were
used (figure: 3) and this study has similar
findings with another study which
indicated, that stainless steel crowns were
more preferred as it was easier to place the
restoration, especially children with
behavior which is difficult to handle or
caries risk is high or if the tooth required a
pulpotomy or had circumferential carries
[27]. A previous study indicated that
composites constitute the resin matrix and
silanized glass. Composite imparts better
aesthetics with minimal cavity preparation,
possesses high wear resistance, and helps to
strengthen the residual tooth structure. The
evaluation of the success rate of posterior
composite resin in the primary dentition has
shown lower success rates mainly due to
micro-leakage, bond failure, and recurrent
caries [26] due to technique sensitivity and
requirement of good moisture control, it
was the less preferred material for a
cavitated lesion in children whose behavior
is often a major shortcoming and this study
supports the results of the present study.
Other findings of this indicated that GICs
fluoride-releasing property and chemical
bond formation to tooth structure were the
two main properties but GICs are not
suitable for load-bearing areas due to their
low tensile strength and wear resistance
properties and was in agreement with a
previous study [28].
Figure 4, depicts the restoration which is
considered for class II caries in a maxillary
first molar, it shows that stainless steel was
preferred over other restorations and for
almost all age groups. A previous study
conducted by Atieh which was a 2-year
randomized control trial regarding
restoration of deciduous teeth that had
undergone a pulpotomy treatment it was
found that a non-significant difference in
survival rate for teeth treated with
preformed metal crowns (95%) as
compared to GIC restoration (92.5%) and
the study was in agreement with the present
study which supports stainless steel crowns
[29]. In a similar prospective study, a
comparison of restoration failure was
compared in calcium hydroxide treated
pulpotomy. It was seen that preformed
metal crowns (79.7%) had less restoration
failure as compared to amalgam (60%) after
1-year follow-up [30]. This study found
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Journal of Survey in Fisheries Sciences 10(1S) 168-175 2023

that stainless steel crowns are far superior Figure 2: Pie chart showing the gender
to multisurface amalgam restorations with distribution, blue color denotes females
respect to life span, replacement, retention, (50%) and green color denotes males
and resistance and were in agreement with (50%)
the previous study which states that the
stainless steel crowns are durable as
compared to multi-surface restorations and
premature contacts are well tolerated by the
child [31].

Figure 3: Pie chart showing the choice of

Figure 1: Pie chart showing the age
restorative material preferred by the
distribution of children in The sample
dentists for restoration in maxillary first
population. Blue color denotes 3 years of
molar in children belonging to 3 to 6
age (25%), green color denotes 4 years of
years of age. 29% Stainless steel (violet
age(31%), white color denotes 5 years of
color), 25% amalgam (white color), 24%
age (25%) and violet color denotes 6
Glass ionomer cement (green color) and
years of age (19%).
22% composite (blue color).

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Journal of Survey in Fisheries Sciences
Figure 4: Barchart shows the association
between various ages and types of
restorative material used. The X-axis
represents the age group and Y-axis
represents the percentage of distribution of
restoration materials among the 3 to 6-year-
old. Blue color denotes composite (which is
5% in 3-year-olds, 8% in 4-year-old, 6% in
5-year-old and 3 % in 6 years old), green
color denotes glass ionomer cement (which
is 6% in 3-year-olds, 8% in 4-year-old, 6%
in 5-year-old and 4% in 6 years old), white
color denotes amalgam (which is 7% in 3-
year-olds, 7% in 4-year-old, 7% in 5-year-
old and 4% in 6-year-old) and violet color
denotes stainless steel (which is 7% in 3-
year-olds, 8% in 4-year-old, 6% in 5-year-
old and 8% in 6 years old). A Chi-square
test was done and the association was found
to be significant. (p-value = 0.003<0.05
statistically significant).
CLINICAL SIGNIFICANCE:
The choice of restorative material for class
II caries in children between the age group
3 to 6 years in the first maxillary molar is of
10(1S) 168-175 2023
utmost importance as the treatment is
changed according to the material being
used and the duration for which the material
could be taken up by the tooth.
CONCLUSION:
Within the limits of the study, about 90% of
the children visiting university dental
hospitals among 800 children had class II
caries in the first maxillary molar. For
children of 3 to 6 years, stainless steel
crowns were used significantly as a
restorative material for class II caries in the
first maxillary molar. The present study
enlightens the preference regarding the
material of choice while restoring Class II
caries in the first maxillary molar at 3 to 6
years old. From the above results, it could
be concluded that Stainless steel crown was
the most suitable material of choice among
other restorative materials like glass
ionomer cement, composite, and amalgam.
The older concept of excavation for
prevention is still applied as compared to
newer minimal invasive strategies. Many
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Deepa Gurunathan.et.al., CHOICE OF RESTORATIVE MATERIAL BY DENTISTS FOR CLASS II
CARIES IN FIRST MAXILLARY MOLAR IN 3- TO 6-YEAR-OLD CHILDREN- A RETROSPECTIVE
STUDY
factors contribute to the treatment and
material choice for restoring Class II in first
maxillary molars in 3 to 6 year old thus
stainless steel could be used for its
durability and ability to avoid high caries
risk.
ACKNOWLEDGEMENTS
The study was supported by the Research
Department of Saveetha Dental College.
We extend our gratitude to our colleagues
who provided insight and expertise that
greatly assisted in the research. The authors
would like to acknowledge the help support
rendered by saveetha dental college and
hospital,saveetha Institute of Medical and
Technical Sciences, Saveetha University,
Chennai
ETHICAL APPROVAL:
Ethical clearance from the institutional
ethical committee board of University
Dental Hospital was obtained prior to the
study (Ethical Approval Number:
SDC/SIHEC/ ……………………….)
FUNDING SUPPORT :
The present project is funded by
● Saveetha Institute of Medical and
Technical Sciences ,
● Saveetha Dental College and
Hospitals,
● Saveetha University,
● Globe Trade.
CONFLICTS OF INTEREST:
The authors declare no potential conflict of
interest
REFERENCES
1. Khurana S, Patel M, Bhatt R, Patel N,
Bhatt R. Choice of material for the
treatment of proximal lesions in
deciduous molars among paediatric
post-graduates and paediatric dentists
of Gujarat: A cross-sectional study.
Advances in Human Biology
2019;9:258.
https://doi.org/10.4103/aihb.aihb_67_1
9.
2. Gift HC, Reisine ST, Larach DC.
Erratum: The social impact of dental
problems and visits (Am J Public
Health (1992) 82 (1663-1668)). Am J
Public Health 1993;83:816–816.
3. Alkarimi HA, Watt RG, Pikhart H,
Sheiham A, Tsakos G. Dental caries
and growth in school-age children.
Pediatrics 2014;133:e616–23.
4. Rodrigues JA, Casagrande L, Araújo
FB, Lenzi TL, Mariath AAS.
Restorative Materials in Pediatric
Dentistry. In: Coelho Leal S, Takeshita
EM, editors. Pediatric Restorative
Dentistry, Cham: Springer International
Publishing; 2019, p. 161–7.
5. Dhar V, Hsu KL, Coll JA, Ginsberg E,
Ball BM, Chhibber S, et al. Evidence-
based Update of Pediatric Dental
Restorative Procedures: Dental
Materials. J Clin Pediatr Dent
2015;39:303–10.
6. Mickenautsch S, Yengopal V, Banerjee
A. Atraumatic restorative treatment
versus amalgam restoration longevity: a
systematic review. Clin Oral Investig
2010;14:233–40.
7. Fuks AB. The use of amalgam in
pediatric dentistry: new insights and
reappraising the tradition. Pediatr Dent
2015;37:125–32.
8. Yengopal V, Harneker SY, Patel N,
Siegfried N. Dental fillings for the
treatment of caries in the primary
dentition. Cochrane Database Syst Rev
173
Journal of Survey in Fisheries Sciences
2009:CD004483.
9. Marquezan M, Raggio DP. Dental
materials in daily pedodontics clinical
practice. Dent Mater Res 2009:88–103.
10. Tran LA, Messer LB. Clinicians’
choices of restorative materials for
children. Aust Dent J 2003;48:221–32.
11. Donly KJ, García-Godoy F. The use of
resin-based composite in children.
Pediatr Dent 2002;24:480–8.
12. Berg JH. The continuum restorative
materials in pediatric dentistry-a review
for the clinician 1998.
https://www.aapd.org/globalassets/med
ia/publications/archives/berg-20-02.pdf
(accessed May 12, 2021).
13. Fleming GJ, Burke FJ, Watson DJ,
Owen FJ. Materials for restoration of
primary teeth: I. Conventional materials
and early glass ionomers. Dent Update
2001;28:486–91.
14. Innes NPT, Ricketts D, Chong LY,
Keightley AJ, Lamont T, Santamaria
RM. Preformed crowns for decayed
primary molar teeth. Cochrane
Database Syst Rev 2015:CD005512.
15. Innes NPT, Evans DJP, Bonifacio CC,
Geneser M, Hesse D, Heimer M, et al.
The Hall Technique 10 years on:
Questions and answers. Br Dent J
2017;222:478–83.
16. Neelakantan P, Grotra D, Sharma S.
Retreatability of 2 mineral trioxide
aggregate-based root canal sealers: a
cone-beam computed tomography
analysis. J Endod 2013;39:893–6.
17. Aldhuwayhi S, Mallineni SK,
Sakhamuri S, Thakare AA, Mallineni S,
Sajja R, et al. Covid-19 Knowledge and
Perceptions Among Dental Specialists:
A Cross-Sectional Online
Questionnaire Survey. Risk Manag
Healthc Policy 2021;14:2851–61.
18. Sheriff KAH, Ahmed Hilal Sheriff K,
10(1S) 168-175 2023
Santhanam A. Knowledge and
Awareness towards Oral Biopsy among
Students of Saveetha Dental College.
Research Journal of Pharmacy and
Technology 2018;11:543.
https://doi.org/10.5958/0974-
360x.2018.00101.4.
19. Markov A, Thangavelu L, Aravindhan
S, Zekiy AO, Jarahian M, Chartrand
MS, et al. Mesenchymal stem/stromal
cells as a valuable source for the
treatment of immune-mediated
disorders. Stem Cell Res Ther
2021;12:192.
20. Jayaraj G, Ramani P, Herald J. Sherlin,
Premkumar P, Anuja N. Inter-observer
agreement in grading oral epithelial
dysplasia – A systematic review.
Journal of Oral and Maxillofacial
Surgery, Medicine, and Pathology
2015;27:112–6.
https://doi.org/10.1016/j.ajoms.2014.0
1.006.
21. Paramasivam A, Priyadharsini JV,
Raghunandhakumar S, Elumalai P. A
novel COVID-19 and its effects on
cardiovascular disease. Hypertens Res
2020;43:729–30.
22. Li Z, Veeraraghavan VP, Mohan SK,
Bolla SR, Lakshmanan H, Kumaran S,
et al. Apoptotic induction and anti-
metastatic activity of eugenol
encapsulated chitosan nanopolymer on
rat glioma C6 cells via alleviating the
MMP signaling pathway. Journal of
Photochemistry and Photobiology B:
Biology 2020;203:111773.
https://doi.org/10.1016/j.jphotobiol.20
19.111773.
23. Gan H, Zhang Y, Zhou Q, Zheng L, Xie
X, Veeraraghavan VP, et al. Zingerone
induced caspase-dependent apoptosis in
MCF-7 cells and prevents 7,12-
dimethylbenz(a)anthracene-induced
174
Deepa Gurunathan.et.al., CHOICE OF RESTORATIVE MATERIAL BY DENTISTS FOR CLASS II
CARIES IN FIRST MAXILLARY MOLAR IN 3- TO 6-YEAR-OLD CHILDREN- A RETROSPECTIVE
STUDY

mammary carcinogenesis in
experimental rats. J Biochem Mol
Toxicol 2019;33:e22387.
24. Dua K, Wadhwa R, Singhvi G, Rapalli
V, Shukla SD, Shastri MD, et al. The
potential of siRNA based drug delivery
in respiratory disorders: Recent
advances and progress. Drug Dev Res
2019;80:714–30.
25. Mohan M, Jagannathan N. Oral field
cancerization: an update on current
concepts. Oncol Rev 2014;8:244.
26. [26] Kilpatrick NM. Durability
of restorations in primary molars. J
Dent 1993;21:67–73.
27. Farhin K, Abhinav S, Thejokrishna P,
Sajjad M. Stainless steel crowns reuse
and decontamination techniques: a
survey among Indian pediatric dentists.
J Indian Soc Pedod Prev Dent
2013;31:265–9.
28. Mathur S, Jaiswal JN, Tripathi AM,
Saha S, Palit M. Restorative materials
used in pediatric dentistry. Int J Oral
Health Med Res 2016;2:101–6.
29. Atieh M. Stainless steel crown versus
modified open-sandwich restorations
for primary molars: a 2-year
randomized clinical trial. Int J Paediatr
Dent 2008;18:325–32.
30. Sonmez D, Duruturk L. Success rate of
calcium hydroxide pulpotomy in
primary molars restored with amalgam
and stainless steel crowns. Br Dent J
2010;208:E18; discussion 408–9.
31. Seale NS. The use of stainless steel
crowns. Pediatr Dent 2002;24:501–5.

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