A comparison of different clinical diagnostic criteria for adhesive restorations in children aged 5-10 years: a cross-sectional observational study.

OBJECTIVES: The primary reason for replacement of adhesive tooth restorations is failure due to secondary caries. The decision may vary depending on the diagnostic criteria used. This cross-sectional observational study aimed to compare clinical treatment decisions for adhesive restorations in high-caries-risk children using three diagnostic systems: International Dental Federation (FDI), Caries Associated with Restorations and Sealants (CARS), and modified United States Public Health Service (USPHS) Ryge. METHOD AND MATERIALS: A total of 267 teeth (475 restored surfaces) in 80 children aged 5 to 10 years, classified as high caries risk, were examined. Each restoration was independently evaluated using FDI, CARS, and modified USPHS criteria. Treatment recommendations were categorized into no intervention, repair, or replacement. Analyses explored associations between treatment decisions and variables like restorative material, tooth type, number of surfaces involved, and age of restoration. Evaluations were performed at both surface and tooth levels. RESULTS: The findings affirm strong correlations within the three diagnostic criteria observed at lower scores (rho = 0.9, P .001). However, within higher scores, there was less overlap for aggressive treatment. The modified USPHS criteria resulted in the highest rate of interventions (59.8%), followed by the FDI (35.2%) and CARS (24.8%) systems. Presence of secondary caries was the strongest predictor of replacement (P .001). Restorations using glass-ionomer cement were significantly more likely to require intervention than those using composite resin (P .001). The number of surfaces did not significantly influence treatment decisions, whereas restoration age and tooth type had variable impacts. CONCLUSIONS: The results of the present study demonstrated an increased shift of treatment decisions towards aggressive interventions (repair/replacement) for restored tooth surfaces/restored primary/permanent teeth as per modified USPHS criteria, with fewer interventions indicated using FDI, followed by the CARS criteria. Future pediatric restorative protocols should incorporate standardized training modules for practitioners and researchers to interpret criteria uniformly.