{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T13:41:05Z","timestamp":1792590065400,"version":"4.5.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oral Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Unmet caries treatment needs are common among people with disabilities, in part due to difficulties with cooperation during conventional dental care. This cohort study aimed to compare the acceptability, feasibility, and survival of Atraumatic Restorative Treatment (ART), Silver-modified Atraumatic Restorative Treatment (SMART), and Conventional Restorative Treatment (CRT) in patients with disabilities referred to a university dental clinic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Seventy-four patients (mean age 20.6\u2009\u00b1\u200911.2 years) referred for restorative care chose: ART (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200926), SMART (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200935), CRT (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200911); two others required sedation\/general anesthesia. A total of 100 restorations were placed by one operator and assessed by two calibrated independent evaluators (Kappa\u2009=\u20090.80) at 6 and 12 months. The restorative material selected for ART and SMART was Fuji 9 Hybrid (GC America, Alsip US) whereas G-Bond\u2009+\u2009Gaenial Accord were used for CRT (GC America, Alsip US). Acceptability, feasibility, and complexity of care were determined using BDA scores and the iADH uCMT domains. Statistical analyses included Chi-square tests, Kaplan\u2013Meier survival analysis, and Cox regression (\u03b1\u2009=\u20090.05). Spearman correlation was used to assess the association between care complexity and BDA and iADH uCMT scores.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      ART, SMART, and CRT were feasible for all patients selecting those options, with optimal restoration placement in 100% of ART and CRT cases, and 95.8% in SMART. Complexity scores (BDA) were significantly higher in the SMART group (OR\u2009=\u20093.730; 95% CI: 1.82\u20136.75;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009\u2264\u20090.001). The \u201cCommunication\u201d and \u201cBehavioral Support\u201d domains required fewer adaptations for CRT patients (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001), whereas \u201cAccess to adapted care\u201d required more adaptations in ART and SMART groups. Out of 100 restorations, 26 failed by ART criteria and 23 by USPHS criteria. According to the latter, survival rates were 90.3% for ART, 67.4% for SMART, and 84.3% for CRT, with significant differences between ART\/CRT vs. SMART (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ART and SMART are acceptable and feasible restorative approaches for patients with disabilities, particularly when adaptations across care domains are required. Patients with lower BDA scores are more likely to opt for CRT. However, the significantly lower survival associated with SMART challenges its suitability as a durable option in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/froh.2026.1846405","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T05:46:37Z","timestamp":1779255997000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["One-year survival of minimally invasive restorations in patients with disabilities: implications for clinical decision-making in special care dentistry"],"prefix":"10.3389","volume":"7","author":[{"given":"Mariana Ruth","family":"Zar","sequence":"first","affiliation":[{"name":"Special Care Dentistry, The Dental School, Faculty of Health Sciences, Universidad Cat\u00f3lica de C\u00f3rdoba","place":["C\u00f3rdoba, Argentina"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leandro","family":"Navarro","sequence":"additional","affiliation":[{"name":"Special Care Dentistry, The Dental School, Faculty of Health Sciences, Universidad Cat\u00f3lica de C\u00f3rdoba","place":["C\u00f3rdoba, Argentina"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doriana","family":"Torres","sequence":"additional","affiliation":[{"name":"Special Care Dentistry, The Dental School, Faculty of Health Sciences, Universidad Cat\u00f3lica de C\u00f3rdoba","place":["C\u00f3rdoba, Argentina"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustavo Fabi\u00e1n","family":"Molina","sequence":"additional","affiliation":[{"name":"Special Care Dentistry, The Dental School, Faculty of Health Sciences, Universidad Cat\u00f3lica de C\u00f3rdoba","place":["C\u00f3rdoba, Argentina"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"B1","year":""},{"key":"B2","doi-asserted-by":"publisher","first-page":"S5","DOI":"10.1016\/j.identj.2022.06.012","article-title":"Burden of oral diseases and access to oral care in an ageing society","volume":"72","author":"Aida","year":"2022","journal-title":"Int Dent J"},{"key":"B3","doi-asserted-by":"publisher","first-page":"107174","DOI":"10.1016\/j.yebeh.2020.107174","article-title":"Dental health in persons with disability","volume":"110","author":"Devinsky","year":"2020","journal-title":"Epilepsy Behav"},{"key":"B4","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1016\/j.sdentj.2023.11.005","article-title":"A narrative review of minimally invasive techniques in restorative dentistry","volume":"36","author":"Alyahya","year":"2024","journal-title":"Saudi Dent J"},{"key":"B5","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1111\/adj.12871","article-title":"Atraumatic restorative treatment restorations performed in different settings: systematic review and meta-analysis","volume":"66","author":"Garbim","year":"2021","journal-title":"Aust Dent J"},{"key":"B6","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1177\/20501684241249545","article-title":"Silver modified atraumatic restorative treatment: a paradigm shift in dental caries management","volume":"13","author":"Hegde","year":"2024","journal-title":"Prim Dent J"},{"key":"B7","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1186\/s12903-022-02432-7","article-title":"COVID-19 as an opportunity for minimally-invasive dentistry: a national cross-sectional survey","volume":"22","author":"Maldupa","year":"2022","journal-title":"BMC Oral Health"},{"key":"B8","doi-asserted-by":"publisher","first-page":"511","DOI":"10.3390\/children12040511","article-title":"Effectiveness of dental restorative materials in the atraumatic treatment of carious primary teeth in pediatric dentistry: a systematic review","volume":"12","author":"Dipalma","year":"2025","journal-title":"Children"},{"key":"B9","doi-asserted-by":"publisher","first-page":"CD012718","DOI":"10.1002\/14651858.CD012718.pub2","article-title":"Topical silver diamine fluoride (SDF) for preventing and managing dental caries in children and adults","volume":"11","author":"Worthington","year":"2024","journal-title":"Cochrane Database Syst Rev"},{"key":"B10","doi-asserted-by":"publisher","first-page":"e13096","DOI":"10.1111\/scd.13096","article-title":"Acceptability and feasibility of minimally invasive restorative procedures for patients with disability. 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