Objective: To compare the clinical performance of two glass–ionomer cements, ChemFlex (Dentsply DeTrey) and Fuji IX GP (GC), when used with the atraumatic restorative treatment (ART) approach in China. Methods: Eighty–nine school children aged between 6 and 14 years who had bilateral matched pairs of carious posterior teeth were included. A split–mouth design was used in which the two materials were randomly placed on contralateral sides. The performance of the restorations was assessed directly and also indirectly from die–stone replicas at baseline and after 6, 12, and 24 months. Results: The 24–month cumulative survival rates of ART restorations in the primary teeth were 93 and 90% for the ChemFlex and Fuji IX GP class I restorations, respectively, while 40 and 46% of class II restorations placed with the respective materials were satisfactory. In the permanent dentition, only class I restorations were involved and the cumulative survival rates were 95 and 96% for ChemFlex and Fuji IX GP. For the primary teeth after 24 months, net mean occlusal wear was 87 µm for ChemFlex and 85 µm for Fuji IX GP. The occlusal wear in the permanent teeth was 75 µm for ChemFlex and 79 µm for Fuji IX GP. Conclusion: The clinical performance of both materials over a 24–month period was similar and the survival rates of class I ART restorations in both primary and permanent teeth were high.

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