This study compared the survival of restorations produced through the atraumatic restorative treatment (ART) approach using glass-ionomer with those produced through the traditional approach using amalgam (MTA) in deciduous dentitions over a period of 3 years. Using a parallel group design, 835 grade 1 children, aged 6–7 years, participated. A total of 482 children were treated through the ART and 353 children through the MTA approach. Eight dentists produced a total of 1,891 single- and multiple-surface restorations. After 3 years, 22.1% of the restorations were lost for evaluation. There was a statistically significant difference in the combined survival of all single- and multiple-surface restorations between the two approaches in favour of the ART approach (p = 0.04). The study revealed a 3-year cumulative survival percentage of single-surface ART and MTA restorations of 86.1 and 79.6%, respectively. The difference was statistically significant (p = 0.03). The main reasons for both single-surface ART and MTA restorations to fail was ‘restoration missing’ followed by ‘gross marginal defect’. The 3-year cumulative survival percentages of multiple-surface ART and MTA restorations were 48.7 and 42.9%, respectively. The difference was not statistically significant (p > 0.05). The 3-year survival percentages of single- and multiple- surface ART and MTA restorations varied widely amongst the 8 operators with an operator effect (p = 0.001) for multiple-surface MTA restorations. It can be concluded that the ART approach using glass-ionomer yielded better results in treating dentinal lesions in deciduous teeth than did the traditional approach using amalgam after 3 years. It is recommended to select the ART approach to complement the other activities of the school oral health programme.

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