One-year survival of minimally invasive restorations in patients with disabilities: implications for clinical decision-making in special care dentistry

Background 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. Methods Seventy-four patients (mean age 20.6 ± 11.2 years) referred for restorative care chose: ART ( n = 26), SMART ( n = 35), CRT ( n = 11); two others required sedation/general anesthesia. A total of 100 restorations were placed by one operator and assessed by two calibrated independent evaluators (Kappa = 0.80) at 6 and 12 months. The restorative material selected for ART and SMART was Fuji 9 Hybrid (GC America, Alsip US) whereas G-Bond + Gaenial 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–Meier survival analysis, and Cox regression (α = 0.05). Spearman correlation was used to assess the association between care complexity and BDA and iADH uCMT scores. Results 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 = 3.730; 95% CI: 1.82–6.75; p ≤ 0.001). The “Communication” and “Behavioral Support” domains required fewer adaptations for CRT patients ( p = 0.001), whereas “Access to adapted care” 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 ( p < 0.001). Conclusions 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.