Design: This was a randomised controlled trial conducted in Indonesia.
Intervention: Children, who each had at least one multisurface cavity in a deciduous molar, were randomly allocated to two treatment groups. The test group was treated using atraumatic restorative techniques (ART) using only hand instruments. The control group received treatment using rotary instruments (operated at 750 rpm), without water cooling. Glass ionomer cement was used for restoration in both groups.
Outcome measure: The extent of discomfort was assessed by measuring the behavioural (psychological) and the physiological aspect represented by, respectively, a modified Venham score and the heart rate of the children at six fixed moments during dental treatment: (i) when the child entered the treatment room, (ii) at the start of excavation, (iii) at the moment of deepest excavation, (iv) at the moment of application of the matrix band and wedges, (v) at the moment the restoration was applied, and (vi) after completion of the treatment.
Results: A total of 403 children were treated. Venham scores showed a marked difference between the two groups at most timepoints. Heart rate measurements were different at deep excavation. Also, a clear relation between Venham scores and heart rate measurements could be found at all time points. Confounding could be shown for operating dentist, gender of the patient and initial anxiety, but not for age. No effect modification could be shown.
Conclusions: Children treated according to the ART approach using hand instruments alone experience less discomfort than those treated using rotary instruments.