A clinical study of the "open sandwich" technique in pediatric dental practice.

Purpose: This study evaluated the clinical efficacy of the "open sandwich" restoration for pediatric dental practice. Methods: Three pediatric dentists used a standardized preparation and restorative technique to place the restorations. The prepared tooth was etched with a phosphoric acid semigel and rinsed. A resin modified glass ionomer (Fuji II LC or Photac-Fil) was placed short of the margins and then light cured. The resin modified glass ionomer was covered with an occlusal layer of a microhybrid flowable composite (Aeliteflo or Flow-it). The same preparation for the experimental restorations was used for the control conventional amalgam (Tytin) restorations. The restorations were evaluated at 6-month intervals and ranked with a modified United States Public Heath Survey (USPHS) scale as follows: Alfa: No discernible marginal opening or stain; Beta: Slight opening of margin discernible with dental explorer, but without stain; Charlie: Open margin and stain; Delta: Recurrent caries or restoration failure. Restoration failures were categorized according to etiology, pulpal necrosis, bruxism, marginal leakage, isthmus fracture, or adhesive failure. Results: All recalled experimental restorations, except 8, were rated as either Alpha or Beta. Six failed due to isthmus fracture and 2 due to pulpal necrosis. Fifteen restorations had delaminating of the flowable composite from the resin modified glass ionomer. The use of the "open sandwich" technique compared favorably with a similar study using adhesive amalgam restorations. Conclusions: The "open sandwich" technique can be successfully used in a pediatric dental practice.