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meta-analysis, conventional glass ionomers are not recommended for Class II restorations in primary molars.77,78 Conventional glass ionomer restorations have other drawbacks such as poor anatomical form and marginal integrity.79,80 Composite restorations were more successful than GICs where moisture control was not a problem.78 Resin-modified glass-ionomer cements (RMGICs), with the acid-base polymerization supplemented by a second resin light cure polymerization, have been shown to be efficacious in primary teeth. Based on a meta-analysis, RMGIC is more successful than conventional glass ionomer as a restorative material.78 A systematic review supports the use of RMGIC in small to moderate sized Class II cavities.77 Class II RMGIC restorations are able to withstand occlusal forces on primary molars for at least one year.78 Because of fluoride release, RMGIC may be considered for Class I and Class II restorations of primary molars in a high caries risk population.80 There is also some evidence that conditioning dentin improves the success rate of RMGIC.77 According to one RCT, cavo-surface beveling leads to high marginal failure in RMGIC restorations and is not recommended.63 With regard to permanent teeth, a meta-analysis review reported significantly fewer carious lesions on single-surface glass ionomer restorations in permanent teeth after six years as compared to restorations with amalgam.80 Data from a meta-analysis shows that RMGIC is more caries preventive than composite resin with or without fluoride.81 Another metaanalysis showed that cervical restorations (Class V) with glass ionomers may have a good retention rate, but poor esthetics.82 For Class II restorations in permanent teeth, one RCT showed unacceptable high failure rates of conventional glass ionomers, irrespective of cavity size. However, a high dropout rate was observed in this study limiting its significance.83 In general, there is insufficient evidence to support the use of RMGIC as long-term restorations in permanent teeth. Other applications of glass ionomers where fluoride release has advantages are for ITR and ART. These procedures have similar techniques but different therapeutic goals. ITR may be used in very young patients,84 uncooperative patients, or patients with special health care needs47 for whom traditional cavity preparation and/or placement of traditional dental restorations are not feasible or need to be postponed. Additionally, ITR may be used for caries control in children with multiple open carious lesions, prior to definitive restoration of the teeth.85 In-vitro, leaving caries-affected dentin does not jeopardize the bonding of glass ionomer cements to the primary tooth dentin.86 ART, endorsed by the World Health Organization and the International Association for Dental Research, is a means of restoring and preventing caries in populations that have little access to traditional dental care and functions as definitive treatment. BEST PRACTICES: RESTORATIVE DENTISTRY 344 THE REFERENCE MANUAL OF PEDIATRIC DENTISTRY According to a meta-analysis, single surface ART restorations showed high survival rates in both primary and permanent teeth.87 One RCT supported single surface restorations irrespective of the cavity size and also reported higher success in non-occlusal posterior ART compared to occlusal posterior ART.88 With regard to multi-surface ART restorations, there is conflicting evidence. Based on a meta-analysis, ART restorations presented similar survival rates to conventional approaches using composite or amalgam for Class II restorations in primary teeth.89 However, another meta-analysis showed that multi-surface ART restorations in primary teeth exhibited high failure rates.87 Recommendations: 1. There is evidence in favor of GICs for Class I restorations in primary teeth. 2. From a systematic review, there is strong evidence that RMGICs for Class I restorations are efficacious, and expert opinion supports Class II restorations in primary teeth. 3. There is insufficient evidence to support the use of conventional or RMGICs as long-term restorative material in permanent teeth. 4. From a meta-analysis, there is strong evidence that ITR/ART using high viscosity glass ionomer