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difficulty, it is sometimes impossible to isolate teeth for the placement of composite restorations. In these cases, GIC or RMGIC is suggested.130,131 Table 1. EVIDENCE OF EFFICACY OF VARIOUS DENTAL MATERIALS/TECHNIQUES IN PRIMARY TEETH WITH REGARD TO CARIES LESION CLASSIFICATIONS Strong evidence – based on well executed randomized control trials, meta-analyses, or systematic reviews; Evidence in favor – based on weaker evidence from clinical trials; Expert opinion – based on retrospective trials, case reports, in vitro studies and opinions from clinical researchers; Evidence against – based on randomized control trials, meta-analysis, systematic reviews. Class I Class II Class III Class IV Class V Amalgam Strong evidence Strong evidence No data No data Expert opinion Composite Strong evidence Strong evidence Expert opinion No data Evidence in favor Glass ionomer Strong evidence α Evidence against β Evidence in favor γ No data Expert opinion γ RMGIC Strong evidence Expert opinion δ Expert opinion No data Expert opinion Compomers Evidence in favor Evidence in favor No data No data Expert opinion SSC Evidence in favor ε Evidence in favor ε No data No data No data Anterior φ crowns N/A N/A Expert opinion Expert opinion Expert opinion RMGIC = resin modified glass ionomer cement. SSC = stainless steel crown. α Evidence from ART trials. δ Small restorations; life span 1-2 years. β Conflicting evidence for multisurface ART restorations. ε Large lesions. γ Preference when moisture control is an issue. φ Strip crowns, stainless steel crowns with/without facings, zirconia crowns. Table 2. EVIDENCE OF EFFICACY OF VARIOUS DENTAL MATERIALS/TECHNIQUES IN PERMANENT TEETH WITH REGARD TO CARIES LESION CLASSIFICATIONS Class I Class II Class III Class IV Class V Amalgam Strong evidence Strong evidence No data No data No data Composite Strong evidence Evidence in favor Expert opinion No data Evidence in favor Glass ionomer Strong evidence α Evidence against Evidence in favor β No data Expert opinion β RMGIC Strong evidence No data Expert opinion No data Evidence in favor Compomers Evidence in favor γ No data Expert opinion No data Expert opinion SSC Evidence in favor δ Evidence in favor δ No data No data No data Anterior φ crowns N/A N/A No data No data No data RMGIC = resin modified glass ionomer cement. SSC = stainless steel crown. α Evidence from ART trials. γ Evidence from studies in adults. β Preference when moisture control is an issue. δ For children and adolescents with gross caries or severely hypoplastic teeth. φ Strip crowns, stainless steel crowns with/without facings. BEST PRACTICES: RESTORATIVE DENTISTRY THE REFERENCE MANUAL OF PEDIATRIC DENTISTRY 347 Full coronal restoration of carious primary incisors may be indicated when: (1) caries is present on multiple surfaces, (2) the incisal edge is involved, (3) there is extensive cervical decalcification, (4) pulpal therapy is indicated, (5) caries may be minor, but oral hygiene is very poor, or (6) the child’s behavior makes moisture control very difficult.129 Successful full-coronal restorations of extensively decayed primary anterior teeth have been reported; however, due to the lack of available clinical studies, it is difficult to determine whether certain techniques of restoring carious primary anterior teeth are effective.128,132 A retrospective study showed that 80 percent of strip crowns were completely retained after three years, and 20 percent were partially retained, with none being completely lost.133 Another retrospective study, with 24-74 months follow-up, reported 80 percent retention of strip crowns.134 Preveneered SSCs also are among the options of restoring primary anterior teeth with full coronal coverage. Three retrospective studies report excellent clinical retention of these types of crowns, yet with a high incidence of partial or complete loss of the resin facings.127,135,136 Preveneered SSCs have the concerns of color stability and surface roughness changes,137 so long term clinical studies are required to establish their comparative effectiveness. Preformed SSCs and openedface stainless steel crowns are still options for treatment on primary