Five-year survival analysis of class I and II restorations performed in non-compliant children.

Objectives To evaluate the survival of occlusal and proximal restorations in deciduous molars of non-compliant children treated under midazolam or nitrous oxide/oxygen (N₂O/O₂) and evaluate predictors of failure.Methods A total of 151 children (517 teeth) received occlusal (102 patients; 228 teeth) or proximal (105 patients; 289 teeth) restorations-and were assessed over 5 years. Kaplan-Meier survival and multilevel Cox proportional hazards models were applied, assessing patient-level (level 2) and tooth-level (level 1) variables-age, sex, restorative need, sedation type, cooperation, jaw, tooth side, isolation, and material.Results 16 children (60 teeth) received N₂O/O₂, 112 children (373 teeth) midazolam, and 23 children (84 teeth) no sedation. Sedation method was not related to restoration failures. Estimated survival at 48 months was 50% for occlusal, and 60% at 60 months for proximal restorations (p=0.072). Occlusal failures were more likely in younger children (p<0.05), lower jaw (p=0.046), and with glass ionomer cements (GIC; p=0.028), while proximal restorations failures occurred more likely in lower molars (p=0.024) and with GIC (p=0.003). Overall, predictors for occlusal and proximal failures were: younger age (HR = 0.27, p = 0.030); lower jaw (HR = 2.09, p = 0.001); and GIC (HR = 3.72, p < 0.001).Conclusions Neither restoration type nor sedation method were significant factors. Overall, restorations in non-compliant children are more likely to fail when placed in younger patients, in lower molars, or when glass ionomer cements are used.Clinical Relevance Although sedation can help non-compliant children, these patients can still be difficult to treat. This study highlights that neither cavity type nor sedation method predicts restoration failures; instead, patient age, tooth location, and restorative material are key factors. These findings can help clinicians make evidence-based choices to improve treatment outcomes in pediatric patients requiring sedation.