Objective: To present comparative study aims to assist the practitioner to choose between behavior modification (BM) techniques, pharmacologic sedation (N2O-O2 alone or combined with midazolam 0.5 mg/ kg) or routine general anesthesia (GA) for the most successful approach in enabling pediatric dental care.

Study design: Dental records of 56 children treated in a university dental clinic between 2006–2016 were reviewed, and data on age, gender, required treatment (amalgam restorations, composite restorations, pulpotomy, and stainless steel crowns [SSC]), treatment approaches and therapeutic success at final follow-up were retrieved. Results: Treatment under GA had the best success rates compared to both BM and pharmacologic sedation. N2O-O2 alone had a 6.1-fold greater risk of failure compared to N2O-O2+midazolam (p− <0.008). Amalgam restorations had a 2.61-fold greater risk of failure than SSC (p− <0.008). Conclusions: The GA mode yielded significantly greater success than the N2O-O2 mode alone. There were no significant differences in success rates between GA and combined midazolam 0.5 mg/kg+N2O-O2. When choosing restoration material, it is important to remember the high success rate of SSC compared to amalgam restoration.

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