ART—a method on its way into dentistry

Abstract

In this issue of the journal, we present a comprehensiveoverview on the state of the art concerning AtraumaticRestorative Treatment (ART) [1]. Although quite a numberof assessments including systematic reviews have been pub-lished on ART already, it was the intension of this article todescribe the potentials and the limitations of ART for den-tistry as such, i.e., an attempt to describe the role of ART indentistry. The development of ARTstarted in the eighties ofthe last century as a necessity to provide dental care inpopulations who were deprived of any dental treatmentand whose alternative would have been and was so far:tooth extractions. Over the years, the ART method and therespective materials were further developed, and a largenumber of studies were published. Reports were available,e.g., on survival rates and on acceptance of this techniquemainly in low- and medium-income countries, indicatingthat ARTcould indeed be regarded not only as an alternativeto tooth extractions practiced so far but also as a way toimprove dental health. These data have been the basis forrespective WHO statements recommending this techniqueunder these circumstances. But, not only was a new treat-ment method created, control criteria and hand instrumentswere also developed for this technique, which weredesigned to fit best these procedures. So far, so good.However, with increasing success of this method in theabove-described deprived populations, the idea was bornthat this method could be used in these populations insteadof introducing classical dental treatment, like the placementof amalgam filling. Indeed, some studies performed in low-and medium-income countries showed for one-surfacecavities that ART revealed equally good results as classicalrestorations. Clear limitations were observed in larger thanone-surface cavities.Then, apparently, the idea emerged that ART would alsobe interesting for developed countries. In these countries,there are special populationgroups,like (small) children, thehandicapped, and anxious or elderly patients, who couldpotentially benefit from such a treatment method due tomany reasons. However, now, the alternative was not any-more tooth extraction, but classical dental treatment with thehighly developed canon of sophisticated materials andmethods, which had been developed over the recent deca-des. ART was entering a new arena.Due to the minimally invasive character, it indeed wasprima vista plausible to assume that ART could also find aplace there. However, now, ART had to and will have tocompete in outcome results derived from classical methodsand materials of restorative dentistry and with hundreds ofstudies—though with different levels of quality—availableconcerning failure or survival rates. Furthermore, the ques-tion now is, is this still ART? Caries removal with anexcavator is not new, and the author of this editorial wastaught this many years ago in dental school as well as thepossibility of not using engine-powered drills in certainclinical cases like anxious children. Also, glass ionomercement (GIC) was used in such cases before ART wasintroduced. On the other side, widening of the opening ofsmall cavities with hand instruments or the use of(improved) GIC in occlusal surfaces has been attributed toART. It would be helpful, though, if a common basis ofunderstanding what ART contributed to dentistry could beformulated. Again, the present overview article [1] could bea starting point.The comparative evaluation between results with classi-cal methods and materials in restorative dentistry and dataderived from ARTstudies was and is difficult due to several