Atraumatic Restorative Treatment Approach Research Articles

A systematic review of randomized controlled trials on survival rate of atraumatic restorative treatment compared with conventional treatment on primary dentition

In this COVID era, it's critical to promote nonaerosol procedures. Atraumatic restorative treatment (ART) is one of them, and it's particularly effective in children for lowering anxiety, enhancing dental health, and giving restorative care. The aim of this study was to assess the survival rate of ART compared with conventional treatment procedures in primary dentition. The review was done in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analysis statement and is been registered in PROSPERO (CRD42021213729). The studies included comprised clinical investigations with randomized controlled trials (RCTs) which compared the survival rate of ART and conventional restorative treatments using the same or different restorative materials to treat carious lesion. RCTs in which ART was compared with conventional treatment on patients in the age group of 6-10 years with minimum follow-up of 6 months. Studies available as open access and free full text in PubMed, DOAJ, and Google Scholar databases, and published in English Language only were included in the study. Cochrane's collaboration tool for RCTs was used for the assessment of risk of bias. The survival rate of single surface and multiple surface in primary dentition treated according to the ART compared with conventional treatment was found to be similar. The ART approach is equally helpful in managing dental caries in children and this method may be considered a useful intervention in clinical practice to enhance the dental health of children.

Atraumatic restorative treatment

Dental caries is a sugar-dependent disease that damages tooth structure and, due to loss of mineral components, may eventually lead to cavitation. Dental caries is the most prevalent disease worldwide and is considered the most important burden of oral health. To overcome the limitations of conventional restorative treatment, the Atraumatic Restorative Treatment (ART) was developed, mainly for treating caries in children living in under-served areas of the world where resources and facilities such as electricity and trained manpower are limited. ART is a minimally invasive approach which involves removal of decayed tissue using hand instruments only, without use of anaesthesia and electrically driven equipment, and restoration of the dental cavity with an adhesive material (glass ionomer cement (GIC), composite resins, resin-modified glass-ionomer cement (RM-GICs) and compomers). The ART approach so far has mainly used high-viscosity glass-ionomer as the sealant and restorative material.

Twelve-month evaluation of the atraumatic restorative treatment approach for class III restorations: An interventional study.

BACKGROUNDAtraumatic restorative treatment (ART) may be appropriate for populations without accessibility and affordability. More data are required regarding the success rate of ART in anterior teeth.AIMTo evaluate the clinical performance of restoring class III cavities in anterior teeth of permanent dentition using the ART approach.METHODSA longitudinal interventional field study was carried out at two rural primary health centers, Tumkur district, India. A total of 54 teeth in 39 patients were evaluated for the survival rate of class III restorations in permanent anterior teeth using the ART approach in children and adult populations. Evaluation of ART restoration was carried out using Frencken J criteria, the mean procedure time, patient acceptance and reported pain severity during the ART approach were evaluated using a visual analog scale. Calculation of the cost of ART was also performed.RESULTSThe mean time taken to perform the ART procedure was 14.79 ± 5.8 min with the majority of patients reporting only mild pain. At 6 mo follow-up, 72.2% remained in a good state, but this reduced to 27% at 12 mo. The cumulative survival rate of the restorations was 94.4% at 6 mo and 80.9% at 12 mo follow-up. Estimation of the direct cost for a single class III restoration was 186.50 INR (2.64 USD).CONCLUSIONART may be a good comprehensive option for basic oral health care for underserved or inaccessible populations, and preventive care for patients.

A 24-month randomized controlled trial on the success rates of restoring untreated and SDF-treated dentine caries lesions in primary teeth with the ART approach

ObjectiveTo compare the success rates of restoring untreated and SDF-treated dentine caries lesions in primary teeth with atraumatic restorative treatment (ART) approach. MethodCavitated dentine caries lesions in preschool children were randomly allocated to two groups to be applied with either 38% silver diamine fluoride (SDF) solution or tonic water (control) ten weeks before being restored with the ART approach. Status of the restorations were assessed every six months by a blinded independent examiner. Multilevel logistic regression and multilevel survival analyses were conducted to assess the restoration success rates. ResultsA total of 194 children (SDF group, 101; control group, 93) were included, with 260 and 249 ART restorations placed in the SDF and the control groups, respectively. At 24-month follow-up, 88 (87 %) and 84 (90 %) children remained in the SDF and the control groups, respectively. There was no significant difference between the ART restoration success rates of the two study groups (p > 0.05). The success rate of ART restorations was associated with the class of restorations. Class I restorations had the highest success rate (∼50 %), followed by Class V (∼35 %), Class II (∼15 %) and Class III (<10 %). Besides, the mean time used to place an ART restoration in a SDF-treated caries lesion was shorter than that in untreated lesion (4.8 vs. 5.1 min, p = 0.006). ConclusionPrior SDF application does not significantly affect the success rate of ART restorations placed in primary teeth. Besides, it is faster to place ART restorations in caries lesions that have been previously treated with SDF. Clinical significancePrior application of silver diamine fluoride solution on cavitated dentine caries lesions in primary teeth can shorten the average time required to place an ART restoration while not jeopardizing the success rate of the restorations.

Desempenho clínico do cimento de ionômero de vidro no tratamento restaurador atraumático: uma revisão da literatura

Trata-se de uma revisão de a literatura acerca do desempenho clínico do cimento de ionômero de vidro (CIV) utilizado no tratamento restaurador atraumático (TRA). Realizaram-se buscas nas bases de dados: Biblioteca Virtual em Saúde Odontologia, Medline, Pubmed e Science Direct, utilizando os descritores “cimentos de ionômeros de vidro”, “tratamento dentário restaurador sem trauma” e “análise de sobrevida”, bem como os respectivos termos em inglês. Foram selecionados 23 artigos nos idiomas português e inglês, publicados nos últimos dez anos, seguindo critérios de inclusão e exclusão pré-determinados. Percebeu-se que a maioria dos estudos aplicou o TRA em crianças (66%), direcionado à dentição decídua (57%) e em cavidades de superfície única e múltipla (48%), simultaneamente. A maioria dos estudos acompanhou o desempenho clínico das restaurações no período de 12 (35%) e 24 meses (35%). O CIV de alta viscosidade foi mais utilizado e as marcas Fuji IX e Ketac Molar foram as mais empregadas no TRA. Concluiu-se que O CIV associado ao TRA demonstra ser uma alternativa viável para tratar cárie em dentes decíduos e permanentes. A longo prazo, o CIV apresenta desempenho superior em cavidades de superfície única em relação às multisuperfície. De modo geral, as taxas de sucesso das restaurações oscilaram entre: 57,5 e 98%, em superfícies únicas, e 24,4 e 97,8%, em superfícies múltiplas. Esta abordagem mostrou ser confiável e efetiva quando comparada a técnica restauradora convencional. O defeito marginal e a perda parcial ou total da restauração foram identificados como principais causas de falha.

Clinical wear of approximal glass ionomer restorations protected with a nanofilled self-adhesive light-cured protective coating.

High viscous glass ionomer cement (GIC) has gained popularity as a restorative material; however, high wear is pointed as one of the major drawbacks of this material. Protective surface coatings were developed to protect GIC from water contamination with the additional advantage of occluding any surface cracks or porosities commonly found in this material, possibly resulting in an increased wear resistance of the restorations.Objective:The objective of this study was to investigate the clinical wear of GIC approximal restorations in primary molars protected either with a nanofilled self-adhesive light-cured protective coating (NPC) or with petroleum jelly.Material and Methods:Approximal caries lesions in primary molars from 32 schoolchildren previously enrolled in another clinical trial were included in this investigation. GIC restorations were performed according to the Atraumatic Restorative Treatment approach and protected with either petroleum jelly or a NPC. Impressions of the restored hemiarch were done after 1 day and 6, 12, 24 and 36 months. The impressions were scanned in a 3-D appliance and the obtained images were superimposed using an appropriate computer software. Two-way ANOVA for repeated measures and Tukey's post-hoc test were used to analyze the wear of restorations (α=5%).Results:A significant difference was found between the two groups, with a wear protection offered by the application of a NPC. Conclusion: These results suggest that the application of a NPC has a protective effect on the clinical wear of approximal GIC restorations in primary teeth.

Microshear Bond Strength of High-viscosity Glass-ionomer to Normal and Caries-affected Dentin Under Simulated Intrapulpal Pressure.

The use of high-viscosity glass-ionomer cements (HVGICs) for atraumatic restorative treatment (ART) restorations is widely practiced with the advent of various HVGICs. However, the bonding of the latter to caries-affected dentin (CAD) should be validated, especially because it is the common substrate left after conservative caries removal following the ART approach. Hence, this study was carried out to evaluate the microshear bond strength (μSBS) of three HVGICs to normal dentin (ND) and CAD under intrapulpal pressure (IPP) simulation. The occlusal enamel of 90 molars with mid-coronal caries was cut to expose flat dentin surfaces containing both ND and CAD. Dentin substrates (ND and CAD) were differentiated using visual, tactile, caries-detecting dye, and dye-permeability methods. Prepared crown segments were equally divided (n=30) according to the tested HVGICs into GC Fuji IX GP Fast, Fuji IX GP containing chlorhexidine, and zinc-reinforced ChemFil Rock HVGIC. Microcylinders of tested HVGICs were built up on both dentin substrates (n=30 for each tested HVGIC per each substrate) using starch tubes while the specimens were subjected to simulated IPP of 15 mm Hg. The μSBS test was conducted using a universal testing machine, and failure modes were determined using a scanning electron microscope. Data were statistically analyzed using two-way analysis of variance (ANOVA) with repeated measures, one-way ANOVA, and Bonferroni post hoc tests (α=0.05). For both dentin substrates (ND and CAD), the μSBS values of ChemFil Rock were significantly higher than those recorded for the other HVGICs. The μSBS values of each tested HVGIC to ND and CAD were not statistically different. Failure modes were mainly mixed. Zinc-reinforced HVGIC ChemFil Rock showed superior bonding to ND and CAD compared to the GC Fuji IX GP Fast and Fuji IX with chlorhexidine. However, each of the tested HVGICs showed comparable bonding to both dentin substrates (ND and CAD).

Glass hybrid restorations as an alternative for restoring hypomineralized molars in the ART model

BackgroundThis study aimed to evaluate the survival rate of glass hybrid restorations placed under the atraumatic restorative treatment (ART) technique in first permanent molars affected by molar incisor hypomineralization (MIH).MethodsSixty teeth with severe MIH associated to carious dentin lesions without pulp involvement were included. Treatments were performed by one trained dentist using the ART approach and restored with a glass hybrid restorative system (Equia Forte, GC®) on school premises. Treatments were evaluated after 6 and 12 months by an independent examiner using the modified ART criterion. Data analysis involved descriptive statistics and actuarial success analysis.ResultsThe sample comprised 24 (54.54%) girls and 20 (45.45%) boys with a mean age of 10.55 (±1.25) years. In regard to the number of surfaces involved in the restorations, 29 (48.3%) comprised one surface and 31 (51.7%) two or more surfaces. Considering cavity extent, 25 (41%) presented dentin cavitation without cusp weakness, 23 (37.7%) with large dentin cavitation with cusp weakness and 13 (21.3%) with large dentin cavitation with the breakdown of one or more cusps. Only 4 teeth required local anesthesia. A success rate of 98.3% after 6 and 12 months was observed, as only one restoration failed. The only failure occurred in a restoration involving three or more sur-faces presenting the breakdown of all cusps.ConclusionRestorations using a glass hybrid restorative system and performed in the field with the ART technique proved, after 12 months of evaluation, to be an effective approach to preserving first permanent molars affected by MIH.Trial registrationREBEC-RBR-8drccq (17/06/15).

EFFICACY OF ATRAUMATIC RESTORATIVE TREATMENT USING GLASS IONOMER CONTAINING CHLOROHEXIDINE: IN VIVO AND IN VITRO STUDY

Introduction: The atraumatic restorative treatment (ART)considered a trusted and effective approach to the control of carious lesions.Since the ART approach using glass ionomer (GICs) the use of antimicrobial agents(chlorhexidine) in combination with restorative materials are being developed for reducing the frequency and severity of secondary caries. hence, it is preferable to keep an optimum chlorhexidine concentration to maintain its antimicrobial effect without affecting GICs’ mechanical performance. Aim of the study: This study was planned to evaluate the antibacterial activity and mechanical properties of the glass ionomer containing different concentrations of chlorhexidine. Material and methods: In vivo study: Sixty children aged 7-9 years old were included in this studywith at least onecavitated dentin carious lesion in occlusal surfacesin primary teeth.these children were randomly divided into three equal treatment groups. Group I: atraumatic restorative treatment approach using a conventional glass ionomer cement. Group II: atraumatic restorative treatment approach using glass ionomer containing1% chlorhexidine. Group III: atraumatic re­storative treatment approach using glass ionomer containing 2% chlorhexidine. A sample was taken from the affected dentine using a sterile sharp small-size hand excavator at baseline and after 7 days. All samples were inoculated for the selective isolation of mutans streptococci, and lactobacilli. In vitro study: Fifteen cylindrical specimens for each group were prepared and tested for their compressive strength, diametral compressive strength and microhardness. Results: The percentage reduction in mean and standard deviation (SD) of mutans streptococci and lactobacilli between treatment groups revealed that there were statistically significant differences between three groups (P= 0.01, P= 0.02).Tukey post hoc test revealed that the main difference was between glass ionomer containing chlorohexidine and conventional glass ionomer while there was no statistically significant difference between glass ionomer containing 1% and 2% chlorohexidine. The comparison of the mechanical properties among the three groups in term of compressive strength, diametral compressive strength and microhardness showed no statistically significant differences between conventional glass ionomer and glass ionomer containing 1% or 2% chlorohexidine. Conclusion: Glass ionomers containing chlorhexidine displayed superior antibacterial activity than conventional glass ionomers without affecting the mechanical properties of glass ionomer

Three-year survival of ART high-viscosity glass-ionomer and resin composite restorations in people with disability.

To assess the 3-year cumulative survival rate of atraumatic restorative treatment (ART) and conventional resin composite restorations (CRT) placed in persons with disability. Patients referred for restorative care to the Haemophilia Foundation special care service were treated by one of two specialists. Patients and/or caregivers were provided with written and verbal information regarding treatment options and selected the alternative they preferred. Treatment was provided as selected unless this option proved clinically unfeasible when an alternative technique was proposed. The treatment protocols were ART (hand instruments/high-viscosity glass-ionomer) in the clinic or CRT (rotary instrumentation/resin composite) in the clinic or under general anaesthesia (GA). After 6, 12, 24 and 36months, two independent, trained and calibrated examiners evaluated restoration survival using established ART codes. The proportional hazard model with frailty corrections gave survival estimates over 3years. Sixty-six patients (13.6±7.8years) with 16 different disability profiles participated. CRT in the clinic proved feasible for five patients (13%), and 14 patients received CRT under GA (21%). ART was used for 47 patients (71.2%). Altogether, 298 dentine carious lesions were restored in primary and permanent teeth (182 ART; 116 CRT). The 3-year cumulative survival rates and jackknife standard errors for the 182 ART and 116 CRT restorations were 94.8±2.1 and 82.8±5.3%, respectively (p=0.01). The 3-year follow-up results confirm that ART is an effective treatment protocol. Patients with disability, many of whom have difficulty coping with CRT, may benefit from the ART approach.

Acceptability, feasibility and perceived satisfaction of the use of the Atraumatic Restorative Treatment approach for people with disability.

Unmet caries treatment need is prevalent among people with disability, partly due to difficulties cooperating with conventional dental treatment. This study compared Atraumatic Restorative Treatment (ART) with conventional restorative treatment (CRT) in the clinic and under general anaesthesia (GA), in terms of feasibility, acceptability and respondent satisfaction in patients referred for special care dentistry. Patients referred for dental restorative care were treated using either ART or CRT approach. Acceptance, feasibility and level of satisfaction with the treatment provided were assessed. ANOVA with Bonferroni correction and Chi-square tests investigated differences in age, gender and Visual Analogue Scale satisfaction scores. A total of 66 patients (mean 13.6 ± 7.8 years) were included and 43 respondents chose ART. ART was feasible for 47 patients, with optimal placement of restorations for 79% of all patients receiving ART. CRT in the clinic was chosen by 15 respondents and was feasible for 5 (33%). Local anaesthesia was required for 4 of the 47 patients receiving ART and for 3 of the 5 patients receiving CRT in the clinic. Neither ART nor CRT could be performed in the clinic for 14 patients who were treated under GA (21%). Respondent satisfaction was higher for those receiving ART than CRT (in the clinic and under GA). It was concluded that ART is a satisfactory, feasible, acceptable and effective approach to restorative dental treatment in patients with disability who have difficulty coping with conventional treatment. More research is now required to confirm these results in a larger study population.

Atraumatic restorative treatment for dental caries among pregnant women attending primary health centres: A small scale demonstration

Background: ART consists of a simplified, low-cost technique that uses only hand instruments in the removal of carious tissues to reduce contamination and viability of microorganisms. This technique requires immediate restoration of the cavity with adhesive restorative material, namely glass ionomer. Since ART approach causes lesser anxiety than the traditional restorative procedure, it may be a very useful tool for providing dental treatment to pregnant women. Objective: The present study was carried out to assess the pregnant women's response to undergo ART in Primary Health Centre set up and clinical evaluation of restoration at 6 month interval. Methods: Pregnant women visiting Primary health centres (PHCs) for prenatal check- up were examined. Those having cavities were restored using ART after taking informed consent. These were followed up telephonically 24 hours later and examined at the end of six months. Results: Of the 308 pregnant women examined, fifty teeth of forty five subjects (83%) were restored using ART. Out of that 45 (90%) were one surface restoration and five (10%) two surface restorations. None of the subjects felt pain during the procedure, 24 hours later or at the end of six months. All the subjects were satisfied with the treatment. All one surface fillings were intact and one out of five, two-surface filling was broken which was replaced with new restoration. Conclusion: This study demonstrates that the patients were satisfied with the ART which can be undertaken at lower cost. Together with preventive and promotional activities, oral health status of pregnant women who visit PHCs can be improved.Clinical Relevance to Interdisciplinary Dentistry Being based on the contemporary philosophy of minimum intervention and maximum preservation of the tooth structure, atraumatic restorative treatment (ART) has been considered a feasible treatment option for moderate to deep carious lesions and can be applied to the entire population.As ART approach causes lesser anxiety than the traditional restorative procedure using dental rotary instruments, it can be used among target groups like children and pregnant women to treat dental caries.This article is an attempt at demonstrating the effectiveness of ART in pregnant women attending primary health centres. This could be utilized for preventive care in low resource and low-cost settings

The effects of ambient temperature and mixing time of glass ionomer cement material on the survival rate of proximal ART restorations in primary molars

Objective:Temperature fluctuations and material mixing times are likely to affect the consistency and integrity of the material mixture, and hence the restoration made out of it. The purpose of the present study was to determine the influence of the ambient temperature and the mixing time of glass ionomer cement (GIC) restorative material on the survival rate of proximal atraumatic restorative treatment (ART) restorations placed in primary molars.Materials and Methods:A total of 804 restorations were placed in the primary molars of 6-8-year-olds using the ART approach. The restorations were then followed for a period of 2 years and evaluated at given intervals. The data collected were analyzed using SPSS computer statistical program, and the results tested and compared using the Chi-square, Kaplan Meier survival analysis and Cox Proportional hazard statistical tests.Results:The cumulative survival rate of the restorations dropped from the initial 94.4% to 30.8% at the end of 2 years. The higher survival rate of the restorations was associated with the experienced operators and assistants when using the rubber dam isolation method. However, there was no statistically significant difference in the survival rate of the restorations when related to the room temperature and the mixing time of the GIC materials used in spite of the variations in the temperature recoded and the methods used in mixing the materials.Conclusion:The ambient temperature and mixing time of GIC did not have a significant effect on the survival of the proximal ART restorations.

Teaching Atraumatic Restorative Treatment in U.S. Dental Schools: A Survey of Predoctoral Pediatric Dentistry Program Directors

The International Dental Federation and World Health Organization have promoted the use of Atraumatic Restorative Treatment (ART) in modern clinical settings worldwide. In the United States, the practice of ART is not believed to be widely used, which may be a result of little attention given to ART training in predoctoral pediatric dentistry curricula in U.S. dental schools. This study investigated the extent of clinical and didactic instruction on ART provided in U.S. dental schools by surveying the predoctoral pediatric dentistry programs in 2010. Of the fifty-seven directors asked to complete the survey, forty-four responded for a response rate of 77 percent. Of these forty-four programs, 66 percent reported providing clinical training on ART, though only 14 percent provide this training often or very often. The types of ART training provided often or very often included interim treatment (18 percent) and single-surface cavities (14 percent) in primary teeth. However, ART was said to be rarely taught as a definitive treatment in permanent teeth (2 percent). Attitude was a major predictor, for clinical training provided and using professional guidelines in treatment decisions were associated with a positive attitude towards ART. These predoctoral pediatric dentistry programs used ART mainly in primary, anterior, and single-surface cavities and as interim treatment. As ART increases access of children to dental care, the incorporation of the ART approach into the curricula of U.S. dental schools should be facilitated by professional organizations.

Managing dental caries with atraumatic restorative treatment in children: successful experience in three Latin American countries

To compare survival rates and cost differentials between the atraumatic restorative treatment (ART) technique and amalgams by type of dental personnel in Ecuador, Panama, and Uruguay. Children 7 to 9 years of age in rural and urban schools with at least one lesion with initial cavitated enamel caries or a dentinal lesion on a first permanent molar were selected and randomized into the ART (intervention) or amalgam (control) group. Restoration failure was evaluated at 12 and 24 months. Cooperation and pain experienced during the procedures were measured. Cumulative and incident failure of restorations at 12 and 24 months was calculated for dentists who placed ART or amalgam restorations and auxiliaries who placed ART restorations at 12 months only. The total sample comprised 1 629 children. Study groups were similar by country, gender, and geographic location. Cumulative failure rate at 12 months varied by group: dentists' amalgam, 0.9% to 5.7%; dentists' ART, 2.0% to 10.5%; and auxiliaries' ART, 5.7% to 15.8%. At 24 months, higher cumulative failures were observed for the dentists' amalgam group compared with the dentists' ART group in Ecuador and Panama but not in Uruguay. Amalgam was least likely to have the best level of cooperation and an auxiliary using ART was associated with the least pain. The cost of using the ART approach for dental caries treatment, including retreatment, was roughly half that of using amalgam without retreatment. Having auxiliary personnel perform ART will lead to treatment survival that is expected to be lower than dentists using amalgam or ART. In spite of the greater risk of failure, the rate is not unacceptable and potential cost savings are substantial.

Suitability of ART approach for managing caries lesions in people with disability—Experts' opinion

Objective. This study aimed to obtain the opinions of experts in Special Care Dentistry (SCD) regarding the suitability of the Atraumatic Restorative Treatment (ART) approach for the treatment of carious lesions in persons with disability. Material and methods. Thirty expert participants from around the world, joining the SCD Task Force meeting, Education Committee of the International Association of Disability and Oral Health (Antalya, Turkey, 2011), completed a questionnaire survey. Frequency distributions of variables were analysed using Chi-Square test for differences between variables. Results. All respondents reported having full or moderate knowledge of ART (23.3% and 63.3%, respectively) and 66.7% indicated that they felt the technique was useful for this population. However, only 50% of respondents used the technique regularly in their practice and five (16.7%) replied that they would never use it, even if a favourable evidence base for ART use in this population became available. The barriers to the introduction of ART to SCD are discussed and the need for training and further research highlighted. Conclusions. Barriers to the implementation of ART in practice were placement of the restoration under difficult conditions and the dentist's pre-conception of the technique as being ‘lower quality dentistry'. Experts suggested that some of these barriers might be overcome by improving the evidence base in favour of the technique, specifically in the population with disability.

Minimal intervention dentistry: part 5. Atraumatic restorative treatment (ART) – a minimum intervention and minimally invasive approach for the management of dental caries

While originally developed in response to a need to provide effective restorative and preventive treatment in underserved communities where running water and electricity might not always be available, over the past two decades, the atraumatic restorative treatment (ART) approach has become a worldwide phenomenon; used not only in some of the poorest developing countries but also in some of the most wealthy. The ART approach involves the removal of infected dentine with hand-instruments followed by the placement of a restoration where the adjacent pits and fissures are sealed simultaneously using high viscosity glass-ionomer inserted under finger pressure. Reliable results can only be obtained if the treatment protocol, as described in this article, is closely followed. ART should be considered as a therapeutic option especially in children, anxious patients and those with special needs.

Is Atraumatic restorative treatment an option for restoring occlusoproximal caries lesions in primary teeth? A systematic review and meta‐analysis

Atraumatic restorative treatment (ART) has demonstrated good longevity when used for single-surface restorations, but lower success rates are reported for occlusoproximal surfaces. This systematic review and meta-analysis aimed to verify the pooled success rate of occlusoproximal ART restorations in primary teeth considering the outcomes: longevity, pulp damage, or caries lesion progression. Literature searching was carried out on the studies reporting clinical trials indexed in PubMed and in English language, comprising the outcomes. A meta-analysis was undertaken considering the results from reviewed studies. An initial search resulted in 126 articles, and three of them were finally selected. The main reasons for excluding articles were the absence of control group, as amalgam, composite resin, or compomer restorations to be compared with ART (hand excavation + high-viscous GIC). The pooled estimate (odds ratio; 95% confidence interval) for ART approach success was 1.04 (0.65-1.66). Atraumatic restorative treatment restorations performed with high-viscous GIC present similar survival/success rates to conventional approach using composite resin or amalgam for occlusoproximal restorations in primary teeth and can be suggested as a good option for occlusoproximal cavities in primary molars. In addition, further randomized controlled clinical investigations concerning occlusoproximal restorations in primary teeth are still necessary.

Atraumatic Restorative Treatment in permanent molars: a systematic review

Aim: This paper presents a systematic review of studies published within the last 10 years on Atraumatic Restorative Treatment (ART) in permanent molars. Methods: A systematic search was carried out in the MEDLINE and PubMed databases from April 1st 2001 to December 31st 2010 using the term “atraumatic restorative treatment” and in the LILACS database using the term “tratamento restaurador atraumatico”. The selection of publications was based on the following criteria: texts written in English, Spanish or Portuguese; presence of an abstract; and investigation of clinical aspects related to ART in permanent molars. Results: The analysis of abstracts led to the selection of 26 studies. Recent clinical studies on ART in permanent molars of children, adolescents and young adults mainly address the survival of restorations through a comparison between caries removal methods and restorative materials. The publications report a survival success rate of ART restorations ranging from 30 to 100% in permanent molars, which is similar to that reported for treatments employing conventional methods and materials. The success rate of ART sealants ranged from 6.2 to 98.5%. The number of studies reporting on the retention and caries preventive effect of ART sealants was small. Conclusions: This systematic review revealed high survival rates for single-surface ART restorations in permanent molars and lower success rates for multiple-surface restorations. Clinical studies conducted with children, adolescents and young adults demonstrate a reliable clinical performance of single-surface and multi-surface ART restorations for 3-year and 2-year periods, respectively. However, long-term clinical studies are scarce and most of them focus on one-surface cavities. The survival rates observed, especially for single-surface restorations, confirm the potential of the ART approach for restoring and saving permanent molars. More clinical studies are required on the retention and caries preventive effect of ART sealants.

Two-year evaluation of the atraumatic restorative treatment approach in primary molars class I and II restorations

Atraumatic restorative treatment (ART) has the advantages of reducing pain and fear and of being more cost-effective than the traditional approach. The aim of this study was to investigate the survival of ART class I and II restorations in primary molars at 2 years. The sample consisted of 190 restorations and placed in 155 children 6-7 years old of both genders. The treatment was performed by two final-year dental students. All patients were treated in a completely supine position on tables available in the schools. The restorations were evaluated at 1, 12, and 24 months. The best results were found for class I in each period of follow-up. After 1 month, the success of class I restorations was 94.6% and class II restorations 70.1%. After 12 months, the success rate was 50.6% for class I and 15.2% for class II. The most frequent failure characteristics were totally or partially lost and gross marginal defect. The rate of success of restorations using the ART approach was significantly lower for class II.