Atraumatic Restorative Treatment Research Articles

Survival Analysis and Cost Effectiveness of Silver Modified Atraumatic Restorative Treatment (SMART) and ART Occlusal Restorations in Primary Molars: a randomized controlled trial

ObjectiveTo evaluate and compare the clinical performance and cost effectiveness of Silver Modified Atraumatic Restorative Treatment (SMART) and Atraumatic Restorative Treatment (ART) restorations in primary molars over 12 months follow up period. Materials and methodsSixty-seven children, aged 5-9 years old having at least one asymptomatic primary molar with active caries, were randomly assigned to either the test arm (SMART) or the control arm (ART). Clinical performance was assessed after 6 and 12-months using the modified United States Public Health Services criteria. The trial was registered at Clinical Trial.gov with a registration number (NCT03881020). Treatment time for each restoration was recorded, Kaplan-Meier survival analysis and the log-rank test were performed (p<0.05) and cost effectiveness was measured at the end of the study. ResultsBoth techniques showed comparable clinical performance and the mean survival time was 11.8 and 11.6 months for SMART and ART restorations respectively with no detected significant differences (p=0.416). Mean treatment time for SMART restorations (7.8 min.), however, was significantly lower than ART (15 min.) (p < 0.001). SMART technique, also, showed statistically significant lower mean total cost per restoration (p <0.001). ConclusionsThough SMART and ART have comparable clinical performance and survival in single-surface occlusal restorations in primary molars, SMART is less time consuming and more cost effective. Clinical significanceUsing SMART technique could change paradigms in caries management. Being a patient friendly and cost-effective approach, it could be adopted as a superior treatment option when dealing with young children, those with behavioral and medical challenges and for promoting access to oral care among the underprivileged.

Morphological, chemical and antimicrobial analysis of glass ionomer cements used for ART in posterior primary teethGlass ionomer cements (GICs) have been gaining prominence as material for atraumatic restorative treatment (ART) due to their acceptable ph

Glass ionomer cements (GICs) have been gaining prominence as material for atraumatic restorative treatment (ART) due to their acceptable physicochemical and biological properties. Objective: To analyze the surface morphology, chemical constitution, and antimicrobial action of GICs used for ART in posterior primary teeth. Material and methods: The tested materials were Vitro Molar®, Ketac Cem Easymix® and Riva Self Cure®. For the structural and chemical analysis, polyethylene tubes with an internal diameter of 3 mm and 3 mm in length were prepared, filled, and then transferred to a chamber with 95% relative humidity and a temperature of 37oC. The surface morphology of the tested materials was examined by scanning electron microscopy (SEM) and main components were investigated by energy-dispersive X-ray microanalysis. For the antimicrobial efficacy analyses, strains of Streptococcus mutans (ATCC 27853) were used. Petri dishes with brain heart infusion agar (BHIA) were inoculated with the microbial suspensions and three cavities were made in each agar plate and filled with one of the GICs. The plates were pre-incubated for 1 hour at room temperature and then incubated at 37oC for 24 to 48 hours. The inhibition zone around each well was recorded in mm. Results: SEM revealed irregular and rough external surface. Cracking was not observed. The main constituents were found to be aluminum, silicon, sodium, and fluoride. Barium was only observed in Vitro Molar®, while lanthanum was only observed in Ketac Cem Easymix®. Elemental mapping of the outer surface revealed high concentration of aluminum and silicon. Inhibition halos were only observed in Riva Self Cure®. Conclusion: The GICs presented irregular outer surfaces and similar chemical elements. Only Riva Self Cure® showed antibacterial action against the S. mutans.

Effectiveness of 38% Silver Diamine Fluoride Application along with Atraumatic Restorative Treatment for Arresting Caries in Permanent Teeth When Compared to Atraumatic Restorative Treatment in Adults-Study Protocol for a Randomized Controlled Trial.

Dental caries in the adult population that require preventive and therapeutic treatment are generally neglected in rural communities. The determination of the effectiveness of the application of 38% silver diamine fluoride (SDF) in arresting caries lesions when combined with atraumatic restorative treatment (ART) is very important, as it serves as a preventive and restorative procedure to regain the function of the permanent dentition. The assessment of optimal SDF application with ART, in comparison with ART alone, in managing cavitated carious lesions in a pragmatic setting, is the need of the hour to recommend optimal dental care, especially in rural settings which have minimal access to comprehensive dental care. The clinical trial will enrol 220 adults (18-65 years) with cavitated carious lesions attending the Amrita School of Dentistry in the Ernakulam district, India. This study is a randomized, controlled trial with a 1:1 allocation ratio in two parallel groups. Study arm 1 will receive 38% SDF application and ART, and study arm 2 will receive ART only. A digital radiograph will be taken immediately after restoration (baseline) as well as at the end of the 6th month for evaluation of caries arrest. The assessment of the survival of the restoration will be done on the 7th day, 30th day, and at the end of the 6th month. The final analysis would include both the tooth and person levels. This trial adheres to the principles of the Declaration of Helsinki and the guidelines of the Indian Council of Medical Research (ICMR). This study protocol has been approved by the Institutional Review Board. This trial has been registered prospectively with the Clinical Trial Registry of India (Registration No: CTRI/2021/12/038816).

Essential Medicines for Dental Caries: Cost-Effectiveness of ART and SDF

Abstract Background Untreated tooth decay (caries) is the most common global health condition and one of the largest preventable disease burdens for society. It concerns both children and adults, particularly in low resource settings whereout of pocket expenditures for oral care often cause catastrophic health expenditures. The 2021 WHO Oral Health Resolution emphasized the relevance of developing so-called “Best Buys” for oral health. The purpose of this study was to identify the cost-effectiveness of Atraumatic Restorative Treatment (ART) and Silver Diamine Fluoride (SDF) as potential treatments to reduce the caries burden worldwide. Methods Leaning on WHO CHOICE methodology, evidence scoping and an expert consensus were facilitated to extract model input parameters which were then fed into cost-effectiveness-analyses (CEA) for ART and SDF. The cost-effectiveness of the interventions was expressed as Cost per DALY averted. Results The evidence scoping revealed relevant, information on the effectiveness and costs of ART and SDF. The CEA identified both ART and SDF to be potentially cost-efficient treatment strategies in settings with limited resources. SDF was found to provide a cost-efficient treatment alternative in settings where the comparably larger (human) resource requirements for ART cannot be met. Conclusions The findings suggest that ART and SDF represent potentially cost-efficient strategies to reduce the caries burden in settings with limited resources. While ART has previously been proposed as part of WHO’s essential package of oral care, SDF could provide a comparably inexpensive treatment alternative. Key messages • Untreated tooth decay (caries) is the most common global health condition and one of the largest preventable disease burdens for society. • The CEA identified both ART and SDF to be potentially cost-efficient treatment strategies in settings with limited resources.

Minimal Intervention Dentistry (MID) mainstream or unconventional option? Study exploring the impact of COVID-19 on paediatric dentists’ views and practices of MID for managing carious primary teeth in children across the United Kingdom and European Union

PurposeTo explore the techniques used to manage carious primary teeth during the COVID-19 pandemic by paediatric dentists and dentists with a special interest in paediatric dentistry (DwSI) who are members of the British Society of Paediatric Dentistry (BSPD) and the European Academy of Paediatric Dentistry (EAPD), and their views on the use of minimal intervention dentistry (MID) in children prior to, during and post the COVID era.MethodsA total of 212 paediatric dentists and DwSI completed an online questionnaire. Six MID techniques were explored: fissure sealants, resin infiltration, Hall Technique (HT), 38% silver diamine fluoride (SDF), atraumatic restorative treatment (ART), stepwise removal and selective caries removal.ResultsThe majority were specialists (26%) followed by clinical academics (23.1%) working mainly in university teaching hospitals (46.2%). Routine dental treatment for children with carious primary teeth was provided by the majority (92.5%) during the pandemic. HT (96%) and 38% SDF (65.7%) were the most commonly used techniques among the BSPD members whereas conventional restoration of non-selective caries removal and pulp therapy remained the most widely used technique among the EAPD members (66.2%). Most of the MID techniques were used as a treatment option (48.1%) rather than a choice (43.4%), with most of these choices having been affected by the patient’s behaviour (82.5%). More than one thirds (39.2%) of the participants were reluctant to adopt MID after the pandemic. Several barriers such as lack of teaching and confidence as well as perceived lack of evidence were identified.ConclusionA range of MID techniques is practiced broadly by a sample of paediatric dentists and DwSI across the United Kingdom (U.K) and European Union (E.U). The majority of clinicians are willing to continue using these techniques going forward after COVID restrictions are lifted. The pandemic served as an opportunity for many dentists to become familiar with various MID practices, such as SDF, which has been already established some time ago.

CHANGES IN PARENTAL SATISFACTION AND ORAL HEALTH-RELATED QUALITY OF LIFE OF PRESCHOOL CHILDREN AFTER RECEIVING ATRAUMATIC RESTORATIVE TREATMENT WITH OR WITHOUT PRIOR SILVER DIAMINE FLUORIDE APPLICATION.

To investigate the short-term and long-term changes in parental satisfaction and oral health-related quality of life (OHRQoL) of preschool children after receiving atraumatic restorative treatment (ART) with or without prior silver diamine fluoride (SDF) application. In a randomized controlled trial, preschool children with cavitated dentine caries lesions in their primary teeth were randomly assigned into two groups to receive either application of SDF solution or placebo (tonic water) on the caries lesions 10 weeks before receiving ART restorations. The information on parental satisfaction and OHRQoL of the children were collected through self-completed questionnaires at baseline, the 6-month and the 24-month follow-up. A five-point scale, from 1 (very dissatisfied) to 5 (very satisfied), was used by parents to indicate their satisfaction with their child's dental conditions. A higher parental satisfaction score indicates that parents were more satisfied with their child's dental condition. In addition, the Chinese version of Early Childhood Oral Health Impact Scale (ECOHIS) was adopted to assess the children's OHRQoL, and a higher ECOHIS score indicates greater negative impacts of oral health on the child's OHRQoL. A total of 194 children participated in this study, with 101 and 93 children receiving SDF and placebo application before ART restorations, respectively. After placement of ART restorations, at 6-month and 24-month follow-up, parental satisfaction scores with their child's dental health status were significantly higher compared with those at baseline (P <.001) indicating the parents were more satisfied at follow-ups. Regarding OHRQoL, no statistically significant changes were found in the child impact section (CIS), family impact section (FIS) and total ECOHIS scores in both study groups at the 6-month follow-up. In contrast, at the 24-month follow-up, the CIS (P = .025) and total ECOHIS scores (P = .015) of the children in the control group were significantly higher than those at baseline (greater negative impacts), but not the FIS score. In this study, after one-off placement of ART restorations irrespective of prior SDF application, short-term and long-term parental satisfaction with their child's dental health status was improved, but not the children's OHRQoL.

RECESSIVE DYSTROPHIC EPIDERMOLYSIS BULLOSA: A DENTAL CARE PROTOCOL TO IMPROVEMENT ON LIFE QUALITY

A 9-year-old female patient with recessive dystrophic epidermolysis bullosa (EB) complained of ulcerated intraoral lesions. Ulcerations in the oral mucosa, lip, and tongue; difficulty in moving the tongue; and carious lesions were observed. A panoramic radiograph was requested. Prior to restorative dental care, the use of mouthwash with 0.12% chlorhexidine 2 × /day was recommended. Bepantol lip balm was supposed to be applied on the lips. Atraumatic restorative treatment was performed using CIV-Ketac Molar. After the procedures, topical oral use of dexamethasone, nystatin, and artificial saliva gel were recommended. Prophylaxis, topical application of fluoride, and indication of sealant were performed after 4 months, and for 2 months, low-power laser therapy (100 mW, 2 J/cm², 20 seconds) was performed. There was a considerable improvement in the condition and the patient is still being monitored.

Arresting active carious dentine lesions and quality of life among a group of preschool children

The aim of this clinical trial was to investigate the efficacy of 38% silver diamine fluoride (SDF) in the arrestment of dentine caries in primary molars of preschool children. The time required for treatment, anxiety, adverse events, parental aesthetic perception and oral health related to quality of life (OHRQoL) were also assessed. Sixty, 3–5 years old children, were assigned randomly to SDF test group or atraumatic restorative treatment (ART) control group. The ICDAS criteria determined the presence of caries and its activity. The treatment time was recorded, and the child’s anxiety was evaluated using the facial image scale before and after treatment. The caregivers were asked about any adverse events and the questions regarding esthetic perception were addressed to them. The OHRQoL was evaluated through the A-ECOHIS questionnaire before and 3 months after treatment. The overall success rates of SDF and ART after 12 months were 86.7% and 80%, respectively. There was no significant difference in arrestment of caries between SDF and ART (P value &gt; 0.05). The time required to treat with SDF was significantly shorter (p &lt; 0.001). The percentage of adverse events revealed no significant difference (p=0.604).

Clinical and Microbiological Evaluation of a Chlorhexidine-Modified Glass Ionomer Cement (GIC-CHX) Restoration Placed Using the Atraumatic Restorative Treatment (ART) Technique.

The aims of this study were to investigate the clinical effectiveness and patient acceptability of a modified glass ionomer cement placed using the atraumatic restorative treatment (ART) technique to treat root caries, and to carry out microbiological analysis of the restored sites. Two clinically visible root surface carious lesions per participant were restored using ART. One was restored with commercial glass ionomer cement (GIC) (ChemFil® Superior, DENTSPLY, Konstonz, Germany) which acted as the control. The other carious root lesion was restored with the same GIC modified with 5% chlorhexidine digluconate (GIC-CHX; test). Patient acceptability and restoration survival rate were evaluated at baseline and after 6 months. Plaque and saliva samples around the test and control restorations were collected, and microbiological analysis for selected bacterial and fungal viability were completed at baseline, and after 1, 3, and 6 months. In total, 52 restorations were placed using GIC and GIC-CHX in 26 participants; 1 patient was lost to follow-up. After reviewing the restorations during their baseline appointments, participants indicated that they were satisfied with the appearance of the restorations (n = 25, 96%) and did not feel anxious during the procedure (n = 24, 92%). Forty-eight percent (n = 12) of the GIC-CHX restorations were continuous with the existing anatomic form as opposed to six for the GIC restorations (24%), a difference which was statistically significant (p = 0.036). There was no statistically significant reduction in the mean count of the tested microorganisms in plaque samples for either type of restorations after 1, 3, or 6 months. Restoration of carious root surfaces with GIC-CHX resulted in higher survival rates than the control GIC. ART using GIC-CHX may therefore be a viable approach for use in outreach dental services to restore root surface carious lesions where dental services are not readily available, and for older people and special needs groups.

Evaluation of Caries Removal Efficacy Using BRIX 3000 and Atraumatic Restorative Treatment in Primary Molars: A Clinical Comparative Study

The aim of the present study was to compare and evaluate the efficacy of two minimally invasive methods in the removal of infected carious dentin in primary molars. Eighty primary molars with class I occlusal caries involving dentin were selected and allocated to either of the two groups using convenient sampling. Group A (n = 40) caries were excavated using BRIX 3000 and in Group B (n = 40) atraumatic restorative treatment (ART) caries were excavated using hand instruments only. In both groups, caries removal efficacy was evaluated clinically using caries detection dye (Sable and Sleek), and the patient's discomfort level was noted using the Wong-Baker faces pain rating scale (WBFPS). The results indicated that BRIX 3000 was effective in the removal of caries from primary molars with a significant difference. While there was no statistically significant difference seen in pain perception on caries excavation using both the methods. Although, a mild discomfort was noted in Group B. Comparing the two minimally invasive techniques, the new chemomechanical solution (BRIX 3000) was an effective method for the removal of caries from primary molars. So, it can be considered an alternative to the conventional caries removal method in treating pediatric dental patients. BRIX 3000 gel is effective in the removal of caries in children who are anxious and apprehensive as it is a noninvasive method of treatment in the pediatric age group.

Glass ionomer polyalkenoate cements and related materials: past, present and future.

The aim of this article is to review the development of glass ionomer cements (GICs) over the last 40 years and look critically at both their clinical advantages and disadvantages. Primarily, it will explore the future development of both GICs and related ion-releasing materials in relation to improved mechanical properties, capability to prevent secondary caries and promoting remineralisation of hard carious dentine left after minimal cavity preparation procedures, including atraumatic restorative treatment. This article will also introduce new materials with a focus on degradable fluorine-containing glass fillers, including alkasite glasses and fluorine-containing bioactive glasses, that have the capability to raise the pH and promote remineralisation with the potential for fluorapatite formation.

Challenges and opportunities for oral health care professionals in COVID-19 pandemic

Abstract Introduction: The World Health Organization announced a pandemic crisis when the virus was isolated in all of its worldwide regions. Being highly transmissible, this novel coronavirus disease-2019, also known as COVID-19, has spread fast all over the world. The outbreak was declared a Public Health Emergency of International Concern. Human-to-human transmission happens mainly through the respiratory tract of droplets and close contact transmission. Dental practitioners are at higher risk of transmission as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has the potential to spread through droplets and aerosols from infected individuals in dental clinics and hospitals. Aim: The aim of the study is to highlight the potential sources of COVID-19 infection in oral health-care services. Materials and Methods: An electronic search was made of the PubMed (MEDLINE), ScienceDirect, and Google Scholar databases. Articles were identified by the searches which were checked based on title first, then by abstract or keywords with “COVID-19,” “SARS-CoV-2,” “Dentist,” and “health-care workers,” for articles involving studies and review articles published in English language only and relevant to the objectives of our review article. Results and Discussion: The majority of the emergency cases required endodontic treatment during the COVID-19 pandemic. Atraumatic restorative treatment and interim therapeutic restoration are alternative approaches to prevent infectious aerosol during dental procedures in dental, community, or hospital settings. Conclusion: Oral healthcare professionals are at higher risk of contracting COVID-19 infection. Risk of COVID-19 can be reduced by appropriate techniques and practice in dental settings.

Comparison of the effectiveness of 38% silver diamine fluoride and atraumatic restorative treatment for treating dental caries in a school setting: A randomized clinical trial.

Dental caries is an infectious microbial disease of the teeth, affecting mostly young children. It is caused by the interplay of numerous factors that are more common in susceptible and lower-income groups. Therefore, there is a dire need for a simple yet effective method of treating dental caries. The aim of the study was to compare the effectiveness of 38% silver diamine fluoride (SDF) and atraumatic restorative treatment (ART) in the treatment of dental caries in a school setting. A randomized clinical trial (RCT) using a parallel-group design was conducted among schoolchildren aged 6-12 years. Oral hygiene practices and sugar exposure were recorded at baseline. In the schoolchildren, 190 dental caries lesions were restored using 38% SDF (group 1) or ART (group 2). The χ 2 test and the Kaplan-Meier survival analysis were done to assess the 2 treatment modalities. The RCT was carried out and reported in accordance with the CONSORT (Consolidated Standards of Reporting Trials) checklist. A total of 190 children fulfilled the inclusion criteria and the mean age of the study population was 9.3 ±1.3 years. The majority of the participants brushed their teeth once daily, using a toothbrush, rinsed their mouth after meals and had optimal sugar exposure. In measuring the outcome of the interventions after 9 months, 58.9% of the participants from group 1 had their restorations intact as compared to 47.8% in group 2, and this was found to be statistically significant (p = 0.004). The survival analysis using the log rank test showed 38% SDF to be better in comparison with ART. This study indicated that SDF was better at arresting caries, and hence it can be considered a viable treatment option in areas with limited access to oral healthcare.

Silver Modified Atraumatic Restorative Technique: A Way towards "SMART" Pediatric Dentistry during the COVID-19 Pandemic.

As the coronavirus disease-2019 pandemic outbreak continues to be a global public health concern, dentists should seek means to provide oral health care with minimal risk. To meet the recommendations of the Center for Disease Control, alternative non-aerosol generating techniques have been proposed to minimize the risk of disease transmission to patients and dental healthcare personnel. Among recent materials, silver diammine fluoride (SDF) has been shown to be effective in preventing and arresting caries. This along with an atraumatic restorative treatment with glass ionomer cements (GICs) makes it a potentially attractive adjunctive therapy for caries management in pediatric patients. In this technique, SDF is applied over carious tissue and the lesion is restored with auto-polymerizing GIC. This review article aims to provide a practical background and clinical guide for the application of silver-modified atraumatic restorative technique (SMART) as a safe way to provide dental services to children during the pandemic.

Silver diamine fluoride, atraumatic restorations, and oral health-related quality of life in children aged 5\u201313 years: results from the CariedAway school-based cluster randomized trial

ObjectiveSilver diamine fluoride (SDF) is a non-surgical treatment for the arrest and prevention of dental caries that results in irreversible black staining of dental decay. The objective of this study was to evaluate the short-term impact of SDF treatment on oral health-related quality of life (OHRQoL) relative to a standard package of glass ionomer sealants and atraumatic restorative treatment (ART) in children aged 5–13 years.MethodsCariedAway is a pragmatic, longitudinal, cluster-randomized non-inferiority trial of non-surgical interventions for caries. Secondary study outcomes included OHRQoL and academic performance. Oral health-related quality of life was measured at each study visit using the Child Oral Health Impact Profile. Change in OHRQoL was assessed using linear regression and non-inferiority was determined using t tests.Results160 children with an average age of 8.7 years completed quality of life assessments. Untreated decay at baseline (approximately 25%) was associated with significantly worse OHRQoL and treatment in both groups resulted in incremental improvement: children receiving SDF improved their OHRQoL scores from 16.44 (SD = 11.12) to 14.62 (SD = 11.90), and those receiving traditional sealants and atraumatic restorations slightly improved from 16.65 (SD = 10.56) to 16.47 (SD = 11.09). Quality of life in children receiving silver diamine fluoride was non-inferior to those receiving sealants and ART at least 6 months post-treatment (mean difference = 1.85, 95% CI = − 2.10, 5.80), and change in OHRQoL did not depend on the severity of baseline decay.ConclusionsOHRQoL is related to untreated dental caries, and observed changes following SDF treatment were non-inferior relative to standard preventive therapies.

Examination of caries‐affected dentin and composite‐resin interface after different caries removal methods: A scanning electron microscope study

To evaluate the caries-affected dentin and composite-resin interface with scanning electron microscopy (SEM) after different caries removal methods in human molars. Twelve with extensive approximal caries lesions that did not reach the pulp and five caries-free molars (control group [CG]) were used. Carious teeth were divided into four experimental groups: Atraumatic Restorative Treatment (ART), Rotary Instrument (RI), Photo-Ablation, and Papain-Based Enzymatic Gel (Brix 3000®, Brix, Brazil). Class II slot cavities were prepared with RI in the CG. Then all caries removed teeth and control groups were restored (All-Bond Universal, BISCO, USA; Clearfil MajestyES-2, Kuraray, Japan). Specimens were prepared for SEM examinations. Hybrid layer (HL) thicknesses were measured using ImageJ programme. Gap measurements were performed with micro-CT. Data were analyzed with ANOVA and posthoc Dunnett's t-tests (p <.05). The highest HL thickness was found in Photo-Ablation Group, and a statistically significant difference was observed among the control and experimental groups (p < .05). The lowest HL thickness was measured in the Enzymatic Gel Group. In terms of internal gap formation, CG showed statistically significant differences compared to the other groups (p < .05). The highest internal gap was observed in RI Group, while the lowest gap was observed in CG. According to SEM, a uniform HL and resin tags were seen in the CG. Smear layer, irregular HL, and gap formation were observed in ART Group. In RI Group, nonuniform HL formation and resin tags were observed. In Photo-Ablation Group, a uniform HL without smear layer and internal gap was observed. In the Enzymatic Gel Group, both opened dentinal tubules, and melting-like formations were observed on the dentin surface. Especially melting-like formations were observed in peritubular dentin. It can be concluded that all caries removal methods except rotary instrumentation were conservative methods, which preserve more healthy dental tissues. RESEARCH HIGHLIGHTS: Among the caries removal procedures, the photo-ablation caries removal method stands out with the highest hybrid layer (HL) thickness and the lowest internal gap formation. Despite having the lowest HL thickness, the enzymatic gel method can be advantageous for patients requesting an alternative caries removal instead of a rotary instrument.

Acceptability of atraumatic restorative treatment and Hall Technique among children, parents, and general dental practitioners: a systematic review and meta-analysis.

This systematic review aimed to evaluate the acceptance level of atraumatic restorative treatment (ART) and Hall Technique (HT) among children, parents, and general dental practitioners. The study was registered in the PROSPERO database. Articles published between January 1960 and January 2021 were searched in 11 online databases and six textbooks according to PRISMA guidelines. Fifteen studies were chosen for qualitative and quantitative analyses. Among them, five studies focused on ART, seven studies on HT, and the remaining three studies compared both ART and HT. The children, parents, and general dental practitioners' acceptance were estimated using the DerSimonian-Laird random--effects method based on both single-arm and two-arm approaches. The risks of bias were evaluated using Cochrane RoB 2, ROBINS-1, NOS, and JBI assessment tools, while evidence levels were determined using OCEBM. Subgroup analysis and meta-regression were conducted to assess the effect of different evaluation methods on the acceptance rates of ART and HT among children and parents. The acceptance rates of ART among children, parents and general dental practitioners were 90.1%, 95.7%, and 67.7%, respectively, whilst the acceptance rates of HT were 88.3%, 85.7%, and 81.8%, respectively. Two-arm meta-analysis revealed no significant difference (P > .05) between the acceptance of HT and ART among children and parents, respectively. Subgroup analysis showed that using questionnaire-based evaluation had a higher (P < .05) acceptance value than using face scale-based evaluation. Both ART and HT are considered well--accepted among children, parents, and general dental practitioners, although general dental practitioners showed a slightly lower level of acceptance. A standardized evaluation tool for assessing acceptance level should be established for better comparison among published articles. Future well-designed studies are warranted to verify the validity of the present review.

Knowledge transfer on the use of Atraumatic Restorative Treatment: A mixed-methods study: Knowledge transfer on the use of ART

Knowledge transfer on the use of Atraumatic Restorative Treatment: A mixed-methods study: Knowledge transfer on the use of ART

Atraumatic restorative treatment as a minimum invasive approach in pediatric dentistry - A literature review

Introduction: Atraumatic restorative treatment (ART) is a minimally invasive approach of dental caries lesions that is indicated in primary and permanent dentition. Objectives: To investigate based on a review of the scientific literature, the use of ART as a minimally invasive treatment approach in Pediatric Dentistry. Methodology: A literature review was conducted to verify the evidence regarding Atraumatic restorative treatment as a minimally invasive treatment in pediatric dental patients. Searches were performed in the following electronic health databases: Pubmed, Scientific Electronic Library Online (SciELO), and Latin American and Caribbean Literature on Health Sciences (LILACS), using the following search terms: minimally invasive treatment and Atraumatic restorative treatment and dental caries. The inclusion criteria for the studies were epidemiological (cross-sectional, case-control, cohort, clinical trials) or qualitative studies that evaluated the use of ART in children's dental care; papers published in English, Portuguese or Spanish; and the publication date of the studies was limited to the last five years (2017 to 2022). Data were presented through a description of the included studies after a complete reading. Results: Twenty-three studies were identified and after the inclusion criteria were applied, eight studies were included in the full analysis. From the data analysis, it was observed that ART is a great alternative for the caries control and treatment of the lesions, contributing to the reduction of the patient's anxiety levels in relation to conventional restorative dental treatment, as it minimizes the fear of children regarding dental caries treatment. ART is a viable alternative to conventional treatments that are associated with local anesthetics, drills, and composite resin. In addition, the materials used in ART showed good results when compared to conventional restorative techniques in relation to the survival of the restoration. Conclusion: The use of the ART technique is an effective option for minimally invasive treatment for children, mainly young children, and especially nowadays due to the minimization of aerosols production for dental treatments due to virus transmission during pandemic period. In addition, ART is a comfortable and easy technique for both patient and dental health professional.

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.