Atraumatic restorative treatment (ART): a three-year clinical study in Malawi--comparison of conventional amalgam and ART restorations. The atraumatic restorative treatment (ART) approach to restoring primary teeth in a standard dental clinic. Is ART really atraumatic? Survival of glass ionomer restorations placed in primary molars using atraumatic restorative treatment (ART) and conventional cavity preparations: 2-year results. Effectiveness of ART and traditional amalgam approach in restoring single-surface cavities in posterior teeth of permanent dentitions in school children after 6.3 years. Amalgam and ART restorations in children: a controlled clinical trial Survival Rate of Atraumatic Restorative Treatment (ART) Restorations Using a Glass Ionomer Bilayer Technique with a Nanofilled Coating: A Bi-center Randomized Clinical Trial. Effectiveness of Glass-Ionomer (ART) and Amalgam Restorations in the Deciduous Dentition: Results after 3 Years Effectiveness of Three Minimal Intervention Approaches for Managing Dental Caries: Survival of Restorations after 2 Years The longevity of different restorations in primary teeth. Survival rates of two atraumatic restorative treatment (ART) types in occlusal carious permanent teeth after two years. Clinical Investigation of Two Glass–Ionomer Restoratives Used with the Atraumatic Restorative Treatment Approach in China: Two–Years Results Two-year survival of ART restorations placed in elderly patients: A randomised controlled clinical trial. Comparison of atraumatic restorative treatment and conventional restorative procedures in a hospital clinic: evaluation after 30 months. Survival of ART and Amalgam Restorations in Permanent Teeth of Children after 6.3 Years An atraumatic restorative treatment (ART) technique: evaluation after one year. A prospective randomised clinical trial of one bis-GMA-based and two ormocer-based composite restorative systems in class II cavities: three-year results.
OBJECTIVE This study compares the quality of class I restorations  made with the atraumatic restorative treatment ( ART ) technique and conventional class I amalgam restorations . METHODS The study was carried out among secondary school students in Mzuzu , Malawi . First-year students in 1987 who needed at least two class I restorations were selected . Based on a split-mouth design , each participant received both ART and conventional restorations . The 89 pairs of class I cavities were divided r and omly into two groups , since two different cermet ionomer cement ( CIC ) filling material s were used . Impressions of the restorations and subsequent models were made shortly after restoration , after six months , one year , two years , and three years . The quality of the restorations was determined on the models following the US Public Health Service criteria . Bulk fracture , contour , marginal integrity , and surface texture of the restorations were recorded and evaluated separately . Survival rates were determined by the result ant score of all criteria . RESULTS Though conventional amalgam restorations performed better on all criteria , this difference was significant only for the contour criterion . The survival rates of ART restorations after three years ( 81.0 % ) were lower than those of amalgam restorations ( 90.4 % ) ( P=.067 ) . CONCLUSIONS The quality of ART class I restorations is competitive with that of conventional amalgam restorations OBJECTIVES The aims of this study are to assess the feasibility of the  Atraumatic Restorative Treatment ( ART ) approach in primary teeth and to compare the ART approach with traditional amalgam restorations in primary molars . METHODS This study was conducted in a paediatric dentistry clinic in Kuwait between April 1999 and December 2001 . The ART and amalgam restorations were placed r and omly on comparable pairs of primary molars , if available . In addition , the ART approach was used for other primary teeth that had no pulpal involvement and no perceived pain before treatment . The restorations were assessed by both the ART evaluation criteria and USPHS criteria in August-September 2000 and in August-December 2001 . The mean follow-up period for the restorations was 8.3 months in the first assessment ( 2000 ) and 22 months in the second assessment ( 2001 ) . The assessment was possible for 35 children ( mean age = 5.7 years ) , 18 of whom had comparable pairs ( n = 35 pairs ) of restorations in their primary molars . In addition , 48 other ART restorations  were assessed in 2000 and 42 in 2001 . RESULTS In a 2-year follow-up , 89.6 % of all ART restorations were considered successful . The failure rate of the comparable pairs of ART and amalgam restorations was 5.7 % . There was no significant difference in success rate between ART and amalgam techniques . CONCLUSIONS Based on a 2-year follow-up evaluation , the class I ART restorations seemed to have a high success rate , indicating the appropriateness of the ART approach in primary teeth Atraumatic restorative treatment ( ART ) is an approach to the management of carious lesions that uses only h and instruments to remove carious tissue and to restore the tooth involved . The name ART implies that the approach is atraumatic to both the patient and the tooth . This study set out to evaluate whether ART is atraumatic in terms of both patient discomfort and tooth tissue conservation .  Three hundred and fifty-nine patients were divided in two groups : one group was treated with h and instruments and the other with rotary equipment . Each patient received two restorations : one using amalgam and one using glass ionomer as the restorative material , placed without the use of anaesthesia . Less discomfort was reported with the ART approach compared to conventional restorations made using rotary instruments and amalgam . Moreover , preparations with h and instruments were smaller than those produced with rotary instruments . Reported discomfort was associated with the size of the preparation , although the influence of the operator on both criteria was considerable . A patient effect was also observed since patients who reported discomfort during the first treatment were more likely to report discomfort after the second treatment . In conclusion , the choice of the term " ART " as an atraumatic procedure is defensible OBJECTIVE To compare the survival of  glass ionomer cement ( GIC ) restorations placed in a dental clinic setting using both the atraumatic restorative treatment ( ART ) approach with h and instruments , and conventional cavity preparation with rotary instruments . METHOD AND MATERIAL S Two encapsulated high-strength conventional GICs ( Fuji IX GP , Ketac-Molar Aplicap ) were placed in 82 Class I and 53 Class II preparations and one encapsulated non-gamma 2 amalgam alloy ( GK-amalgam ) was placed in 32 Class I preparations , in the primary molars of 60 Chinese children with a mean age of 7.40 + /- 1.24 ( SD ) years . Thus , 9 treatment groups were formed . RESULTS After two years , there were no significant survival differences found among 7 of the 9 treatment groups ( p = 0.99 ) . However , two groups comprising Fuji IX GP and Ketac-Molar Aplicap placed in Class II cavities prepared using the ART approach showed significantly lower restoration survivals ( p < 0.001 ) . Only 3 of the 72 initially sealed fissures adjacent to the restorations appeared to retain any GIC material . CONCLUSIONS In a clinic setting , both the ART h and instrument and conventional rotary instrument methods were equally suitable for high Class I restoration survival , but not for Class II restoration survival where the conventional cavity preparation method was preferable OBJECTIVES The Atraumatic Restorative Treatment ( ART ) approach was compared with the traditional amalgam ( TA ) approach in order to test their appropriateness to complement a preventive and educational school oral health programme in Syria . METHODS Using a parallel group design , 370 and 311 grade 2 children were r and omly assigned to the ART and the TA group respectively . Eight dentists placed 1117  single- and multiple-surface restorations .  A modified actuarial method was used to estimate survival curves . The jackknife method was applied to calculate the st and ard error in the cumulative survival percentages . RESULTS A statistically significant difference in cumulative survival percentages between single-surface non-occlusal ART and comparable amalgam restorations was observed after 4.3 , 5.3 and 6.3 years . The survival of single-surface non-occlusal  ART  posterior restorations ( 80.2 + /- 4.9 % ) was statistically significantly higher than that of occlusal posterior ART restorations ( 64.8 + /- 3.9 % ) at evaluation year 6.3 . There was no statistically significant difference observed between survival percentages of large ( 55.8 + /- 10 % ) and that of small ( 69.2 + /- 4.6 % ) single-surface posterior ART restorations after 6.3 years . There was an operator effect observed for single-surface ART and comparable amalgam restorations . Secondary caries was observed in 2.3 % of single-surface ART restorations and in 3.7 % of single-surface amalgam restorations during the 6.3 year observation period . CONCLUSIONS The ART approach provided higher survival percentages for single-surface restorations than the TA approach over 6.3 years and is therefore appropriate for use in school oral health programmes . Secondary caries was only a minor reason for ART restorations to fail . An operator effect was observed for both treatment approaches Objectives The aims of this study were to compare 2-year cumulative survival rates of  amalgam and atraumatic restorative treatment ( ART ) restorations in primary molars and to investigate the determinants of the survival rate of restorations . Material s and methods A controlled clinical trial using a parallel group design was carried out on 258 children aged 6–7 years old , allocated to two treatment groups : conventional restorative treatment using amalgam and ART using high-viscosity glass ionomer . A total of 364 amalgam restorations and 386 ART restorations were placed by three pedodontists in 126 and 158 children , respectively , and were evaluated after 0.5 , 1 , and 2 years . Restorations were placed in vital primary molars with neither pain nor signs of pulp involvement . The survival analysis was conducted using the proportional hazard rate regression model with frailty correction . Results The 2-year cumulative survival rates for all amalgam ( 77.3 % ) and ART ( 73.5 % ) restorations were not statistically significantly different , but there was an effect of “ type of surface ” ( single/multiple ) and “ cavity filling time ” on the survival rates . Both amalgam and ART single-surface restorations had higher survival rates than multiple-surface restorations of the same material . Secondary caries was responsible for 36 and 38 % of failures in amalgam and ART restorations , respectively . Mean time for restoring all type of cavities with amalgam and ART restorations was 13.6 and 13.7 min , respectively . Conclusions Amalgam and ART restorations presented similar survival rates over a 2-year period for all , single-surface , and multiple-surface restorations . Clinical relevance In the cause of finding alternatives to amalgam , ART restorations using high-viscosity glass ionomer might be a suitable option for managing cavitated dentine carious lesions in vital primary molars PURPOSE The high-viscosity consistency of glass ionomer cement ( GIC ) contributes to its inappropriate adaptation , while the material 's premature exposure to humidity decreases its mechanical properties . This study 's purpose s were to : ( 1 ) investigate approximal atraumatic restorative treatment ( ART ) restorations ' survival in primary molars using two different insertion techniques and two surface protection material s ; and ( 2 ) compare the results of cities where treatments were performed . METHODS A total of 389 six- to seven-year-olds were selected from two cities in Brazil and r and omly assigned into four groups : ( 1 ) ART restorations plus petroleum jelly ( PJ ) ; ( 2 ) bilayer-ART restorations plus PJ ; ( 3 ) ART restorations plus nanofilled coating for GIC ( NC ) ; ( 4 ) bilayer-ART restorations plus NC . Restorations were evaluated after one , six , 12 , 18 , and 24 months . Kaplan-Meier survival analysis , log-rank test , and Cox regression analysis were performed . RESULTS Restorations ' cumulative survival was 46.4 percent . There was a higher survival of bilayer-ART restorations ( P=0.03 ) . No difference was observed between surface protection material s ( P=0.57 ) . Restorations made in Barueri were almost 2.5-fold more likely to survive than those from Recife ( P<0.001 ) . CONCLUSIONS The bilayer technique improves approximal ART restorations ' survival in primary molars . The nanofilled coating does not influence restorations ' survival rate , and the city where treatments were performed influences restoration survival This study compared the survival of restorations produced through the atraumatic restorative treatment ( ART ) approach using glass-ionomer with those produced through the traditional approach using amalgam ( MTA ) in deciduous dentitions over a period of 3 years . Using a parallel group design , 835 grade 1 children , aged 6–7 years , participated . A total of 482 children were treated through the ART and 353 children through the MTA approach .  Eight dentists produced a total of 1,891 single- and multiple-surface restorations . After 3 years , 22.1 % of the restorations were lost for evaluation . There was a statistically significant difference in the combined survival of all single- and multiple-surface restorations between the two approaches in favour of the ART approach ( p = 0.04 ) . The study revealed a 3-year cumulative survival percentage of single-surface ART and MTA restorations of 86.1 and 79.6 % , respectively . The difference was statistically significant ( p = 0.03 ) . The main reasons for both single-surface ART and MTA restorations to fail was ‘ restoration missing ’ followed by ‘ gross marginal defect ’ . The 3-year cumulative survival percentages of multiple-surface ART and MTA restorations were 48.7 and 42.9 % , respectively . The difference was not statistically significant ( p > 0.05 ) . The 3-year survival percentages of single- and multiple- surface ART and MTA restorations varied widely amongst the 8 operators with an operator effect ( p = 0.001 ) for multiple-surface MTA restorations . It can be concluded that the ART approach using glass-ionomer yielded better results in treating dentinal lesions in deciduous teeth than did the traditional approach using amalgam after 3 years . It is recommended to select the ART approach to complement the other activities of the school oral health programme The present study was aim ed at comparing the effectiveness of three minimally invasive restorative treatment approaches for dentinal lesions in occlusal surfaces . The approaches tested comprised a conventional and a modified – conventional treatment and a modified Atraumatic Restorative Treatment ( ART ) . The conventional approach was performed in a university dental clinic whilst the modified – conventional , employing portable equipment , and the modified ART , using h and instruments and a caries removal solution ( Caridex ® ) , were carried out in the field . Using the split – mouth design , 430 matched contralateral pairs of occlusal cavities were restored with amalgam or glass – ionomers in permanent molars of 152 school children by one dental therapist . The restorations were assessed using a modified USPHS – Ryge criteria . After 2 years , the cumulative survival percentages for occlusal amalgam and glass – ionomer restorations were 92 and 96 % , respectively . The survival of all restorations in the conventional , modified – conventional and the modified ART group was 96 , 96 and 91 % , respectively . The survival of occlusal amalgam and glass – ionomer restorations per treatment group was as follows : 94 and 99 % , respectively ( conventional group ) ; 95 and 97 % , respectively ( modified – conventional group ) , and 89 and 93 % , respectively ( modified ART group ) . The differences in survival percentage between restorations with amalgam and glass – ionomer , and between the three restorative treatment approaches were not statistically significant . In countries facing scarcity in re sources for dental care , ART seems a promising restorative approach to occlusal caries in posterior teeth . However , a longer clinical observation period is required to substantiate this initial conclusion BACKGROUND AND AIM This paper review s three published papers and adds results from a fourth study which aim ed to determine which restorative material would be the best alternative(s ) to amalgam ( AM )  in primary teeth . DESIGN All studies had a practice -based design and were part of the routine treatment of children and adolescents . The clinicians were assigned which material s to use in a r and omised matter in the first three studies which lasted for 7 - 8 years . In the fourth study conducted 4 years after the initial studies , the clinicians were free to select the restorative material s. RESULTS AND CONCLUSIONS Resin modified glass ionomer ( RMGI ) and compomer ( COM ) restorations showed similar longevity compared with AM , whereas conventional GI restorations showed significantly shorter longevity . The studies indicated that the ' new and improved ' material s based on in vitro tests did not always show enhanced clinical properties . In the last study , where clinicians freely selected the restorative material s they used in their practice s , seven used COM , one used conventional GI material s and one used a combination of the two types of material OBJECTIVE To compare survival rates of Atraumatic Restorative Treatment ( ART ) restorations placed with and without conditioners in occlusal cariouspermanent teeth after two years . MATERIAL AND METHODS The study was an experimental study among children , mean age 13.1 + /- 3.0 years . Two types of ART restorations  were r and omly placed on 186 occlusal carious permanent teeth on contralateral sides using split mouth design . Ethical clearance to conduct the study was obtained from the UI/UCH Review Committee . ART was performed using GC Fuji IX GP and teeth that were conditioned with GC Dentine Conditioner .  Time taken to place restorations and average material cost were recorded . Follow-up of subjects to evaluate integrity of restorations was conducted at 6 monthly intervals by one independent examiner . Proportions and percentages were generated ; student t-test was used to compare means . Cumulative survival rates were determined by the coded scores and st and ard criteria for evaluating ART restorations . RESULTS There was no significant difference in the mean time for placing ART restorations  with or without conditioners and in the cumulative survival rates of both treatment types after 2 years ( p > 0.05 ) . CONCLUSION ART restorations placed without tooth conditioners can achieve similar result as those placed with conditioners Objective : To compare the clinical performance of two glass – ionomer cements , ChemFlex ( Dentsply DeTrey ) and Fuji IX GP ( GC ) , when used with the atraumatic restorative treatment ( ART ) approach in China . Methods : Eighty – nine school children aged between 6 and 14 years who had bilateral matched pairs of carious posterior teeth were included . A split – mouth design was used in which the two material s were r and omly placed on contralateral sides . The performance of the restorations was assessed directly and also indirectly from die – stone replicas at baseline and after 6 , 12 , and 24 months . Results : The 24–month cumulative survival rates of ART restorations  in the primary teeth were 93 and 90 % for the ChemFlex and Fuji IX GP class I restorations , respectively , while 40 and 46 % of class II restorations placed with the respective material s were satisfactory . In the permanent dentition , only class I restorations were involved and the cumulative survival rates were 95 and 96 % for ChemFlex and Fuji IX GP . For the primary teeth after 24 months , net mean occlusal wear was 87 µm for ChemFlex and 85 µm for Fuji IX GP . The occlusal wear in the permanent teeth was 75 µm for ChemFlex and 79 µm for Fuji IX GP . Conclusion : The clinical performance of both material s over a 24–month period was similar and the survival rates of class I ART restorations  in both primary and permanent teeth were high OBJECTIVES Older dentate adults are a high caries risk group who could potentially benefit from the use of the atraumatic restorative treatment ( ART ) . This study aim ed to compare the survival of ART and a conventional restorative technique ( CT ) using rotary instruments and a resin-modified glass-ionomer for restoring carious lesions as part of a preventive and restorative programme for older adults after 2 years . METHODS In this r and omised controlled clinical trial , 99 independently living adults ( 65 - 90 years ) with carious lesions were r and omly allocated to receive either ART or conventional restorations . The survival of restorations was assessed by an independent and blinded examiner 6 months , 1 year and 2 years after restoration placement . RESULTS Ninety-six ( 67.6 % ) and 121 ( 76.6 % ) restorations were assessed in the ART and CT groups , respectively , after 2 years . The cumulative restoration survival percentages after 2 years were 85.4 % in the ART and 90.9 % in the CT group . No statistically significant between group differences were detected ( p=0.2050 , logistic regression analysis ) . CONCLUSIONS In terms of restoration survival , ART was as effective as a conventional restorative approach to treat older adults after 2 years . This technique could be a useful tool to provide dental care for older adults particularly in the non- clinical setting . ( TRIAL REGISTRATION NUMBER IS RCT N 76299321 ) . CLINICAL SIGNIFICANCE The results of this study show that ART presented survival rates similar to conventional restorations in older adults . ART appears to be a cost-effective way to provide dental care to elderly patients , particularly in out of surgery facilities , such as nursing homes OBJECTIVE The purpose of this study was to evaluate two glass-ionomer cements placed in the occlusal surfaces of permanent molar teeth , using two cavity preparation methods . METHOD AND MATERIAL S Three dentists placed 149 restorations for 68 patients in a hospital clinic .  Atraumatic restorative treatment or conventional cavity preparation methods were used for two encapsulated , high-strength conventional glass-ionomer cements : Fuji IX GP and Ketac-Molar . Non-gamma 2 amalgam alloy was used in conventional preparations for comparison . RESULTS The restorative procedures were uneventful , but cavity preparations made with atraumatic restorative treatment h and instruments took approximately twice as long as did conventional rotary instrumentation . After 30 months , only one glass-ionomer cement restoration had failed . Both glass-ionomer cements showed high early losses of sealant material , but caries was not detected in the exposed fissures . Both glass-ionomer cements also showed relatively high restoration wear . At 30 months , the mean cumulative net occlusal wear was 119 + /- 12 mm for Fuji IX GP and 96 + /- 13 mm for Ketac-Molar ; the difference was not statistically significant . Color matching improved significantly by 6 months ; there was no significant difference in color match between the two glass-ionomer cements by 12 months . Minor surface tarnishing and marginal discrepancies were present in the amalgam restorations and increased with time . CONCLUSION The occlusal restorations performed satisfactorily over periods of up to 30 months . However , the continued deterioration of the cements requires longer-term studies to be undertaken The null hypothesis tested was that there is no difference in the survival percentages of all restorations placed through the Atraumatic Restorative Treatment ( ART ) approach , with high-viscosity glass ionomer , and those produced through the traditional approach , with amalgam ( TA ) , in the permanent dentitions of children after 6.3 years . Using a parallel group design , we r and omly assigned a total of 370 children , aged 6 to 9 years , to the ART group and 311 children , also aged 6 to 9 years , to the TA group . Eight dentists placed a total of 1117 single- and multiple-surface restorations . The cumulative survival percentages  for ART glass-ionomer restorations were statistically significantly higher than those of amalgam restorations at all time intervals except the first ( p ≤ 0.044 ) . After 6.3 years , the cumulative survival percentages of ART and amalgam restorations were 66.1 % ( SE = 3.1 % ) and 57.0 % ( SE = 3.3 % ) , respectively . We concluded that the restorations produced with the ART approach , with high-viscosity glass ionomer , survived longer than those produced with the traditional approach , with amalgam , in the permanent teeth of young children Extraction is the most common dental treatment provided for people in rural and suburban areas in many less-industrialised countries . By comparison , restorative care is rarely provided . In order to improve such situations , a treatment technique has been developed based only on h and excavation of carious lesions and using glass-ionomer cement as a filling material and a sealant . This Atraumatic Restorative Treatment ( ART ) technique follows the concept of minimal intervention and does not require electrically driven equipment . This paper reports on the longevity of fillings and sealants placed using the technique under field conditions in rural Thail and .  Dental caries was treated using the ART technique in one village , whilst the population in a second village received restorative care ( amalgam fillings ) through mobile dental units . A third village was the control . After one year , 79 per cent of single surface ART fillings and 55 per cent of ART fillings of greater than one surface placed in deciduous teeth were judged successful . The success rate of ART fillings  in the permanent dentition ( mainly single surface fillings ) was 93 per cent and the retention rate for sealants was 78 per cent . Children were pleased at having received treatment by this technique and showed little fear . The ART technique is a promising caries treatment procedure for use in rural and sub-urban areas in less-industrialised countries OBJECTIVES Ormocer composites , consisting of a silicon-based polymer , have been developed recently as a tooth-coloured restorative material . The purpose of this prospect i ve r and omised clinical trial was to evaluate the performance of two small-particle hybrid ormocer-based restorative systems ( AD , Admira/Admira Bond , VOCO ; DE , Definite/Etch & Prime 3.0 , Dentsply ) and one small-particle hybrid bis-GMA-based composite restorative system ( TC , Tetric-Ceram/Syntac , Ivoclar-Vivadent ) in occlusal stress-bearing restorations . METHODS One hundred and twenty-eight occlusal-proximal restorations ( 44 AD , 43 DE and 41 TC ) were placed according to the manufacturer 's instructions in thirty-two adult patients . Their clinical performance was scored according to the USPHS criteria and evaluation of bite-wing radiographs . RESULTS After 3 years , four AD , five DE and four TC restorations had failed due to fracture or marginal gap formation . Surface roughness improved significantly when compared to the baseline in AD and TC ( Friedman test , p<0.05 ) during the first year but returned to baseline values after 3 years . DE had a significant tendency towards discolouration ( p<0.05 ) . Bite-wing radiographs showed two AD and one TC restorations with internal porosities . ANOVA showed that larger restorations ( > or = 3 surfaces ) showed significantly more degradation than smaller ones . CONCLUSIONS In a group of class II restorations , there was no significant difference in failures after 3 years between ormocer-based and bis-GMA-based restorative systems
Studies investigating restorations placed in the primary dentition showed no significant differences between the groups after 12 and 24 months .
In the permanent dentition , the longevity of ART restorations is equal to or greater than that of equivalent amalgam restorations for up to 6.3 years and is site-dependent .
No difference was observed in primary teeth .
The aim was to report on the longevity of  restorations placed using the atraumatic restorative treatment ( ART ) approach  compared with that of  equivalent placed amalgam restorations .