Twenty-five-year atraumatic restorative treatment (ART) approach: a comprehensive overview

Introduction of the ART approach in Egypt: intentions, clinical effects and perceived barriers. A cohort study

AIM

To evaluate the effect of the introduction of ART in Upper-Egypt and assess the participating General Dental Practitioners' (GDPs) opinions, intentions, expectations and experiences regarding barriers related to using ART.

METHODS

Thirty-five GDPs were selected and trained on ART for 5 days. Knowledge assessments were done immediately before and after the training, using a questionnaire. Regular evaluation and assessment data were collected after 6 and 12 months, through questionnaires with closed and open-ended questions. Clinical data in government and private clinics were collected, using clinical record-forms. GDPs' opinions, intentions, expectations and experiences regarding barriers related to ART were assessed, through questionnaires, at the start and after 1 year. The control group comprised 35 other GPDs.

RESULTS

At the start, the most GDPs were intended to make ART restorations. After 1 year 65% and 97% actually made ART restorations in their government and private clinics, respectively. The barriers faced by the GDPs to making ART restorations in the government clinics were mainly unavailability of suitable restoration material and of hand instruments. After 1 year post-training, ART restorations constituted 41% of the total plastic restorations made. Finally, the majority of GDPs believe that ART is suitable for use in their government and private practices.

CONCLUSION

All participating GDPs intended to introduce ART in their government and private clinics. They successfully introduced this technique in their private clinics but, owing to the unavailability of suitable instruments and restoration materials, failed to do so in the government clinics. They liked the simplicity of the technique.

Survival rate of approximal-ART restorations using a two-layer technique for glass ionomer insertion

OBJECTIVE

Good survival rates (SR) have been reported for occlusal-atraumatic restorative treatment (ART) restorations but not for approximal-ART restorations. The high-viscosity consistency of the glass ionomer cement (GIC) may lead to its incorrect adaptation into the cavity and thus to failure of the restoration. Because the use of a flowable GIC layer seemed to improve its adaptation in approximal restorations in vitro, we evaluated whether the use of an intermediate flowable GIC layer would improve the SR of approximal-ART restorations.

METHODS

A total of 208 children (6-7 years old) with at least one occluso-proximal carious lesion in a primary molar were selected and randomly allocated to two groups: G1, conventional technique, one-layer GIC (powder/liquid ratio 1:1); and G2, two-layer technique, consisting of a first layer of GIC with a flowable consistency (powder/liquid ratio 1:2) and a second layer of a regular consistency. Restorations were made by final-year students and evaluated after 1, 6, 12 and 18 months. Restoration survival was evaluated using Kaplan-Meier survival and logrank test. Poisson regression analyses (α = 5) were used to verify the influence of factors such as insertion technique, restoration surface and operators.

RESULTS

The overall SR of the restorations after 18 months was 68 %. There was no difference in SR between the techniques, neither did the other factors influence the SR.

CONCLUSIONS

Over 18 months, the use of an intermediate flowable GIC layer in approximal-ART restorations does not improve the restoration survival.

CLINICAL RELEVANCE

This study suggests that the two-layer technique is not the answer for increasing approximal-ART restoration longevity.