The impact of the ART approach on the treatment profile in a mobile dental system (MDS) in South Africa

Short-term Clinical and Microbiological Performance of Resin-modified Glass Ionomer Cement Containing Chlorhexidine for Atraumatic Restorative Treatment

Aim

This study evaluated the short-term clinical and microbiological performance of resin-modified glass ionomer cement (RM-GIC) cement containing chlorhexidine (CHX) for atraumatic restorative treatment (ART) in primary teeth.

Materials and methods

The clinical trial was conducted in 36 children that received ART in primary molars either with GIC (group I, n = 18) or GIC containing 1.25% CHX (group II, n = 18). The survival rate of restorations was checked 7 days, 3, and 6 months after their application when saliva and biofilm were collected for microbiological assessment of mutans streptococci (MS) counts. Data were analyzed using the Kruskal-Wallis/Mann-Whitney U tests for clinical analysis and microbiological evaluations (p < 0.05).

Results

The survival rate of restorations was similar comparing groups I with II. Microbiological analysis showed a significant reduction in MS levels 7 days after the treatment in both saliva and biofilm of children treated with RM-GIC containing CHX (group II); however, MS counts at 3 and 6 months did not differ from the initial counts.

Conclusion

A total of 1.25% CHX improved the microbiological properties of GIC in the short term without impairing the clinical performance of ART restorations.

Clinical significance

Glass ionomer cement (GIC) containing CHX could be an alternative in ART procedures with the objective of promoting an additional antimicrobial effect, which is interesting for children with high counts of MS during the initial phase of adaptation to dental treatment.

How to cite this article

da Silva ME, de Sena MD, Colombo NH, et al. Short-term Clinical and Microbiological Performance of Resin-modified Glass Ionomer Cement Containing Chlorhexidine for Atraumatic Restorative Treatment. Int J Clin Pediatr Dent 2023;16(S-1):S27-S32.

Survival percentages of atraumatic restorative treatment (ART) restorations and sealants in posterior teeth: an updated systematic review and meta-analysis

OBJECTIVE

The aim of the present study is to update the results of two previous meta-analyses, published in 2006 and 2012, on the survival percentages of atraumatic restorative treatment (ART) restorations and ART sealants. The current meta-analysis includes Chinese publications not investigated before.

MATERIALS AND METHODS

Until February 2017, six databases were interrogated (two English, one Portuguese, one Spanish and two Chinese). Using six exclusion criteria, a group of six independent reviewers selected 43 publications from a total of 1958 potentially relevant studies retrieved. Confidence intervals and/or standard errors were calculated and the heterogeneity variance of the survival rates was estimated.

RESULTS

The survival percentages and standard errors of single-surface and multiple-surface ART restorations in primary posterior teeth over the first 2 years were 94.3% (± 1.5) and 65.4% (± 3.9), respectively; for single-surface ART restorations in permanent posterior teeth over the first 3 years, they were 87.1% (± 3.2); and for multiple-surface ART restorations in permanent posterior teeth over the first 5 years, they were 77% (± 9.0). The mean annual dentine-carious-lesion-failure percentages in previously sealed pits and fissures using ART sealants in permanent posterior teeth over the first 3 and 5 years were 0.9 and 1.9%, respectively.

CONCLUSIONS

ART single-surface restorations presented high survival percentages in both primary and permanent posterior teeth, whilst ART multiple-surface restorations presented lower survival percentages. ART sealants presented a high-caries-preventive effect.

CLINICAL RELEVANCE

ART is an effective evidence-based option for treating and preventing carious lesions in primary and permanent posterior teeth.

WHO Global Consultation on Public Health Intervention against Early Childhood Caries

Early Childhood Caries (ECC) is prevalent around the world, but in particular the disease is growing rapidly in low- and middle-income countries in parallel with changing diet and lifestyles. In many countries, ECC is often left untreated, a condition which leads to pain and adversely affects general health, growth and development, and quality of life of children, their families and their communities. Importantly, ECC is also a global public health burden, medically, socially and economically. In many countries, a substantial number of children require general anaesthesia for the treatment of caries in their primary teeth (usually extractions), and this has considerable cost and social implications. A WHO Global Consultation with oral health experts on "Public Health Intervention against Early Childhood Caries" was held on 26-28 January 2016 in Bangkok (Thailand) to identify public health solutions and to highlight their applicability to low- and middle-income countries. After a 3-day consultation, participants agreed on specific recommendations for further action. National health authorities should develop strategies and implement interventions aimed at preventing and controlling ECC. These should align with existing international initiatives such as the Sixtieth World Health Assembly Resolution WHA 60.17 Oral health: action plan for promotion and integrated disease prevention, WHO Guideline on Sugars and WHO breastfeeding recommendation. ECC prevention and control interventions should be integrated into existing primary healthcare systems. WHO public health principles must be considered when tackling the effect of social determinants in ECC. Initiatives aimed at modifying behaviour should focus on families and communities. The involvement of communities in health promotion, and population-directed and individual fluoride administration for the prevention and control of ECC is essential. Surveillance and research, including cost-effectiveness studies, should be conducted to evaluate interventions aimed at preventing ECC in different population groups.

Anxiety Levels among Five-Year-Old Children Undergoing ART Restoration- A Cross-Sectional Study

INTRODUCTION

Atraumatic Restorative Treatment (ART) involves manually excavating the carious part of the tooth and restoring the prepared cavity with chemically adhesive restorative material [Glass Ionomer Cement (GIC)] and it may induce and/or impact the dental anxiety in children. It is well established that ART procedure is less anxiety producing when compared with other restorative procedures using dental drill.

AIM

The aim of this study was to evaluate the anxiety levels among five-year-old children undergoing ART restoration in I.T.S. Dental College, Greater Noida, India.

MATERIALS AND METHODS

A sample of 50, five-year-old children visiting the Outpatient Department (OPD) of ITS Dental College, Greater Noida was selected for ART treatment using Fuji IX GIC. Modified Venham Anxiety Scale based on their behaviour and heart rate of the children were measured and recorded before, during and after the ART procedure. Heart rate was measured using Radial Pulse examination method. Chi-square test was used and tests were conducted using IBM SPSS software (ver.20.0; IBM, Chicago, IL, USA).

RESULTS

Before the ART treatment, heart rates and Modified Venham Anxiety Scores of majority of children were higher than that after the treatment. A p-value was statistically significant (0.028 and 0.048 respectively) for association of gender with heart rate and Modified Venham's score before the ART treatment. No statistically significant relation was found between the variables during and after the ART treatment.

CONCLUSION

The level of anxiety for ART treatment in children was higher before the treatment than that during and after the treatment. There is a correlation between the gender of children and their level of anxiety for ART treatment.

Effectiveness of Single-surface ART Restorations in the Permanent Dentition: A Meta-analysis

Over the past few years, there has been an increase in the number of studies reporting on various aspects of the Atraumatic Restorative Treatment (ART) approach. Five randomized clinical trials in which ART restorations with glass ionomers were compared with amalgam restorations in permanent teeth for a maximum period of 3 yrs constituted the database. This meta-analysis divided the publications into ‘early’ (1987–1992) and ‘late’ (1995-) studies on the basis of improvements in the approach. The analysis showed that, in the ‘early’ studies, single-surface amalgam restorations survived statistically significantly longer than comparable ART restorations after 1, 2, and 3 yrs. This trend did not continue into the late group of studies; no statistically significant difference between the 2 types of restorations was found. Based on the available data, it appears that there is no difference in survival results between single-surface ART restorations and amalgam restorations in permanent teeth over the first 3 yrs.

One-year follow-up of Atraumatic Restorative Treatment(ART) for dental caries in children undergoing oncohematological treatment: a pragmatic trial

Background

The oral condition in children undergoing oncohematological treatment can have a negative impact on the course of disease. Little is known about survival of tooth restorations in these patients. The aim of this study was to evaluate the longevity of restorations and sealants performed by Atraumatic Restoration Treatment (ART) in patients undergoing oncohematological treatment.

Methods

ART single surface restorations and sealants were performed in the experimental group (E), which comprised children (2–13 years old) undergoing oncohematological treatment, and in the control group (C), in which patients did not undergo such treatment. The same examiner evaluated the ART at 1, 3, 6 and 12 months after preparation, using the same criteria for restorations and sealants. ART was successful if the sealant or restoration did not need a repair in the follow-up assessment. Descriptive, bivariate and Cox’s proportional hazard analyses were performed at a significance level of 5 %.

Results

The two groups, one including 24 children (E) and the other 14 children (C), received 101 and 52 ART procedures, respectively. The success rates were 95.0 % (E) and 100 % (C) at 1 month (P = 0.233); 81.2 % (E) and 92.3 % (C) at 3 months (P = 0.009); 72.2 % (E) and 80.8 % (C) at 6 months (P = 0.050) and 48.5 % (E) and 73.1 % (C) at 12 months (P = 0.001). The final Cox’s regression model for occurrence of ART failure needing repair did not show differences between groups (E: OR = 1.6, 95 % CI 0.8–2.9); primary teeth had a shorter survival than permanent teeth (OR = 2.1, 95 % CI 1.2–3.7).

Conclusions

Oncohematological treatment did not interfere with the longevity of ART restorations and sealants, which suggests the potential use of this technique in children undergoing chemotherapy.

Trial registration

Brazilian Clinical Trials Registry (REBEC) RBR-2c3c52. Registered 5 June 2014. http://www.ensaiosclinicos.gov.br/rg/RBR-2c3c52/

Electronic supplementary material

The online version of this article (doi:10.1186/s12903-015-0110-y) contains supplementary material, which is available to authorized users.

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

BACKGROUND

Atraumatic restorative treatment (ART) has demonstrated good longevity when used for single-surface restorations, but lower success rates are reported for occlusoproximal surfaces.

AIM

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.

DESIGN

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.

RESULTS

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).

CONCLUSION

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.

The atraumatic restorative treatment (ART) strategy in Mexico: two-years follow up of ART sealants and restorations

BACKGROUND

The massive use of preventive measures in Mexico has resulted in a large decline in dental caries over the past two decades. There does however remain a largely unmet need for restorative treatment. This paper describes the steps leading up to the adoption of a strategy, as part of general health policy, to use Atraumatic Restorative Treatment (ART) within the Mexican public health service as a means of addressing this. The objective was to evaluate ART restorations and sealants placed in primary and permanent teeth in schoolchildren from deprived areas over a period of 2 years.

METHODS

18 Dentists from 13 municipalities in 6 states with the lowest human development index treated 304, 6- to 13-year-old schoolchildren with ART sealants and ART restorations (single-surfaces) on the school compounds. Ketac Molar Easymix was the filling material used. ART procedures were evaluated according to the ART assessment criteria after 1 and 2 years, by 7 calibrated evaluators. Survival rates were estimated, using the PHREG Model with frailty correction.

RESULTS

The 2-year cumulative survival rates of fully and partially retained ART sealants were 73.1% (primary teeth) and 48.8% (permanent teeth). The dentine carious lesion failure rates of ART sealants in primary and permanent teeth over the 2-year period were 0% and 2.5%, respectively. The 2-year cumulative survival rates of single-surface ART restorations in primary and permanent teeth were 74% and 80.9%, respectively. Secondary carious lesion development occurred in 6 restored primary teeth (2.1%) and in one restored permanent tooth (1.3%). All restorations placed in primary teeth in one state survived, whilst those in one of the 5 remaining states failed statistically significantly more than those in the other 4.

CONCLUSIONS

The ART procedures were of substantial quality and had prevented to a large extent the development of new dentine carious lesions in these children from socio-economically deprived areas.

Rural dentistry: Is it an imagination or obligation in community dental health education?

During the past two decades, epidemiologic studies in less developed or developing countries have clearly reported that caries prevalence shows the distinctive patterns over the word, even though it is declining in many developed countries. Due to huge rural districts where arrival is problematic and ineffective dental and preventive care centers in most suburban districts, there has been significant difference between the different parts of the communities to provide dental care service, and unfortunately the sole preventive measure has been limited with the advising of using the tooth brush and paste. The problems are usually arisen not only from the inadequacy of trained personnel but also from the absence of an effective economic and pragmatic system which aims to effectively dispense the dental service to all over the country. For this reason, the basic aim of dental care should be to carry out the many dental services in a multidisciplinary manner within the first appointment and to serve the people at their own homes and/or districts. Clearly, the needed multidisciplinary dental care system can lead to a new educational doctrine for rural dental practice. This versatile and practical training program based on specific perceived needs of a specific population(s) could need a new educational program. So, various preventive and/or restorative procedures included by this new doctrine could be named as "rural dentistry." In this review, with the examples from the many in vivo studies carried out under rural conditions over the world, the probable practices in this specific dental doctrine have generally been exemplified.

Six-month evaluation of ART one-surface restorations in a community with high caries experience in Brazil

The aim of this study to evaluate the success rate in one-surface ART restorations placed in permanent molars using a glass ionomer cement especially developed for ART in a community with high caries experience; to evaluate the operator influence on its success, post-operative sensitivity and technique acceptance by patients. Prior to placement of the restorations, the Gingival Bleeding Index, Visible Plaque Index, DMFT, dmft indices and treatment needed were assessed. One hundred and fifty five one-surface restorations were placed in permanent molars of school children, according to the WHO ART manual, 1997. After 6 months, the success rate was verified clinically and by slides. At baseline, the mean DMFT was 2.56 (±1.08) and the mean dmft, 2.53 (±2.33). Operators A and B have placed 102 and 53 ART restorations respectively. The mean time of placement was 16 minutes and 25 seconds to operator A and 14 minutes and 43 seconds to operator B. At 6-month follow up, 152 ART restorations were evaluated and 97.3% were assessed to be successful. Two restorations were excluded from the sample because the ART restorations were replaced by amalgam fillings. Only 4 restorations have failed, in which 2 due to caries, 1 due to fistula presence and the other because the restoration was lost. Four patients reported postoperative sensitivity. At this study period, ART treatment seems to be suitable for its purpose. Further evaluations are necessary to the new glass ionomer cements especially developed for ART technique provided good results at 6-month follow up in a community with high DMFT and dmft indices. The success rate for one-surface cavities in permanent molars was 97.3%, and the studied indices seemed to have no influence in this early evolution period.

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

Background

The atraumatic restorative treatment (ART) approach was born 25 years ago in Tanzania. It has evolved into an essential caries management concept for improving quality and access to oral care globally.

Results

Meta-analyses and systematic reviews have indicated that the high effectiveness of ART sealants using high-viscosity glass ionomers in carious lesion development prevention is not different from that of resin fissure sealants. ART using high-viscosity glass ionomer can safely be used to restore single-surface cavities both in primary and in permanent posterior teeth, but its quality in restoring multiple surfaces in primary posterior teeth cavities needs to be improved. Insufficient information is available regarding the quality of ART restorations in multiple surfaces in permanent anterior and posterior teeth. There appears to be no difference in the survival of single-surface high-viscosity glass-ionomer ART restorations and amalgam restorations.

Discussion

The use of ART results in smaller cavities and in high acceptance of preventive and restorative care by children. Because local anaesthesia is seldom needed and only hand instruments are used, ART is considered to be a promising approach for treating children suffering from early childhood caries. ART has been implemented in the public oral health services of a number of countries, and clearly, proper implementation requires the availability of sufficient stocks of good high-viscosity glass ionomers and sets of ART instruments right from the start. Textbooks including chapters on ART are available, and the concept is being included in graduate courses at dental schools in a number of countries. Recent development and testing of e-learning modules for distance learning has increasingly facilitated the distribution of ART information amongst professionals, thus enabling more people to benefit from ART. However, this development and further research require adequate funding, which is not always easily obtainable. The next major challenge is the continuation of care to the frail elderly, in which ART may play a part.

Conclusion

ART, as part of the Basic Package of Oral Care, is an important cornerstone for the development of global oral health and alleviating inequality in oral care.

Survival of atraumatic restorative treatment (ART) sealants and restorations: a meta-analysis

The purpose of this study is to perform a systematic investigation plus meta-analysis into survival of atraumatic restorative treatment (ART) sealants and restorations using high-viscosity glass ionomers and to compare the results with those from the 2005 ART meta-analysis. Until February 2010, four databases were searched. Two hundred four publications were found, and 66 reported on ART restorations or sealant survival. Based on five exclusion criteria, two independent reviewers selected the 29 publications that accounted for the meta-analysis. Confidence intervals (CI) and or standard errors were calculated and the heterogeneity variance of the survival rates was estimated. Location (school/clinic) was an independent variable. The survival rates of single-surface and multiple-surface ART restorations in primary teeth over the first 2 years were 93% (CI, 91-94%) and 62% (CI, 51-73%), respectively; for single-surface ART restorations in permanent teeth over the first 3 and 5 years it was 85% (CI, 77-91%) and 80% (CI, 76-83%), respectively and for multiple-surface ART restorations in permanent teeth over 1 year it was 86% (CI, 59-98%). The mean annual dentine lesion incidence rate, in pits and fissures previously sealed using ART, over the first 3 years was 1%. No location effect and no differences between the 2005 and 2010 survival rates of ART restorations and sealants were observed. The short-term survival rates of single-surface ART restorations in primary and permanent teeth, and the caries-preventive effect of ART sealants were high.

CLINICAL RELEVANCE

ART can safely be used in single-surface cavities in both primary and permanent teeth. ART sealants have a high caries preventive effect.

Systematic reviews, systematic error and the acquisition of clinical knowledge

BACKGROUND

Since its inception, evidence-based medicine and its application through systematic reviews, has been widely accepted. However, it has also been strongly criticised and resisted by some academic groups and clinicians. One of the main criticisms of evidence-based medicine is that it appears to claim to have unique access to absolute scientific truth and thus devalues and replaces other types of knowledge sources.

DISCUSSION

The various types of clinical knowledge sources are categorised on the basis of Kant's categories of knowledge acquisition, as being either 'analytic' or 'synthetic'. It is shown that these categories do not act in opposition but rather, depend upon each other. The unity of analysis and synthesis in knowledge acquisition is demonstrated during the process of systematic reviewing of clinical trials. Systematic reviews constitute comprehensive synthesis of clinical knowledge but depend upon plausible, analytical hypothesis development for the trials reviewed. The dangers of systematic error regarding the internal validity of acquired knowledge are highlighted on the basis of empirical evidence. It has been shown that the systematic review process reduces systematic error, thus ensuring high internal validity. It is argued that this process does not exclude other types of knowledge sources. Instead, amongst these other types it functions as an integrated element during the acquisition of clinical knowledge.

CONCLUSIONS

The acquisition of clinical knowledge is based on interaction between analysis and synthesis. Systematic reviews provide the highest form of synthetic knowledge acquisition in terms of achieving internal validity of results. In that capacity it informs the analytic knowledge of the clinician but does not replace it.

Clinical trials with Atraumatic Restorative Treatment (ART) in deciduos and permanent teeth

This paper presents a review of the literature on clinical trials with Atraumatic Restorative Treatment. The available scientific literature is encouraging in terms of management of dental caries by this approach, especially for one-surface lesions. The steps of ART are described and the crucial points highlighted. The incorporation of ART into primary health care services, as Family Health Program - PSF, was considered.

Physical-mechanical properties of glass ionomer cements indicated for atraumatic restorative treatment

BACKGROUND

This study evaluated mechanical properties of glass ionomer cements (GICs) used for atraumatic restorative treatment. Wear resistance, Knoop hardness (Kh), flexural (F(s)) and compressive strength (C(s)) were evaluated. The GICs used were Riva Self Cure (RVA), Fuji IX (FIX), Hi Dense (HD), Vitro Molar (VM), Maxxion R (MXR) and Ketac Molar Easymix (KME).

METHODS

Wear was evaluated after 1, 4, 63 and 365 days. Two-way ANOVA and Tukey post hoc tests (P = 0.05) analysed differences in wear of the GICs and the time effect. F(s), C(s), and Kh were analysed with one-way ANOVA.

RESULTS

The type of cement (p < 0.001) and the time (p < 0.001) had a significant effect on wear. In early-term wear and Kh, KME and FIX presented the best performance. In long-term wear, F(s) and C(s), KME, FIX and HD had the best performance. Strong explanatory power between F(s) and the Kh (r(2) = 0.85), C(s) and the Kh (r(2) = 0.82), long-term wear and F(s) of 24 h (r(2) = 0.79) were observed.

CONCLUSIONS

The data suggested that KME and FIX presented the best in vitro performance. HD showed good results except for early-term wear.

Utilization of the ART approach in a group of public oral health operators in South Africa: a 5-year longitudinal study

Background

A significant increase in the proportion of restorations to the number of tooth extractions was reported after the introduction of ART in an academic mobile dental service in South Africa. The changes were ascribed to its less threatening procedure. Based on these findings, ART was subsequently introduced into the public oral health service of Ekurhuleni district in the South African province of Gauteng. This article reports on the 5-year restorative treatment pattern of operators in the Ekurhuleni district, who adopted the ART approach into their daily dental practice.

Methods

Of the 21 trained operators, 11 had placed more than 10% of restorations using ART at year 1 and were evaluated after 5 years. Data, including number of restored and extracted teeth and type of restoration, were drawn from clinical records 4 months before, and up to 5 years after training. The restoration/extraction ratio (REX score) and the proportion of ART restorations to the total number of restorations were calculated. The paired sample t-test and linear regression analysis were applied.

Results

The mean percentage of ART restorations after 1 year was 24.0% (SE 7.2) and significantly increased annually to 42.7% (SE 9.2) after 5 years in permanent dentitions. In primary dentitions the mean percentage of ART restorations after 1 year was 80.6% (SE 4.9) and 72.6% (SE 8.8) after 5 years. The mean REX score before ART training was 0.08 (SE 0.03) and 0.07 (SE 0.04) for permanent and primary teeth, respectively and 0.11 (SE 0.03) and 0.17 (SE 0.05) after 5 years.

Conclusion

Five years after training, ART had been used consistently in this selected group of operators as the predominant restorative treatment used for primary teeth and showed a significant annual increase in permanent teeth. However, this change had not resulted in an increase in the REX score in both dentitions.

Atraumatic restorative treatment and dental anxiety in outpatients attending public oral health clinics in South Africa

OBJECTIVES

This study was undertaken to test the hypotheses that using the atraumatic restorative treatment (ART) approach results in lower patient anxiety and that lower anxiety leads to higher restoration/extraction ratios.

METHODS

The test group of dental operators (n = 9) was trained in ART The control group (n = 11) was not, and did not apply ART The Short Form of the Dental Subscale of the Children's Fear Survey Schedule (CFSS-SF) and Corah's Dental Anxiety Scale (DAS) were used to assess patient anxiety after ART (test group) and after traditional restorations (control group). The restoration/extraction ratio calculated for primary (children) and permanent dentitions (adults) per operator was based on 12-month treatment statistics. Dental anxiety assessments were analysed using ANOVA. Differences were compared using the t-test and corrected for confounding factors (ANCOVA). The Pearson correlation coefficient was used to measure the correlation between dental anxiety levels and restoration/extraction ratios.

RESULTS

The mean CFSS-SF score for test-group children was statistically significantly lower than for the control-group children. The mean DAS score for test-group adults was statistically significant lower than the control. No significant correlation was observed between dental anxiety level and restoration/extraction ratio per operator for both dentitions in both groups.

CONCLUSION

The first hypothesis was accepted; the second, rejected. Although dental anxiety scores were lower both in child and in adult patients treated by ART than in those who received traditional restorative treatments, this positive effect had not resulted in higher restoration/extraction ratios.

Six-year follow up of atraumatic restorative treatment restorations placed in Chinese school children

OBJECTIVES

This study aimed to evaluate the clinical performance of atraumatic restorative treatment (ART) restorations placed in school children in China over a 6-year period.

METHODS

This study was implemented in 1996 and 294 ART restorations were placed in 197 children aged 12-13 years by five assistant dentists in four schools. Standard ART procedures and instruments were used combined with a high-strength glass-ionomer restorative material. One examiner evaluated the restorations annually using the ART criteria while at 5 years an independent external examiner used US Public Health Service (USPHS) criteria.

RESULTS

Fifty-eight per cent of the restorations were followed for 6 years. At the 6-year evaluation examination, 76% and 59% of the small and large restorations respectively were present and were without major wear or defect (P < 0.01). Similar results were obtained when using the USPHS criteria. Results of a multilevel survival analysis show that the correlation between restoration failure and operator was small but failure of restorations placed in the same child was substantial. Net wear of the small and large restorations after 6 years were 176 and 172 microm respectively (P > 0.05).

CONCLUSION

The 6-year survival rate of the class I ART restorations in this study, especially the smaller ones, was satisfactory. This suggests that the ART approach can be used in the school setting to improve the oral health of large populations of underserved children.

The atraumatic restorative treatment (ART) approach for managing dental caries: a meta-analysis

The number of publications reporting on the survival of ART sealants and ART restorations has increased considerably in recent years. A systematic investigation of their longevity is therefore warranted. Based on three exclusion criteria, a literature search in the electronic libraries Pubmed and Medline revealed 28 eligible publications for inclusion in a meta-analysis. High mean survival rates for single-surface ART restorations using high-viscosity glass-ionomer in primary dentitions over 3 years were found (95% after 1 year to 86% after 3 years). These rates were statistically significantly higher than for those of multiple-surface ART restorations in primary dentitions (p<0.0001). High mean survival rates for single-surface ART restorations using high-viscosity glass-ionomer in permanent dentitions over 6 years were found (97% after 1 year to 72% after 6 years). The mean annual failure rates for single-surface ART restorations using high-viscosity glass-ionomer in primary and permanent dentitions and for multiple-surface ART restorations in primary dentitions are 4.7%, 4.7% and 17%, respectively. The number of studies reporting on the retention and caries preventive effect of ART sealants was low. It is concluded that single-surface ART restorations using high-viscosity glass-ionomer in both primary and permanent dentitions show high survival rates. Medium-viscosity glass-ionomer should not be used for ART restorations.

Influence of residual caries and cervical gaps on the survival rate of Class II glass ionomer restorations

AIM

To assess the influence of different variables on the survival of class II glass ionomer restorations a clinical study was carried out among 6-7 year old schoolchildren in and around Dar es Salaam, Tanzania.

METHODS

217 children were randomly divided into three groups. In the conventional group, Class-II cavities were excavated with burs, in the ART group they were excavated with hand instruments and in the Carisolv group excavation took place with a chemical solution and special blunt hand instruments. The preparations in all groups were restored with hand mixed glass ionomer cement (Fuji IX). Four operators were involved in the treatment phase. After restoration, residual caries and cervical gaps were assessed on bite-wings. The quality of the restorations was established and the survival rate determined in two subsequent evaluations.

RESULTS

195 children (90%) were present at the first evaluation which took place after 7 months and 194 (89%) were present at the second evaluation, after one year. At the first evaluation the survival rate of the ART-restorations was 38%, of the conventional restorations 50%, and of the Carisolv restorations 35%. Survival rates at the time of the second evaluation were 30%, 42% and 28% respectively. The differences between the three treatment groups were, however, not significant (p = 0.200 at t = 1 and p = 0.247 at t = 2). In the first evaluation 161 bitewings were available of the 195 restorations, while for the second evaluation 130 cases were available. There was no significant relation between residual caries and the success/failure rate (p = 0.140 at t = 1 and p = 0,201 at t = 2). Also cervical gaps appeared to have no relation with the failure rate (p = 0.057 at t = 1 and p = 0.833 at t = 2) However, together those variables have a significant influence on the survival rate (p = 0.025).

CONCLUSION

The combination of two variables (residual caries and cervical gaps) has considerable influence on the survival rate of class II glass ionomer restorations compared to each variable alone.

Residual caries and marginal integrity in relation to Class II glass ionomer restorations in primary molars

AIM

To assess the effectiveness of three treatment methods (ART, Carisolv(TM) and rotary instruments) in caries removal and sealing capability of hand-mixed glass ionomer in the management of proximal caries in deciduous molars.

METHODS

In a clinical study 217 dentally naïve children (age 7.5, SD 0.57) were randomly divided in three treatment groups and among 4 operators. Each child received one class II glass ionomer restoration. Immediately after restoration bitewings were made. The dependent variables were: residual caries and marginal adaptation. Independent variables were operator effect, child's behaviour and time to remove caries.

RESULTS

There was no statistical significant difference in residual caries between the three treatment methods (p < 0.05). In 33% of the cases a clear radiolucency underneath the restoration was visible on the bitewings. In 26% doubt existed on the presence of residual caries. A clear cervical gap was seen in 16% of the restorations, while in 18% signs of cervical gaps were less obvious. Between the four operators a significant difference in relation to residual caries (p = 0.015) was found as well as a significant difference between the operators for the preparation time in the three treatment methods (p < 0.05). The child's behaviour seems to have no influence on residual caries and marginal gaps.

CONCLUSION

This study indicates that there is no preparation method superior to another, though the treatment methods seem to be sensitive for operator effects. Using hand-mixed glass ionomer cement resulted in considerable number of cervical gaps found.

Atraumatic Restorative Treatment (ART): the Tanzanian experience

OBJECTIVES

Atraumatic Restorative Treatment (ART), which involves the use of hand instruments, is a relatively inexpensive, non-sophisticated, tooth conservative technique that offers the opportunity for restorative work in remote areas without electricity. The objectives of this survey were to evaluate the experience of dental practitioners with ART and the impact of the technique on oral health care in Tanzania, where ART was pioneered.

METHODS

Dental officers (DOs), assistant dental officers (ADOs) and dental therapists (DTs) from different parts of the Tanzania mainland participated in a cross-sectional study that gathered information using a self-administered structured questionnaire.

RESULTS

Only 41 (35%) of the 117 respondents were practising ART with only 6.5% of them doing so either "most of the time" or "always". Practising ART was significantly associated with the cadre of the dental practitioner, being higher among ADOs (50%) than DOs (37%) and DTs (20%), and with ART training, but was not related to either working experience or material availability.

CONCLUSIONS

To date, ART has made little impact on oral health care delivery in Tanzania, where dental extractions still account for over 90% of all forms of dental treatment, and restorative work for less than 5%. Several problems in providing ART were noted, such as limited practical training and practice in ART, scarce resources, and lack of advocacy.

RECOMMENDATIONS

An increased involvement and support for ART from the Ministry of Health and professional organisations, and public education of ART is called for.

Atraumatic restorative treatment with resin-modified glass ionomer material: short-term results of a pilot study

OBJECTIVES

The aim of this study was to assess the feasibility of the resin-modified glass ionomer (RMGI) material in atraumatic restorative treatment (ART) approach and compare RMGI with the high-strength traditional glass ionomer cement (GIC) in permanent teeth with one or more surface-carious cavities.

MATERIALS AND METHODS

This study was conducted in a village school in rural southeastern Anatolia, Turkey. The RMGI and GIC restorations with the ART technique were placed randomly employing a split mouth design. In addition, the ART approach was used when necessary for both primary and/or permanent teeth with no pulpal involvement and no perceived pain before treatment. Ninety-one fillings were placed on contralateral molar pairs of 37 children. Baseline and 6-month evaluation of the fillings were made with the classic ART, modified Ryge and USPHS criteria.

RESULTS

Based on the ART criteria, 100% of RMGI and 92.4% of GIC restorations were classified as successful after 6 months, and the difference between the 2 groups was statistically significant (p=0.009). While marginal discoloration was the commonest failure in the RMGI group according to both the modified Ryge and USPHS criteria, unsatisfactory surface texture and low anatomic form were the commonly seen failures in the ART technique.

CONCLUSION

Generally, for each rating system, RMGI exhibited better clinical performance than GIC in all categories, except for marginal discoloration. Results based on the 6-month evaluation show that RMGI can be an alternative material to the GIC.

Survival of glass ionomer restorations placed in primary molars using atraumatic restorative treatment (ART) and conventional cavity preparations: 2-year results

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 hand instruments, and conventional cavity preparation with rotary instruments.

METHOD AND MATERIALS

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 hand 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.

The effects of two cavity preparation methods on the longevity of glass ionomer cement restorations: an evaluation after 12 months

BACKGROUND

The authors undertook a study to evaluate the effect of two cavity preparation methods on the initial survival of two more-viscous glass ionomer cements, or GICs, placed in the occlusal surfaces of permanent molar teeth.

METHODS

Three dentists placed 149 restorations in 68 adult patients in a hospital clinic. They used either atraumatic restorative treatment, or ART, or conventional cavity preparation methods to place two encapsulated esthetic conventional GICs: Fuji IX GP (GC International Corp., Tokyo) and Ketac-Molar Aplicap (3M ESPE, Seefeld, Germany). For comparison, they used high-copper-content GK Amalgam Alloy (Advanced Technology & Materials Co. Ltd., Beijing) in conventional preparations. They evaluated the restorations using both direct and indirect observation methods.

RESULTS

Cavity preparations for which the authors used ART hand instruments took approximately twice as long to complete as did those for which they used conventional rotary instruments. After 12 months, no restorations had failed, but restorations comprising both GICs showed early losses of adjacent sealant material. Both GICs also showed relatively high restoration wear. At 12 months, the mean cumulative net occlusal wear for Fuji IX GP was 77 +/- 47 micrometers, and for Ketac-Molar 83 +/- 51 microm, without statistical significance (P > .05). Color matching improved significantly with time (P < .001), without significant differences in color between the two GICs by 12 months (P = .09). The amalgam alloy had minor surface tarnishing and marginal discrepancies increased with time (P < .00 1).

CONCLUSIONS

All of the occlusal restorations were rated as satisfactory after 12 months. The method of cavity preparation did not affect the restoration performance of the GICs. However, their deterioration requires long-term monitoring. Clinical Implications. The more viscous GICs appear initially suitable for restricted use in clinical practice when placed using either of two cavity preparation methods in the occlusal surfaces of permanent molar teeth in adults.

Glass ionomer cements used as fissure sealants with the atraumatic restorative treatment (ART) approach: review of literature

AIM

To review the success of newer, more-viscous aesthetic conventional glass ionomer cements (GICs), that have been marketed specifically for the atraumatic restorative (ART) technique or approach, when used as pit and fissure sealants. As part of this approach, enamel fissures adjacent to the ART restorations are conditioned with poly (acrylic) acid (PAA) and then usually sealed with a GIC, using the finger-press method.

RESULTS

The newer GICs appear in vitro to penetrate adequately and seal occlusal fissures in permanent molar teeth, and clinical studies of the ART approach over three years have found sealant retention (full and partial) to be approximately 70%, with fissure caries approximately 0-4%. In two studies, fissure caries was significantly reduced in sealed as compared with unsealed teeth over three years.

CONCLUSIONS

Although the results appear to be better with the newer than with earlier conventional GIC products, the ART studies have generally involved populations at low-risk to caries, and further improvements in the mechanical properties of the cements are required for optimal long-term clinical success. Etching the enamel fissures with phosphoric acid, instead of conditioning with PAA, before GIC sealant placement warrants clinical investigation.

Provision of Atraumatic Restorative Treatment (ART) restorations to Chinese pre-school children--a 30-month evaluation

OBJECTIVES

The objectives of this study were: to provide restorations using the ART approach to pre-school children in Southern China in a kindergarten environment, using a high-strength glass-ionomer restorative material; to assess the acceptability of this approach and to evaluate on a longitudinal basis the restorations placed.

SAMPLE AND METHODS

A total of 170 ART restorations were placed in 95 children, aged 5.1 +/- 0.7 years, by seven final-year dental students using standard ART procedures and hand instruments. The restorations were evaluated every six months thereafter by two calibrated independent examiners using explorers and mouth-mirrors.

RESULTS

93% of the children reported that they did not feel pain during treatment and 86% were willing to receive ART restorations again. The cumulative 12- and 30-month survival rates of Class I restorations were 91% and 79%, respectively. The corresponding figures for Class V restorations were 79% and 70%, while those for Class II restorations were 75% and 51%. The failure rates of Class III and IV restorations were high with more than half of them scored as missing within the first year.

CONCLUSIONS

The ART approach was shown to be acceptable to Chinese pre-school children for providing restorative dental care outside the traditional clinical setting. The success rates were high for Class I and V restorations in primary teeth, modest for Class II, and low for Class III and IV restorations.