tangent
12-13-01, 10:57
The removal of caries by hand instruments alone is by no means a new approach since over the years dentists have used hand instruments when they considered it necessary or when they could not use other dental equipment. The ART technique, however differs in concept from previous treatment. Instead of filling excavated cavities with a temporary filling material that later needs to be replaced with a permanent restoration, a long-lasting high-technology restorative material is used. Furthermore, the minimal cavity preparation from the use of hand instruments is in line with modern concepts foe a biologic cavity preparation.
The ART technique is subject to further investigation, including clinical, laboratory, behavioral and economic studies. However, extrapolation of results from preliminary studies suggested that ART results in a long-lasting restoration. Thus, an implication from using the ART technique is that the many extractions constituting the predominant treatment for dentinal lesions in economically less developed countries will not be needed. ART offers a curative solution for caries that can be used globally.
CONCLUSIONS
The greater part of the world's population has no access to restorative dental care. One of the main obstacles is the traditional manner of treating caries, which relies on electrically driven equipment. The basic concepts of the ART technique are the removal of decalcified dental tissues using only readily available hand instruments
following the modern concepts of cavity preparation and the use of a high-technology adhesive restorative material. This technique has the potential to make oral health care more available to a larger part of the world's population than before.
Jo E. Frencken, PhD; Taco Pilot, PhD; Yupin Songpaisan, Odont Dr; Prathip Phantumvanit, MSc.
Journal of Public Health Dentistry, Vol 56, No. 3 Special issue 1996
------------
1: J Dent 2000 May;28(4):249-56
In vitro caries inhibition at the enamel margins of glass ionomer restoratives developed for the ART approach.
Smales RJ, Gao W
Conservative Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, 34 Hospital Road, Hong Kong, People's Republic of China.
[Medline record in process]
Objectives: To rectumess the ability of conventional glass ionomer cements manufactured specifically for the atraumatic restorative treatment (ART) approach to inhibit the in vitro demineralization of enamel.Methods: Twenty-four sound permanent premolar teeth, extracted for orthodontic reasons, had cervical cavities (4x2x1. 5mm(3)) prepared in enamel. These were restored with Fuji IX, Fuji IX GP, Ketac-Molar and Compoglass, and then thermocycled 300 times between 5-55 degrees C before being placed in a demineralizing solution (0.1M lactic acid with 1g/l dissolved hydroxyapatite at pH 4.7) for four weeks. Buccolingual planoparallel sections were cut axially through the restorations, and subsequently lapped to approximately 100&mgr;m thickness. The sections were examined with a polarized light microscope, and lesion measurements made using image analysis software. ANOVA and coefficients of variance were used to compare the findings.Results: Compoglass and Ketac-Molar showed significantly less surface erosion than did the other two cements (p<0.0001). Inhibition of enamel demineralization immediately adjacent to the restoration margins was more frequent with the glass ionomer cements (20.5-25.0%) than with Compoglass (13.0%). However, the widths of the inhibition zones varied between materials and sites.Conclusions: Fluoride ion release from the restorative materials afforded some degree of protection to the adjacent enamel against in vitro demineralization.
PMID: 10722898, UI: 20189903
2: Community Dent Oral Epidemiol 1999 Dec;27(6):449-53
Painting the future for ART.
Holmgren CJ, Frencken JE
Faculty of Dentistry, The University of Hong Kong, Hong Kong. holmgren@club-internet.fr
The objective of this paper is to review recent research and developments with respect to the atraumatic restorative treatment (ART) approach and to outline future areas of research and development. Areas identified as requiring further investigation include the evaluation of: ART restorations for longer than 3 years duration using recognised evaluation criteria, multi-surface ART restorations, ART restorations in primary teeth and ART sealants. In addition, the possibility and potential dangers of caries remaining after cavity cleaning with hand instruments must be investigated and the findings balanced against the known damage to sound tooth tissue caused by more routine cavity preparation techniques. New bioactive restorative materials which offer the possibility of healing dentinal caries lesions should be developed and evaluated. Finally, behavioural and educational aspects of the ART approach should be investigated. Publication Types:
Review
Review literature
PMID: 10600080, UI: 20067063
3: Community Dent Oral Epidemiol 1999 Dec;27(6):431-5
Is ART really atraumatic?
van Amerongen WE, Rahimtoola S
Department of Cariology, Endodontology Pedodontology, ACTA, Amsterdam, The
Netherlands. w.e.van.amerongen@acta.nl
Atraumatic restorative treatment (ART) is an approach to the management of carious lesions that uses only hand 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 hand 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 hand instruments were smaller than those produced with rotary instruments. Reported discomfort was rectumociated 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.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 10600077, UI: 20067060
4: Caries Res 1999 Nov-Dec;33(6):437-40
In vitro effectiveness of hand excavation of caries with the ART technique. Atraumatic restorative treatment.
Smales RJ, Fang DT
Conservative Dentistry, The Prince Philip Dental Hospital, Hong Kong, ROC.
The purpose of this study was to evaluate the effectiveness of the atraumatic restorative treatment (ART) hand-instruments and of round steel burs for removing caries at the enamel-dentine junction (EDJ) in occlusal cavities prepared in 50 extracted permanent molars. The teeth were divided randomly into two equal groups for the two treatments provided by 1 operator. Stained but hard dentine was not removed. The teeth were then sectioned vertically, buccolingually through the prepared cavities to give 200 sections, each 500 microm thick, which were photographed (x1 magnification) before and after staining with a caries detector dye. rectumessments were made (x3 magnification) of (a) the amount of brown-stained residual dentine, and (b) the amount of red dye-stained dentine present at the EDJ, using two sets of standards devised and transparencies arranged as six-category incremental rating scales. There was no statistically significant difference found between the two caries-removal methods for the amount of residual brown-stained dentine present (chi(2 )= 3. 394, p = 0.64), but there was for the amount of red dye-stained dentine present (chi(2) = 32.137, p<0.0001), although 57% of the ART and 80% of the steel bur sections had very little to mild red-dye staining present. Excavation of caries at the DJE appeared to be less effective with the ART technique, although the clinical implications of this may not be significant.
PMID: 10529528, UI: 20002315
5: Community Dent Oral Epidemiol 1999 Jun;27(3):195-201
A 2-year clinical study of two glass ionomer cements used in the atraumatic restorative treatment (ART) technique.
Ho TF, Smales RJ, Fang DT
Faculty of Dentistry, The University of Hong Kong, Hong Kong.
The purpose of the study was to evaluate, in a clinical study over 2 years, the deterioration of two glass ionomer cements used with the atraumatic restorative treatment (ART) technique or approach. Fifty-five Fuji IX and 45 ChemFil Superior restorations were placed randomly in 23 adult patients, mainly in small occlusal preparations in molar teeth. The restorations were placed in a dental hospital by one dentist using the ART technique. Photographs, radiographs and replicas were obtained at baseline and subsequent recalls. Both cements were easy to mix and place, but the radiolucency of ChemFil Superior was a disadvantage. Both cements also showed early high losses of sealant and restorative material. After 2 years, 34.5% of the sealants appeared to be completely lost, with caries recorded in 5.3% of the exposed fissures. In some instances, these small lesions may have been present, but not detected clinically, at the time of sealing. Restoration failures of 7.0% were from wear and fracture of the cements and recurrent caries. Mean cumulative wear was 83.1 microm for Fuji IX and 104.0 microm for ChemFil Superior, which was not statistically significant. The cements became darker after their placement to more closely match the restored teeth, but there were few exact matches. There was no surface staining and only minor marginal discrepancies and staining rectumociated with the restorations. Although the short-term clinical performance of the two glass ionomer cements was reasonable, the materials require further improvements in their mechanical properties, to reduce sealant losses and wear. The cements evaluated appear suitable for restricted use only, in posterior teeth.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 10385357, UI: 99312083
6: Spec Care Dentist 1997 Jan-Feb;17(1):19-24
The physical and adhesive properties of dental cements used for atraumatic restorative treatment.
Ewoldsen N, Covey D, Lavin M
Department of Adult Restorative Dentistry, UNMC College of Dentistry, Lincoln
68583-0740, USA.
Atraumatic restorative treatment (ART), a recently reported field dentistry technique, involves removal of carious debris using only hand instruments and placement of a glass-ionomer cement (GIC) restoration. While small ART-GIC restorations are effective short-term replacements for lost tooth form, many larger ART-GIC restorations are defective after two years. Presently, resin-modified GICs (R-M GIC) are available which require no special activation equipment and handle easily in field settings. This study measured the compressive, tensile, and shear bond strengths to enamel and dentin of a conventional ART-GIC (Fuji IX) and two R-M GICs (Fuji Plus and Advance) at a powder-to-liquid ratio of 3.6:1. The compressive strengths of the GICs tested were significantly different. Fuji IX had the highest compressive strength, and Advance had the lowest strength (p < 0.05). The tensile strength of the R-M GICs was greater than that of the ART-GIC. Fuji Plus showed the highest shear bond strength to enamel and dentin and was significantly different from both Fuji IX and Advance. A clinical protocol is presented followed by case reports where the ART technique was used for management of acute caries in a modern dental setting.
PMID: 9582705, UI: 98243511
7: J Philipp Dent rectumoc 1996 Sep-Nov;48(2):39-41
The atraumatic restorative treatment (ART) technique in the English-speaking Caribbean.
Adewakun AA
FDI World has featured the atraumatic restorative technique on several occasions. In this article, Dr. Adenike A. Adewakun of the School of Dentistry, Faculty of Medical Sciences at the University of the West Indies, St. Augustine, Trinidad, describes a workshop which took place to introduce the concept and practicalities of the technique to nations in the Caribbean region.
PMID: 9462083, UI: 98123635
8: Caries Res 1996;30(6):428-33
Atraumatic restorative treatment and glass-ionomer sealants in a school oral health programme in Zimbabwe: evaluation after 1 year.
Frencken JE, Makoni F, Sithole WD
Dental Department, Ministry of Health & Child Welfare, Harare, Zimbabwe.
An oral health care programme in secondary schools using the atraumatic restorative treatment (ART) technique for dental caries was started in 1993. Glass-ionomer was used as the restorative and sealant material. Sealants were placed using the "press finger' technique. Results after 1 year revealed a survival percentage for one-surface ART restorations of 93.4 whilst the complete and partial retention percentages for sealants were 60.3 and 13.4, respectively. No caries was observed in teeth restored using ART, and only 0.8% of surfaces diagnosed as having early enamel lesions at the start of the programme and sealed consequently had progressed into active dentinal lesions after 1 year. The sealant retention percentage and the survival percentage of ART restorations were influenced by an operator effect. The majority of restorations were carried out without administering local anaesthesia. The mean treatment time for one-surface ART restorations was 22.1 min (range per operator of 19.8-23.6 min), whilst the mean time for placing sealants was 9.4 min (range per operator of 8.2-10.8 min). Post-operative sensitivity was reported for 6% of the teeth restored. 95% of the students were satisfied with ART as a treatment modality. It is concluded that ART may in part be the answer to the unavailability of restorative care for many population groups globally.
PMID: 8946101, UI: 97101583
9: J Public Health Dent 1996;56(3 Spec No):141-5; discussion 161-3
Atraumatic restorative treatment (ART): a three-year community field trial in Thailand--survival of one-surface restorations in the permanent dentition.
Phantumvanit P, Songpaisan Y, Pilot T, Frencken JE
Faculty of Dentistry, Thammasat University, Patumtani, Thailand.
This study compares the Atraumatic Restorative Treatment (ART) technique to conventional amalgam restorations in the management of dental caries. The present report is limited to the results for one-surface restorations in the permanent dentition over a three-year period. A community field trial was carried out in rural villages in northeastern Thailand. Dental caries was treated using the ART technique in one village where 144 persons were treated with 241 restorations. In a second village, 205 conventional amalgam restorations were provided to 138 persons using mobile dental equipment. Both ART and amalgam restorations were performed by one dentist and two dental nurses without administering local anesthesia. Clinical evaluation was carried out one, two, and three years after placement. The longevity of the restorations was determined by computing the estimated cumulative survival rates according to the life table method. The survival rates of ART restorations (93%, 83%, 71% in years one, two, and three, respectively) were close to those for amalgam restorations (98%, 94%, 85%); however, differences were statistically significant. No statistically significant differences were observed between ART restorations in children and adults, or between those placed by the dentist and dental nurses. Survival rates were lower for occlusal surface restorations compared to those in other surfaces. ART is a feasible approach for the management of dental caries, especially for one-surface lesions in the permanent dentition. Because of its simplicity as a minimal intervention technique, ART can make the control of dental caries available to all people irrespective of their economic and living conditions.
PMID: 8915959, UI: 97073211
10: J Public Health Dent 1996;56(3 Spec No):135-40; discussion 161-3
Atraumatic restorative treatment (ART): rationale, technique, and development.
Frencken JE, Pilot T, Songpaisan Y, Phantumvanit P
Ministry of Health and Child Welfare, Dental Department, Causeway, Harare,
Zimbabwe. frencken@zimbix.uz.zw
Despite long-term efforts to use appropriate dental equipment for treating dental caries in economically less developed countries, the predominant treatment remains extraction. The reasons for this failure to save teeth are given in this paper. Supported by results of research undertaken in economically developed countries, a 15-step treatment module for dental caries is presented. This technique, which is called Atraumatic Restorative Treatment (ART), is based on removing decalcified tooth tissue using only hand instruments and restoring the cavity with an adhesive filling material. The technique does not require electricity. The advantages and limitations of the technique are discussed and its use in a school oral health program in Zimbabwe presented. We conclude that ART can make restorative oral care more available to a larger part of the world population than it is today.
PMID: 8915958, UI: 97073210
The ART technique is subject to further investigation, including clinical, laboratory, behavioral and economic studies. However, extrapolation of results from preliminary studies suggested that ART results in a long-lasting restoration. Thus, an implication from using the ART technique is that the many extractions constituting the predominant treatment for dentinal lesions in economically less developed countries will not be needed. ART offers a curative solution for caries that can be used globally.
CONCLUSIONS
The greater part of the world's population has no access to restorative dental care. One of the main obstacles is the traditional manner of treating caries, which relies on electrically driven equipment. The basic concepts of the ART technique are the removal of decalcified dental tissues using only readily available hand instruments
following the modern concepts of cavity preparation and the use of a high-technology adhesive restorative material. This technique has the potential to make oral health care more available to a larger part of the world's population than before.
Jo E. Frencken, PhD; Taco Pilot, PhD; Yupin Songpaisan, Odont Dr; Prathip Phantumvanit, MSc.
Journal of Public Health Dentistry, Vol 56, No. 3 Special issue 1996
------------
1: J Dent 2000 May;28(4):249-56
In vitro caries inhibition at the enamel margins of glass ionomer restoratives developed for the ART approach.
Smales RJ, Gao W
Conservative Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, 34 Hospital Road, Hong Kong, People's Republic of China.
[Medline record in process]
Objectives: To rectumess the ability of conventional glass ionomer cements manufactured specifically for the atraumatic restorative treatment (ART) approach to inhibit the in vitro demineralization of enamel.Methods: Twenty-four sound permanent premolar teeth, extracted for orthodontic reasons, had cervical cavities (4x2x1. 5mm(3)) prepared in enamel. These were restored with Fuji IX, Fuji IX GP, Ketac-Molar and Compoglass, and then thermocycled 300 times between 5-55 degrees C before being placed in a demineralizing solution (0.1M lactic acid with 1g/l dissolved hydroxyapatite at pH 4.7) for four weeks. Buccolingual planoparallel sections were cut axially through the restorations, and subsequently lapped to approximately 100&mgr;m thickness. The sections were examined with a polarized light microscope, and lesion measurements made using image analysis software. ANOVA and coefficients of variance were used to compare the findings.Results: Compoglass and Ketac-Molar showed significantly less surface erosion than did the other two cements (p<0.0001). Inhibition of enamel demineralization immediately adjacent to the restoration margins was more frequent with the glass ionomer cements (20.5-25.0%) than with Compoglass (13.0%). However, the widths of the inhibition zones varied between materials and sites.Conclusions: Fluoride ion release from the restorative materials afforded some degree of protection to the adjacent enamel against in vitro demineralization.
PMID: 10722898, UI: 20189903
2: Community Dent Oral Epidemiol 1999 Dec;27(6):449-53
Painting the future for ART.
Holmgren CJ, Frencken JE
Faculty of Dentistry, The University of Hong Kong, Hong Kong. holmgren@club-internet.fr
The objective of this paper is to review recent research and developments with respect to the atraumatic restorative treatment (ART) approach and to outline future areas of research and development. Areas identified as requiring further investigation include the evaluation of: ART restorations for longer than 3 years duration using recognised evaluation criteria, multi-surface ART restorations, ART restorations in primary teeth and ART sealants. In addition, the possibility and potential dangers of caries remaining after cavity cleaning with hand instruments must be investigated and the findings balanced against the known damage to sound tooth tissue caused by more routine cavity preparation techniques. New bioactive restorative materials which offer the possibility of healing dentinal caries lesions should be developed and evaluated. Finally, behavioural and educational aspects of the ART approach should be investigated. Publication Types:
Review
Review literature
PMID: 10600080, UI: 20067063
3: Community Dent Oral Epidemiol 1999 Dec;27(6):431-5
Is ART really atraumatic?
van Amerongen WE, Rahimtoola S
Department of Cariology, Endodontology Pedodontology, ACTA, Amsterdam, The
Netherlands. w.e.van.amerongen@acta.nl
Atraumatic restorative treatment (ART) is an approach to the management of carious lesions that uses only hand 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 hand 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 hand instruments were smaller than those produced with rotary instruments. Reported discomfort was rectumociated 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.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 10600077, UI: 20067060
4: Caries Res 1999 Nov-Dec;33(6):437-40
In vitro effectiveness of hand excavation of caries with the ART technique. Atraumatic restorative treatment.
Smales RJ, Fang DT
Conservative Dentistry, The Prince Philip Dental Hospital, Hong Kong, ROC.
The purpose of this study was to evaluate the effectiveness of the atraumatic restorative treatment (ART) hand-instruments and of round steel burs for removing caries at the enamel-dentine junction (EDJ) in occlusal cavities prepared in 50 extracted permanent molars. The teeth were divided randomly into two equal groups for the two treatments provided by 1 operator. Stained but hard dentine was not removed. The teeth were then sectioned vertically, buccolingually through the prepared cavities to give 200 sections, each 500 microm thick, which were photographed (x1 magnification) before and after staining with a caries detector dye. rectumessments were made (x3 magnification) of (a) the amount of brown-stained residual dentine, and (b) the amount of red dye-stained dentine present at the EDJ, using two sets of standards devised and transparencies arranged as six-category incremental rating scales. There was no statistically significant difference found between the two caries-removal methods for the amount of residual brown-stained dentine present (chi(2 )= 3. 394, p = 0.64), but there was for the amount of red dye-stained dentine present (chi(2) = 32.137, p<0.0001), although 57% of the ART and 80% of the steel bur sections had very little to mild red-dye staining present. Excavation of caries at the DJE appeared to be less effective with the ART technique, although the clinical implications of this may not be significant.
PMID: 10529528, UI: 20002315
5: Community Dent Oral Epidemiol 1999 Jun;27(3):195-201
A 2-year clinical study of two glass ionomer cements used in the atraumatic restorative treatment (ART) technique.
Ho TF, Smales RJ, Fang DT
Faculty of Dentistry, The University of Hong Kong, Hong Kong.
The purpose of the study was to evaluate, in a clinical study over 2 years, the deterioration of two glass ionomer cements used with the atraumatic restorative treatment (ART) technique or approach. Fifty-five Fuji IX and 45 ChemFil Superior restorations were placed randomly in 23 adult patients, mainly in small occlusal preparations in molar teeth. The restorations were placed in a dental hospital by one dentist using the ART technique. Photographs, radiographs and replicas were obtained at baseline and subsequent recalls. Both cements were easy to mix and place, but the radiolucency of ChemFil Superior was a disadvantage. Both cements also showed early high losses of sealant and restorative material. After 2 years, 34.5% of the sealants appeared to be completely lost, with caries recorded in 5.3% of the exposed fissures. In some instances, these small lesions may have been present, but not detected clinically, at the time of sealing. Restoration failures of 7.0% were from wear and fracture of the cements and recurrent caries. Mean cumulative wear was 83.1 microm for Fuji IX and 104.0 microm for ChemFil Superior, which was not statistically significant. The cements became darker after their placement to more closely match the restored teeth, but there were few exact matches. There was no surface staining and only minor marginal discrepancies and staining rectumociated with the restorations. Although the short-term clinical performance of the two glass ionomer cements was reasonable, the materials require further improvements in their mechanical properties, to reduce sealant losses and wear. The cements evaluated appear suitable for restricted use only, in posterior teeth.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 10385357, UI: 99312083
6: Spec Care Dentist 1997 Jan-Feb;17(1):19-24
The physical and adhesive properties of dental cements used for atraumatic restorative treatment.
Ewoldsen N, Covey D, Lavin M
Department of Adult Restorative Dentistry, UNMC College of Dentistry, Lincoln
68583-0740, USA.
Atraumatic restorative treatment (ART), a recently reported field dentistry technique, involves removal of carious debris using only hand instruments and placement of a glass-ionomer cement (GIC) restoration. While small ART-GIC restorations are effective short-term replacements for lost tooth form, many larger ART-GIC restorations are defective after two years. Presently, resin-modified GICs (R-M GIC) are available which require no special activation equipment and handle easily in field settings. This study measured the compressive, tensile, and shear bond strengths to enamel and dentin of a conventional ART-GIC (Fuji IX) and two R-M GICs (Fuji Plus and Advance) at a powder-to-liquid ratio of 3.6:1. The compressive strengths of the GICs tested were significantly different. Fuji IX had the highest compressive strength, and Advance had the lowest strength (p < 0.05). The tensile strength of the R-M GICs was greater than that of the ART-GIC. Fuji Plus showed the highest shear bond strength to enamel and dentin and was significantly different from both Fuji IX and Advance. A clinical protocol is presented followed by case reports where the ART technique was used for management of acute caries in a modern dental setting.
PMID: 9582705, UI: 98243511
7: J Philipp Dent rectumoc 1996 Sep-Nov;48(2):39-41
The atraumatic restorative treatment (ART) technique in the English-speaking Caribbean.
Adewakun AA
FDI World has featured the atraumatic restorative technique on several occasions. In this article, Dr. Adenike A. Adewakun of the School of Dentistry, Faculty of Medical Sciences at the University of the West Indies, St. Augustine, Trinidad, describes a workshop which took place to introduce the concept and practicalities of the technique to nations in the Caribbean region.
PMID: 9462083, UI: 98123635
8: Caries Res 1996;30(6):428-33
Atraumatic restorative treatment and glass-ionomer sealants in a school oral health programme in Zimbabwe: evaluation after 1 year.
Frencken JE, Makoni F, Sithole WD
Dental Department, Ministry of Health & Child Welfare, Harare, Zimbabwe.
An oral health care programme in secondary schools using the atraumatic restorative treatment (ART) technique for dental caries was started in 1993. Glass-ionomer was used as the restorative and sealant material. Sealants were placed using the "press finger' technique. Results after 1 year revealed a survival percentage for one-surface ART restorations of 93.4 whilst the complete and partial retention percentages for sealants were 60.3 and 13.4, respectively. No caries was observed in teeth restored using ART, and only 0.8% of surfaces diagnosed as having early enamel lesions at the start of the programme and sealed consequently had progressed into active dentinal lesions after 1 year. The sealant retention percentage and the survival percentage of ART restorations were influenced by an operator effect. The majority of restorations were carried out without administering local anaesthesia. The mean treatment time for one-surface ART restorations was 22.1 min (range per operator of 19.8-23.6 min), whilst the mean time for placing sealants was 9.4 min (range per operator of 8.2-10.8 min). Post-operative sensitivity was reported for 6% of the teeth restored. 95% of the students were satisfied with ART as a treatment modality. It is concluded that ART may in part be the answer to the unavailability of restorative care for many population groups globally.
PMID: 8946101, UI: 97101583
9: J Public Health Dent 1996;56(3 Spec No):141-5; discussion 161-3
Atraumatic restorative treatment (ART): a three-year community field trial in Thailand--survival of one-surface restorations in the permanent dentition.
Phantumvanit P, Songpaisan Y, Pilot T, Frencken JE
Faculty of Dentistry, Thammasat University, Patumtani, Thailand.
This study compares the Atraumatic Restorative Treatment (ART) technique to conventional amalgam restorations in the management of dental caries. The present report is limited to the results for one-surface restorations in the permanent dentition over a three-year period. A community field trial was carried out in rural villages in northeastern Thailand. Dental caries was treated using the ART technique in one village where 144 persons were treated with 241 restorations. In a second village, 205 conventional amalgam restorations were provided to 138 persons using mobile dental equipment. Both ART and amalgam restorations were performed by one dentist and two dental nurses without administering local anesthesia. Clinical evaluation was carried out one, two, and three years after placement. The longevity of the restorations was determined by computing the estimated cumulative survival rates according to the life table method. The survival rates of ART restorations (93%, 83%, 71% in years one, two, and three, respectively) were close to those for amalgam restorations (98%, 94%, 85%); however, differences were statistically significant. No statistically significant differences were observed between ART restorations in children and adults, or between those placed by the dentist and dental nurses. Survival rates were lower for occlusal surface restorations compared to those in other surfaces. ART is a feasible approach for the management of dental caries, especially for one-surface lesions in the permanent dentition. Because of its simplicity as a minimal intervention technique, ART can make the control of dental caries available to all people irrespective of their economic and living conditions.
PMID: 8915959, UI: 97073211
10: J Public Health Dent 1996;56(3 Spec No):135-40; discussion 161-3
Atraumatic restorative treatment (ART): rationale, technique, and development.
Frencken JE, Pilot T, Songpaisan Y, Phantumvanit P
Ministry of Health and Child Welfare, Dental Department, Causeway, Harare,
Zimbabwe. frencken@zimbix.uz.zw
Despite long-term efforts to use appropriate dental equipment for treating dental caries in economically less developed countries, the predominant treatment remains extraction. The reasons for this failure to save teeth are given in this paper. Supported by results of research undertaken in economically developed countries, a 15-step treatment module for dental caries is presented. This technique, which is called Atraumatic Restorative Treatment (ART), is based on removing decalcified tooth tissue using only hand instruments and restoring the cavity with an adhesive filling material. The technique does not require electricity. The advantages and limitations of the technique are discussed and its use in a school oral health program in Zimbabwe presented. We conclude that ART can make restorative oral care more available to a larger part of the world population than it is today.
PMID: 8915958, UI: 97073210