How effective is ART in the management of dental caries?

The ART approach involves excavating cavitated dentine caries with hand instruments, then restoring the cavity and sealing any associated fissures and pits with an adhesive restorative material, resulting in a sealant restoration. Until recently, ART has mainly been used under field conditions, and thus the adhesive restorative material used has been glass ionomer which does not require mixing machines and curing lights. Since the inception of ART, a growing number of studies world-wide have taken place. A total of four studies have reported 3-year survival percentages for one-surface ART restorations. The highest 3-year survival percentage in permanent teeth was 88%, which is comparable to the 85% survival of one-surface amalgam restorations placed under the same field conditions after 3 years. The outcomes depend to some extent on the material used, operator experience and presence of caries. The presence of caries as a reason for failure was higher in the early than in the most recent studies. Only one study has reported on the use of ART restorations in the deciduous dentition. It is concluded that: a very large proportion of dentine lesions in the permanent teeth can be treated using the ART approach; the 3-year survival rate of the more recently placed one-surface ART restorations in permanent teeth was higher than that of ART restorations placed in the beginning; the survival of one-surface ART restorations in the permanent dentition with newer glass ionomers is comparable to that of one-surface conventional restorations placed using amalgam in a comparable setting after 3 years; more studies of longer duration are needed to confirm these findings; ART should be considered a caries treatment modality that benefits people; and educational courses need to be organised before the approach is applied in the clinic.     

Assessment of manual restorative treatment (MRT) with amalgam in high-caries Filipino children: results after 2 years

BACKGROUND: The atraumatic restorative treatment (ART), using only hand instruments and glass-ionomer cement as adhesive material is recommended for restorative dental treatment in disadvantaged communities lacking electricity and sophisticated dental equipment. Research is required on more durable restorative materials appropriate for populations with high-caries experience. OBJECTIVES: The aim of the study was to evaluate, under field conditions, the applicability and effectiveness of an encapsulated amalgam as restorative material in ART prepared cavities in permanent teeth of children with high-caries rates. As the definition of ART restricts the manual treatment to adhesive materials the approach used is called the manual restorative treatment (MRT). METHODS: Two dentists and two trained healthcare workers, using hand instruments and an encapsulated amalgam that was mixed with a manually driven triturator, placed a total of 934 restorations in the permanent dentition in 466 children. Due to irregular school attendance of Filipino children only 611 restorations could be evaluated by one independent dentist. The average age at reassessment of restorations was 27 +/- 4.5 months. RESULTS: 93.3% of the restorations were acceptable. The failure rate of occlusal surface restorations was 5.6% compared with 13.6% of buccal surface fillings. The survival rate of large occlusal restorations was 95.1% compared with 93.7% for small restorations. The survival of MRT restorations was not influenced by the experience and professional level of the operator. CONCLUSIONS: Amalgam is a suitable MRT material, especially for extensive occlusal lesions in high-caries populations. Studies of longer duration are needed to confirm this finding.     

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.     

ART restorations and glass ionomer sealants in Zimbabwe: survival after 3 years

Atraumatic restorative treatment (ART) consists of removing demineralised tooth tissues with hand instruments only, restoring the prepared cavity and sealing the adjacent pits and fissures with an adhesive filling material. This relatively painless, no-handpiece, minimal intervention approach to controlling dental caries is described. ART was applied in an oral health care programme in Zimbabwe that was carried out amongst secondary school students from 1994 to 1997. A new glass ionomer (Fuji IX) was used as the restorative and sealant material. Sealants were placed in high caries risk students using the ‘press-finger’ technique. A total of 297 one-surface ART restorations and 95 glass ionomer sealants were placed in 142 and 66 students, respectively. After 3 years, the lost-to-follow-up percentages for one-surface ART restorations and glass ionomer sealants were 30.6% and 30.5%, respectively. Actuarial (life table) analysis resulted in 3-year survival rates of one-surface ART restorations of 88.3% (95% CI: 92.4%–84.2%), ranging from 94.3% to 65.4% per operator. A total of 28 ART restorations placed in 25 students failed. Reasons for failure related to the material and the operator (11 restorations or 5.3% each), and to caries adjacent to the restoration (one restoration or 0.5%). Reasons for failure were not recorded for five restorations (2.3%). Seal-ants were placed on surfaces diagnosed as early enamel lesions. After 3 years, 71.4% (95% CI: 81.7%–61.1%) of the fully and partially retained sealants survived with a range of 100% to 55.6% per operator. Of the sealed surfaces 96.3% (95% CI: 100%–92.2%) survived 3 years without developing caries. Experienced operators placed better ART restorations than inexperienced operators. This study has demonstrated that ART with a glass ionomer restorative material and sealants provided high quality preventive and restorative dental care to this student population. ART has become one of the treatment modalities available to oral health workers in managing dental caries.     

无创伤性修复治疗技术修复乳牙一年后效果观察

目的评价无创伤性修复治疗技术(ART)用于防治儿童乳牙龋损的效果和可接受性.方法采用无创伤性修复治疗技术完成258颗乳牙单面洞和172颗乳牙复面洞的修复治疗,一年后复查ART修复体.结果单面洞ART修复的成功率明显高于复面洞(P＜0.05),成功率分别为87.8%,68.9%.ART修复一颗乳牙单面洞的平均时间为16.2分钟,一颗乳牙复面洞的平均时间为28.1分钟.7.5%的儿童修复治疗后有不适的主诉.92.2%的儿童愿意接受ART治疗.结论ART是一种简便易行、经济有效的治疗技术,可以在口腔医师的指导下,由经过培训的基层口腔保健人员进行操作完成.     

Assessment of Atraumatic Restorative Treatment (ART) on the permanent dentition in a primary care setting in Nigeria

Objectives: To assess the acceptability of ART and to evaluate on a longitudinal basis the survival rate of single surface occlusal ART restorations in the permanent dentition. Design: Longitudinal Study of ART restorations. Setting: Primary Oral Health Care Setting. Participants: Aged 8–19 years in a low socioeconomic community, Southwestern Nigeria. Interventions/methods: Ninety‐three ART restorations were applied on single surface occlusal caries by a dentist who had undergone training on ART. Main outcome measures: Six monthly follow‐up of patients to evaluate restoration retention and marginal defect was conducted by an independent evaluator. Results: Over 90.0% of the subjects had never undergone dental treatment, yet 63.0% perceived dental treatment as painful. After undergoing the treatment as many as 98.0% admitted that ART was not painful. On the question of their willingness to make recall visits, about 95.0% responded in the affirmative and about 96.0% reported that they would encourage others to come for treatment. The cumulative survival rate of single surface occlusal ART restorations after 2 years was 93.5% (SE = 2.3%). Conclusions: ART was shown to be acceptable and effective in the management of single surface occlusal caries in the permanent dentition in these Nigerian children and adolescents outside the traditional clinical setting.     

Evaluation of Atraumatic Restorative Treatment restorations and sealants under field conditions.

Conventional restorative procedures require the use of dental materials, expensive equipment, instruments and electricity. This makes dental restorations costly and limits the availability and accessibility of the service to areas where these facilities are available. The new philosophy of restorative care requires minimal intervention and advocates early interception of the caries process through the use of glass-ionomers as sealants and as restorations. This new approach makes dental care accessible to all members of society in developing countries. The aim of this study was to evaluate the use of Atraumatic Restorative Treatment (ART) restorations and sealants under field conditions. Both were assessed for their retentive properties and the development of secondary caries adjacent to the procedures. A longitudinal study design was followed. ART restorations and sealants were assessed at intervals of 6 and 12 months. After 12 months 56.5% of ART restorations were still present in the primary dentition and 84% in the permanent dentition. Of these 85.1% had no defects in the primary and 78.6% no defects in the permanent teeth. 72.3% of primary and 92% of permanent teeth on which ART restorations were placed had no caries after 1 year. Even though most of the sealants were absent due to poor retention after 12 months (89.6%), 98.9% of the teeth where the sealant was initially placed had no caries. Only 6.3% of sealants present had marginal defects. The ART technique is strongly recommended for the management of small, occlusal carious lesions in primary and permanent teeth.     

Restoration of permanent teeth in young rural children in Cambodia using the atraumatic restorative treatment (ART) technique and Fuji II glass ionomer cement

Several recent studies have demonstrated the success of the ART (atraumatic restorative treatment) technique under field conditions in developing countries. The ART technique involves removal of caries using only hand instruments, and placing a glass ionomer cement (GIC) restoration.
Objectives. To estimate the longevity of Fuji II GIC ART restorations placed in permanent teeth by dental nurse students under field conditions in rural Cambodia.
Design . Clinical field trial.
Setting . One high school in rural Cambodia.
Sample and methods . 53 subjects between the ages of 12 and 17 who had dental caries were selected to participate. Subjects were randomly assigned to a dental nurse student for cavity preparation and placement of ART restorations (without cavity conditioning).
Results . 92·1% of the carious lesions required class I or class V restorations, and 85·4% were in the lower molars. 89 teeth were filled. At 1 and 3 years 86·4% and 79·5% of restorations were still present. Restorations were assessed by one dentist according to standard criteria. 76·3% of the restorations were judged to be successful at 1 year, and 57·9% at 3 years.
Conclusions . Factors which may have affected the success rates included: the material used, technical factors, failure to condition the cavity prior to restoration, and inexperience of the operators. The results suggest that ART restorations in permanent teeth using Fuji II GIC are only moderately successful after 3 years. Better results could be expected by using a dentine conditioner in conjunction with one of the newer stronger glass ionomer cements.     

Comparison of two tooth-saving preparation techniques for one-surface cavities

The atraumatic restorative treatment technique (ART) is based on removing infected tooth material using only hand instruments and filling the subsequently cleaned cavity with adhesive material such as glass ionomer. As its name suggests, the ART technique should be atraumatic during treatment, as well as for the tooth itself as for the patient. It was primarily developed for treating people living in underserved areas of the world where resources and facilities such as electricity and trained manpower are limited. Many studies have evaluated the ART technique and the results have supported its application. However, a very limited number of studies have compared ART with more conventional techniques. For that reason, a study was conducted in Pakistan, to compare the ART technique with another more conventional treatment technique. The results of this study show that the preparations with hand instruments resulted in smaller sized cavities and therefore may be less traumatic to the tooth. It was also associated with less pain reactions compared to the more conventional technique. Although preparations with hand instruments required more time, this did not seem to affect the survival of restorations. The survival of glass ionomer cement restorations made with hand instruments was comparable with single surface amalgam restorations made with a more conventional technique. Recurrent caries was not associated with any glass ionomer cement restorations made with hand instruments. The retention rate of glass ionomer sealants was low, however one dentist had a sealant retention rate of 81.5 percent that suggests that this procedure can be performed satisfactorily in conjunction with a glass ionomer cement restoration. Operator variances did seem to affect the restorations. Survival of glass ionomer restorations made with both hand and rotary instruments varied for different operators. Similarly, the retention of fissure sealant also varied amongst operators. Operator differences also influenced the extent of tooth substance lost due to cavity preparation. The ART technique is a feasible approach towards the treatment of dental caries especially of one-surface lesions for underserved populations.     

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.     

Effectiveness of three minimal intervention approaches for managing dental caries: survival of restorations after 2 years

The present study was aimed 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 hand 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 resources 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.     

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

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 randomly 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 standard 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.     

Three-year survival of single- and two-surface ART restorations in a high-caries child population

The aim of this study was to evaluate the survival of single- and two-surface atraumatic restorative treatment (ART) restorations in the primary and permanent dentitions of children from a high-caries population, in a field setting. The study was conducted in the rainforest of Suriname, South America. ART restorations, made by four Dutch dentists, were evaluated after 6 months, 1, 2, and 3 years. Four hundred seventy-five ART restorations were placed in the primary dentition and 54 in first permanent molars of 194 children (mean age 6.09 ± 0.48 years). Three-year cumulative survivals of single- and two-surface ART restorations in the primary dentition were 43.4 and 12.2%, respectively. Main failure characteristics were gross marginal defects and total or partial losses. Three-year cumulative survival for single-surface ART restorations in the permanent dentition was 29.6%. Main failure characteristics were secondary caries and gross marginal defects. An operator effect was found only for two-surface restorations. The results show extremely low survival rates for single- and two-surface ART restorations in the primary and permanent dentitions. The variable success for ART may initiate further discussion about alternative treatment strategies, especially in those situations where choices have to be made with respect to a well-balanced, cost-effective package of basic oral health care.     

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

The changing profile of oral care rendered through the Mobile Dental System (MDS), after the introduction of the Atraumatic Restorative Treatment (ART) approach is described. During the first year of introduction of ART, the percentages of amalgam restorations and tooth extractions decreased significantly (P < 0.0001). This is partly ascribed to a change in choice of treatment by dental operators in favour of ART and also due to an increase in acceptance by patients because of the reduced fear, and the patient-friendly nature of the ART approach. The reduction in amalgam restorations was 16.0 per cent for permanent and 1.4 per cent for primary posterior teeth. Extraction of posterior teeth was reduced by 17.4 per cent in the permanent and 35.7 per cent in the primary dentitions. The restorative component of oral care increased by 33.4 per cent in the permanent and 37.1 per cent in primary posterior teeth. The one-year survival of one-surface ART restorations using Fuji IX and KetacMolar was 93.6 per cent. Full and partial (more than 90 per cent) retention of the sealant part of the ART restoration was obtained in 75 per cent of the cases after one-year. During the one-year period, infection control was made more simple and this facilitated easier maintenance of mobile dental equipment. The introduction of the ART approach reduced extraction, restored more teeth and made oral care in the MDS more preventive, less threatening and thus more patient-friendly.     

The post-amalgam era: a selection of materials and their longevity in the primary and young permanent dentitions

Summary. Objectives. During the last decade there has been a rapid change in the selection of dental restorative materials as the use of amalgam has decreased. The aim of this study was to obtain information on children's restorative dental care in Finland and to analyse the longevity of failed restorations. Design. A random sample of public dental health care centres was drawn from the registers and the dentists working there were asked to record information for each restoration they placed during a three‐day period. The survey data comprised a total of 2186 restorations in patients younger than 17 years. Results. Of the children in need of restorative treatment, only a few had previous amalgam restorations. Primary caries was the main reason for restorative treatment in both primary and permanent dentitions (80% and 83%, respectively). In primary teeth, the most common restorative material was resin‐modified glass ionomer cement (57·4%), whereas in permanent teeth, composite resin dominated (58·7%). Amalgam was not used at all in the primary dentition and in only 0·6% of permanent teeth. Eighteen per cent of treatments in primary and 12% in permanent teeth were replacements of previous fillings. The mean age of failed glass ionomer restorations was 2·8 years (n = 101) in the primary dentition, and 3·5 years (n = 54) in the permanent dentition. Conclusions. Until better restorative materials are developed, more attention should be paid to the prevention of dental caries as well as to the proper handling of alternative materials.     

Six-year success rates of occlusal amalgam and glass-ionomer restorations placed using three minimal intervention approaches

The present randomised clinical trial was aimed at comparing three minimally invasive restorative treatment approaches for managing dental caries in occlusal surfaces using a non-gamma-2 amalgam and a low-viscosity glass-ionomer as the restorative material. The treatment approaches tested in parallel groups were: conventional in a university setting, modified-conventional and ultraconservative (Atraumatic Restorative Treatment, ART) approaches in a field setting. A split-mouth design was used in which the two restorative materials were randomly placed in 430 matched contralateral pairs of permanent molar teeth. A total of 152 children from five primary schools were recruited and treated by a dental therapist. The restorations were evaluated after 6 years by 2 calibrated independent examiners. The 6-year successes for all occlusal amalgam and glass-ionomer restorations were 72.6 and 72.3%, respectively. There were no statistically significant differences observed between the successes for both amalgam and glass-ionomer restorations placed either by the ART (68.6%, with 95% CI = 61-76%) approach or by the conventional (74.5%, with 95% CI = 65-82%) and the modified-conventional (75.8%, with 95% CI = 67-83%) approaches after 6 years. There was also no statistically significant difference observed between the successes of occlusal ART restorations with glass-ionomer (67.1%, with 95% CI = 56-77%) and occlusal conventional restorations with amalgam (74%, with 95% CI = 61-85%) after 6 years. 'Restoration fracture/marginal defects' and 'loss of material' were the most common causes for failure. The former was more often recorded in amalgam restorations and the latter in glass-ionomer restorations. Secondary caries was observed for 2% of glass-ionomer and for 10% of amalgam restorations. This difference was statistically significant (p = 0.001). The ART approach using glass-ionomer performed equally well as conventional restorative approaches using electrically driven equipment and amalgam for treating dentinal lesions in occlusal surfaces after 6 years.     

Long term cost of restorative therapy using different materials

The cost of restorative treatment over a 60-yr period has been assessed, based on the present cost of restorations at the time of insertion and the median longevity of the different types of restorations. Such theoretic extrapolations indicate that the long term cost of two- or three-surface gold and composite restorations in permanent teeth is similar and about 4 times more than for amalgam therapy. The cost of one-surface composite restorations would be about 2–2.5 times that of amalgam restorations, while small gold restorations would cost 5 times more than amalgam restorations. Due to the short median longevity of composite restorations in primary teeth, a 5 times higher cost can be estimated compared to amalgam therapy over a 10-yr period.     

Restorative treatment pattern and longevity of amalgam restorations in Denmark

A survey has been made of the reasons for placement and replacement of 6052 amalgam restorations in Denmark. In patients more than 16 years of age 48% of all restorations were made because of primary caries, and 52% were replacements of failed restorations. In primary teeth 64% and in permanent teeth of children 83% of the restorations were made because of primary caries. The reasons for replacement of restorations were dependent on dentition, age of the patient, and type of restoration. Secondary caries was the most frequent reason for replacement of failed restorations in permanent teeth, comprising a third of all replacements. Marginal discrepancies and bulk fracture of fillings were the other two major reasons. In primary teeth fracture and loss of fillings were the two major reasons for replacement of amalgam restorations, whereas secondary caries caused less than a quarter of all restorations to be replaced. The age of the restorations replaced ranged from 0 to 38 years, and half of the restorations replaced in permanent teeth of adults were less than 7 years old. A shorter longevity of failed restorations was noted in primary teeth and permanent teeth of children.     

Effect of fluoride in amalgam on secondary caries incidence

Abstract – Caries incidence is falling in many developed countries but is believed to be increasing in developing countries. Insofar as treatment for caries is provided, ordinary amalgam restorations are usually the standard choice. These carry a risk of failing due to secondary caries. The aim of this study was to compare the occurrence of secondary caries adjacent to fluoride-containing amalgam with that adjacent to a conventional amalgam under Held conditions in Bahrain. Children ( n =4l5) aged 6-14 yr who required occlusal restorations in two homologous contralateral permanent molar teeth were identified. Using the split-mouth design, one tooth received a fluoride-containing amalgam filling and the other a conventional amalgam restoration. A random method was used to determine which type of filling was placed on each side. After 4 yr, 357 children were still available for examination; of these 5 had to be eliminated from analysis for various reasons. Of the 704 teeth in the analysis, secondary caries had occurred in 135 (86 conventional amalgam. 49 fluoridated amalgam). By comparison with the conventional amalgam, the effectiveness of the fluoride amalgam was 43% (95% C.I. 24.4%, 57.1%) and the net gain 10.3% (95% C.I. 4.75%, 16.3%). The relative risk was 0.570 (95% C.I. 0.444%, 0.731%). Since fluoride amalgam has identical handling properties to conventional amalgam, performs similarly under clinical conditions and costs about the same, it should be the amalgam of choice for restorations in communities where the incidence of secondary caries is high.     

ART: a minimal intervention approach to manage dental caries

The number of studies investigating aspects of the Atraumatic Restorative Treatment (ART) approach has increased in recent years. This tissue preservative treatment approach appears to be less painful and is, therefore, more patient-friendly than conventional caries treatments. The investigations so far have shown that the ART approach is effective for the management of single-surface cavities in both deciduous and permanent dentitions. There appears to be no difference in survival results between single-surface ART restorations and comparable amalgam restorations in the permanent dentition after three years. The surface wear of ART restorations using high-viscosity glass-ionomers after two years is low. ART sealants using high-viscosity glass-ionomers are retained longer than ART sealants using low-viscosity glass-ionomers after three years. It is concluded that the ART approach is beneficial in improving the oral health of many, not only in developing but also in more advanced countries.