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Purpose: To compare the 2-year cumulative survival rates of class II restorations made according to Atraumatic Restorative Treatment (ART) with axial grooves and the high-viscosity glass-ionomer cement (HVGIC) Equia Fil (GC) and the conventional method using the resin composite Filtek Z250 (3M Oral Care). Materials and Methods: A parallel-group study design and a stratified randomization process (DMFS count and cavity size) were applied. Restorations were evaluated according to the ART restoration and USPHS criteria. Data were statistically analyzed using the proportional hazard rate regression model with frailty correction. Results: 272 class II restorations were placed in 131 people (mean age 26.2 years) by two dentists. The dropout rate of restorations was 2.6%. According to ART restoration and USPHS criteria, the 2-year cumulative survival rates of class II ART/HVGIC restorations were 96.2% and 97.0%, respectively, and 97.8% and 98.5%, respectively, for the conventional class II resin-composite restorations. No differences were observed in the cumulative survival rates between the two treatment groups at 2 years (ART criteria: p=0.26; USPHS criteria p=0.23). Conclusion: HVGIC Equia Fil used in the ART method with axial grooves and Filtek Z250 in the conventional method provided high survival rates for restoring class II cavities over 2 years. [ABSTRACT FROM AUTHOR]

Purpose: To test the hypotheses: 1) cumulative survival rates of fully and partially retained high-viscosity glass-ionomer (HVGIC) ART sealants with heat application and glass-carbomer sealants on occlusal and free-smooth surfaces are both higher than that of resin sealants; 2) cumulative survival rate of fully and partially retained high-viscosity glass-ionomer ART sealant with heat application on occlusal and free-smooth surfaces is higher than that of comparable ART sealants without heat application. Materials and Methods: The block-randomised clinical trial covered 405 eight-year-old children. The HVGIC was Ketac Molar Easymix, the glass carbomer was GlassCarbomer and the resin sealant was Clinpro. Retention rates of sealants on occlusal and free-smooth surfaces using conventional and modified categorisation (fully and partially retained sealants vs those completely lost [at least one-third of surface re-exposed]) were the dependent variables. The Kaplan-Meier survival method was used. Results: The cumulative survival rate of completely and partially retained resin sealants on occlusal (81.2%) and free-smooth (81%) surfaces after 4 years was statistically significantly higher, and that of glass-carbomer sealants (10.8% and 21.1%, respectively) was statistically significantly lower than those of the other sealant groups. There was no statistically significant difference in survival rates of completely and partially retained high-viscosity glass-ionomer ART sealants with (56% for both surfaces) or without heat application (56%) on occlusal and free-smooth surfaces (55.7% and 59.1%, respectively). Conclusions: Resin sealants had the highest and glass-carbomer sealants the lowest retention rate after 4 years. Application of heat to high-viscosity glass-ionomer ART sealants did not result in a significantly higher sealant retention rate. Use of the modified categorisation for determining sealant retention is advocated. [ABSTRACT FROM AUTHOR]

Objectives: To assess the 3-year cumulative survival rate of atraumatic restorative treatment (ART) and conventional resin composite restorations (CRT) placed in persons with disability. Materials and methods: Patients referred for restorative care to the Haemophilia Foundation special care service were treated by one of two specialists. Patients and/or caregivers were provided with written and verbal information regarding treatment options and selected the alternative they preferred. Treatment was provided as selected unless this option proved clinically unfeasible when an alternative technique was proposed. The treatment protocols were ART (hand instruments/high-viscosity glass-ionomer) in the clinic or CRT (rotary instrumentation/resin composite) in the clinic or under general anaesthesia (GA). After 6, 12, 24 and 36 months, two independent, trained and calibrated examiners evaluated restoration survival using established ART codes. The proportional hazard model with frailty corrections gave survival estimates over 3 years. Results: Sixty-six patients (13.6 ± 7.8 years) with 16 different disability profiles participated. CRT in the clinic proved feasible for five patients (13%), and 14 patients received CRT under GA (21%). ART was used for 47 patients (71.2%). Altogether, 298 dentine carious lesions were restored in primary and permanent teeth (182 ART; 116 CRT). The 3-year cumulative survival rates and jackknife standard errors for the 182 ART and 116 CRT restorations were 94.8 ± 2.1 and 82.8 ± 5.3%, respectively ( p = 0.01). Conclusions: The 3-year follow-up results confirm that ART is an effective treatment protocol. Clinical relevance: Patients with disability, many of whom have difficulty coping with CRT, may benefit from the ART approach. [ABSTRACT FROM AUTHOR]

Objective The aim of the study was to evaluate the exfoliation pattern of primary molars treated according to three treatment protocols. The hypothesis tested was that there is no difference in the exfoliation pattern of primary molars treated according to conventional restorative treatment using amalgam ( CRT), atraumatic restorative treatment using high-viscosity glass-ionomer ( ART), and ultraconservative treatment ( UCT). The latter consisted of restoring small cavities with ART and cleaning medium/large nonrestored cavities daily with toothpaste/toothbrush under supervision. Methods A sample of 302 children aged 6-7 years from a suburban area of Brasilia was followed up for 3.5 years. The numbers of treated molars were 341 ( CRT), 244 ( ART), and 275 ( UCT). Exfoliation rates were obtained using the PHREG procedure. Differences between the three treatment protocol groups were tested using the Wald test. Results After 3.5 years, there was no difference over the exfoliation rates of all primary molars as 51.0% ( CRT), 48.7% ( ART), and 48.1% ( UCT) had exfoliated at the overall period ( P = 0.37). Teeth with multiple-surfaces treatment had exfoliated in a higher proportion than teeth with single-surface treatments for all the three treatment groups ( P = 0.04). Conclusion The three treatment protocols led to similar exfoliation patterns of all primary molars after 3.5 years. [ABSTRACT FROM AUTHOR]

Background Providing restorative treatment for persons with disability may be challenging and has been related to the patient's ability to cope with the anxiety engendered by treatment and to cooperate fully with the demands of the clinical situation. The aim of the present study was to assess the survival rate of ART restorations compared to conventional restorations in people with disability referred for special care dentistry Methods Three treatment protocols were distinguished: ART (hand instruments/high-viscosity glassionomer); conventional restorative treatment (rotary instrumentation/resin composite) in the clinic (CRT/clinic) and under general anaesthesia (CRT/GA). Patients were referred for restorative care to a special care centre and treated by one of two specialists. Patients and/or their caregivers were provided with written and verbal information regarding the proposed techniques, and selected the type of treatment they were to receive. Treatment was provided as selected but if this option proved clinically unfeasible one of the alternative techniques was subsequently proposed. Evaluation of restoration survival was performed by two independent trained and calibrated examiners using established ART restoration assessment codes at 6 months and 12 months. The Proportional Hazard model with frailty corrections was applied to calculate survival estimates over a one year period Results 66 patients (13.6 ± 7.8 years) with 16 different medical disorders participated. CRT/clinic proved feasible for 5 patients (7.5%), the ART approach for 47 patients (71.2%), and 14 patients received CRT/GA (21.2%). In all, 298 dentine carious lesions were restored in primary and permanent teeth, 182 (ART), 21 (CRT/clinic) and 95 (CRT/GA). The 1-year survival rates and jackknife standard error of ART and CRT restorations were 97.8 ± 1.0% and 90.5 ± 3.2%, respectively (p = 0.01) Conclusions These short-term results indicate that ART appears to be an effective treatment protocol for treating patients with disability restoratively, many of whom have difficulty coping with the conventional restorative treatment. Trial registration number Netherlands Trial Registration: NTR 4400. [ABSTRACT FROM AUTHOR]

Objectives: The aims of this study were to compare 2-year cumulative survival rates of amalgam and atraumatic restorative treatment (ART) restorations in primary molars and to investigate the determinants of the survival rate of restorations. Materials and methods: A controlled clinical trial using a parallel group design was carried out on 258 children aged 6-7 years old, allocated to two treatment groups: conventional restorative treatment using amalgam and ART using high-viscosity glass ionomer. A total of 364 amalgam restorations and 386 ART restorations were placed by three pedodontists in 126 and 158 children, respectively, and were evaluated after 0.5, 1, and 2 years. Restorations were placed in vital primary molars with neither pain nor signs of pulp involvement. The survival analysis was conducted using the proportional hazard rate regression model with frailty correction. Results: The 2-year cumulative survival rates for all amalgam (77.3 %) and ART (73.5 %) restorations were not statistically significantly different, but there was an effect of 'type of surface' (single/multiple) and 'cavity filling time' on the survival rates. Both amalgam and ART single-surface restorations had higher survival rates than multiple-surface restorations of the same material. Secondary caries was responsible for 36 and 38 % of failures in amalgam and ART restorations, respectively. Mean time for restoring all type of cavities with amalgam and ART restorations was 13.6 and 13.7 min, respectively. Conclusions: Amalgam and ART restorations presented similar survival rates over a 2-year period for all, single-surface, and multiple-surface restorations. Clinical relevance: In the cause of finding alternatives to amalgam, ART restorations using high-viscosity glass ionomer might be a suitable option for managing cavitated dentine carious lesions in vital primary molars. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective. To test the hypothesis that dental anxiety levels of children treated in accordance with the conventional restorative treatment (CRT) are higher than in children treated with the atraumatic restorative treatment (ART) or ultra-conservative treatment (UCT) protocols. Materials and methods. In total, 302 children aged 6-7-years old, with at least two dentine carious lesions, constituted the sample. A parallel group study design was used with ART and UCT as test groups and CRT as the control. The treatment was divided into two sessions. In the first session, one carious tooth (class II in a primary molar) was randomly selected and treated according to one of the treatments. All other treatments were performed in the second session. Before the first (FIS Tx-1) and before the second session (FIS Tx-2) the level of dental anxiety was assessed using the Facial Image Scale (FIS). The GLM test and Spearman's Rank Correlation Coefficient were used to analyse the data. Results. No treatment group effect was observed on the FIS Tx-2 score ( p == 0.64). A FIS Tx-1 score ( p < 0.0001) effect on the FIS Tx-2 score was observed. The correlation coefficient between FIS Tx-1 and FIS Tx-2 scores was r == 0.30 ( p < 0.0001). Conclusion. At the beginning of the second session there was no difference in dental anxiety levels of the children treated in the first session according to the three treatment protocols. A high dental anxiety score before the first session was a predictor of a high dental anxiety score at the second treatment session. [ABSTRACT FROM AUTHOR]

de Menezes Abreu DM, Leal SC, Mulder J, Frencken JE. Pain experience after conventional, atraumatic, and ultraconservative restorative treatments in 6- to 7-yr-old children. Eur J Oral Sci 2011; 119: 163-168. © 2011 Eur J Oral Sci The hypothesis was tested that the level of pain experienced by children during conventional restorative treatment is higher than during atraumatic restorative treatment (ART) or an ultraconservative treatment. The sample consisted of 244 children, 6- to 7 yr of age, who had at least two teeth with dentine carious lesions. Before the first treatment session (Tx-1), in which one of the carious teeth was treated using one of the treatments, the level of dental anxiety was assessed using the Facial Image Scale (FIS). The child reported the intensity of pain experienced during the procedure using the Wong-Baker FACES Pain Rating Scale. When conventional restorative treatment was used, more children needed local anaesthesia. Analyses excluding the data of children who had received local anaesthesia showed no treatment group effect on the Wong-Baker score, a FIS Tx-1 effect on the Wong-Baker score, and a statistically significant correlation between FIS Tx-1 and Wong-Baker scores. There was no significant difference in the pain levels of children treated using conventional restorative treatment, atraumatic restorative treatment or ultraconservative treatment. Local anaesthesia had to be administered more frequently to children in the conventional restorative group than to those in the other two treatment groups. [ABSTRACT FROM AUTHOR]

Objectives To assess and compare the cumulative survival rate of amalgam and atraumatic restorative treatment (ART) restorations in primary molars over 3 years. Methods 280 children aged 6–7 years old were enrolled in a cluster randomized controlled clinical trial using a parallel group design covering two treatment groups: conventional restorative treatment with amalgam (CRT) and atraumatic restorative treatment (ART) using a high-viscosity glass-ionomer (HVGIC) Ketac Molar Easymix. Three pedodontists placed 750 restorations (364 amalgam and 386 ART in 126 and 154 children, respectively) which were evaluated at 0.5, 1, 2 and 3 years. The proportional hazard rate regression model with frailty correction, ANOVA and Wald tests, and the Jackknife procedure were applied in analysing the data. Results The cumulative survival rates over 3 years for all, single- and multiple-surface CRT/amalgam restorations (72.6%, 93.4%, 64.7%, respectively) were no different from those of comparable ART/HVGIC restorations (66.8%; 90.1% and 56.4%, respectively) ( p = 0.10). Single-surface restorations had higher survival rates than multiple-surface restorations for the both treatment procedures ( p < 0.0001). A higher proportion of restorations failed because of mechanical reasons (94.8%) than of secondary caries (5.2%). No difference in reasons for restoration failures between all types of amalgam and ART/HVGIC restorations were observed ( p = 0.24). Significance The high-viscosity glass-ionomer used in this study in conjunction with the ART is a viable option for restoring carious dentin lesions in single surfaces in vital primary molars. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The hypotheses tested were: the cumulative survival rates of dentin caries lesion-free pits and fissures of ART conventional high-viscosity glass-ionomer sealants with light-curing (high-intensity LED) and glass-carbomer sealants are higher than those of conventional ART sealants and resin-composite sealants after 4 years. Methods: The randomized controlled clinical trial covered 405 children (mean age 8-years). Three dentists placed sealants in pits and fissures of high caries-risk children. Evaluation by two independent evaluators was conducted after 0.5, 1, 2, 3 and 4 years. The Kaplan–Meier survival method, ANOVA and t-test were used in data analyses. Results: 1304 first permanent molars were sealed. 12.3% of children and 15.4% of sealants dropped out. 46 re-exposed pits and fissures, 39 (occlusal) 7 (free smooth surfaces), in 42 children developed a dentin carious lesion. The cumulative survival of dentin caries lesion-free occlusal pits and fissures in ART plus LED group (98%) was statistically significantly higher than in the resin-composite group (96.4%) and in the glass-carbomer group (94.5%). The cumulative survival of dentin caries lesion-free occlusal pits and fissures in the glass-carbomer group was statistically significantly lower than that in the conventional ART group (97.3%). For the free smooth surfaces, there was no statistically significantly difference among the four sealant groups. Significance: Light-cured ART conventional high-viscosity glass-ionomer sealants prevented the occurrence of dentin cavities best. [Copyright &y& Elsevier]