One-year follow-up of Atraumatic Restorative Treatment(ART) for dental caries in children undergoing oncohematological treatment: a pragmatic trial Low-cost glass ionomer cement as ART sealant in permanent molars: a randomized clinical trial. 3-year survival rates of retained composite resin and ART sealants using two assessment criteria. An atraumatic restorative treatment (ART) technique: evaluation after one year. Cost-effectiveness of ART restorations in elderly adults: a randomized clinical trial. Comparison of two tooth-saving preparation techniques for one-surface cavities. Effectiveness of conventional treatment using bulk-fill composite resin versus Atraumatic Restorative Treatments in primary and permanent dentition: a pragmatic randomized clinical trial Survival of ART and Amalgam Restorations in Permanent Teeth of Children after 6.3 Years Two-year survival of ART restorations placed in elderly patients: A randomised controlled clinical trial. Effectiveness of Three Minimal Intervention Approaches for Managing Dental Caries: Survival of Restorations after 2 Years A 2-year clinical study of two glass ionomer cements used in the atraumatic restorative treatment (ART) technique. Amalgam and ART restorations in children: a controlled clinical trial Clinical evaluation of the ART approach and materials in peri-urban farm schools of the Johannesburg area. Survival of glass ionomer restorations placed in primary molars using atraumatic restorative treatment (ART) and conventional cavity preparations: 2-year results. Survival Rate of Atraumatic Restorative Treatment (ART) Restorations Using a Glass Ionomer Bilayer Technique with a Nanofilled Coating: A Bi-center Randomized Clinical Trial. 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. Atraumatic restorative treatment (ART): a three-year clinical study in Malawi--comparison of conventional amalgam and ART restorations. Provision of Atraumatic Restorative Treatment (ART) restorations to Chinese pre-school children--a 30-month evaluation. Survival rates of two atraumatic restorative treatment (ART) types in occlusal carious permanent teeth after two years. Bilayer technique and nano-filled coating increase success of approximal ART restorations: a randomized clinical trial. Is high-viscosity glass-ionomer-cement a successor to amalgam for treating primary molars? The effect of GIC-brand on the survival rate of proximal-ART restorations. Clinical Investigation of Two Glass–Ionomer Restoratives Used with the Atraumatic Restorative Treatment Approach in China: Two–Years Results Effectiveness of Glass-Ionomer (ART) and Amalgam Restorations in the Deciduous Dentition: Results after 3 Years Effects of oral hygiene, residual caries and cervical Marginal-gaps on the survival of proximal atraumatic restorative treatment approach restorations Survival rate of approximal-ART restorations using a two-layer technique for glass ionomer insertion Is ART really atraumatic? Managing dental caries with atraumatic restorative treatment in children: successful experience in three Latin American countries. One-year survival of occlusal ART restorations in primary molars placed with and without cavity conditioner. ART and Conventional Root Restorations in Elders after 12 Months The atraumatic restorative treatment (ART) approach to restoring primary teeth in a standard dental clinic. In vitro evaluation of sealing pits and fissures with newer glass-ionomer cements developed for the ART technique. Survival of occlusal ART restorations in primary molars placed in school environment and hospital dental setup-one year follow-up study. Evaluation of Class I ART restorations in Brazilian schoolchildren: three-year results. Self-report of pain in children treated according to the atraumatic restorative treatment and the conventional restorative treatment--a pilot study. Restoration of permanent teeth in young rural children in Cambodia using the atraumatic restorative treatment (ART) technique and Fuji II glass ionomer cement. Influence of the cavity-size on the survival rate of proximal ART restorations in primary molars. A clinical evaluation of resin-based composite and glass ionomer cement restorations placed in primary teeth using the ART approach: results at 24 months. Atraumatic perspectives of ART: psychological and physiological aspects of treatment with and without rotary instruments. Two years survival rate of Class II ART restorations in primary molars using two ways to avoid saliva contamination. Restorative Outcomes of a Minimally Invasive Restorative Approach Based on Atraumatic Restorative Treatment to Manage Early Childhood Caries: A Randomised Controlled Trial Clinical evaluation of the ART technique using high density and resin-modified glass lonomer cements. Survival of Fuji IX ART fillings in permanent teeth of primary school children in Tanzania. Caries-preventive Effect of Supervised Toothbrushing and Sealants Influence of the experience of operator and assistant on the survival rate of proximal ART restorations: two-year results The influence of restorative treatment approaches and the use of local analgesia, on the children's discomfort. Performance of atraumatic restorative treatment (ART) depending on operator-experience. Caries-Preventive Effect of a One-Time Application of Composite Resin and Glass Ionomer Sealants after 5 Years Cost‐effectiveness analysis of the atraumatic restorative treatment‐based approach to managing early childhood caries The 3.5-year survival rates of primary molars treated according to three treatment protocols: a controlled clinical trial Survival of self-etch adhesive Class II composite restorations using ART and conventional cavity preparations in primary molars. Six-Year Success Rates of Occlusal Amalgam and Glass-Ionomer Restorations Placed Using Three Minimal Intervention Approaches Atraumatic Restorative Treatment: Clinical, Ultrastructural and Chemical Analysis Clinical Trial of a New Glass Ionomer for an Atraumatic Restorative Treatment Technique in Class I Restorations Placed in Latvian School Children Pain related to different ways of minimal intervention in the treatment of small caries lesions. The effects of two cavity preparation methods on the longevity of glass ionomer cement restorations: an evaluation after 12 months. Short communication: Influence of different isolation methods on the survival of proximal ART restorations in primary molars after two years. One-year evaluation of atraumatic restorative treatment and minimum intervention techniques on primary teeth. Atraumatic Restorative Treatment with Resin-Modified Glass Ionomer Material: Short-Term Results of a Pilot Study COMPARISON OF TWO MINIMALLY INVASIVE METHODS ON THE LONGEVITY OF GLASS IONOMER CEMENT RESTORATIONS: SHORT-TERM RESULTS OF A PILOT STUDY A clinical evaluation of two glass ionomer cements in primary molars using atraumatic restorative treatment technique in India: 1 year follow up. Efficacy of conventional treatment with composite resin and atraumatic restorative treatment in posterior primary teeth: study protocol for a randomised controlled trial Clinical investigation of a high-strength glass ionomer restorative used with the ART technique in Wuhan, China: one-year results. Clinical evaluation of multiple-surface ART restorations: 12 month follow-up. The dilemma of selecting suitable proximal carious lesions in primary molars for restoration using ART technique. Caries-preventive effect of glass ionomer and resin-based fissure sealants on permanent teeth: An update of systematic review evidence Atraumatic Restorative Treatment compared to the Hall Technique for occluso-proximal cavities in primary molars: study protocol for a randomized controlled trial A study on the survival of primary molars with intact and with defective restorations. Improving antiretroviral therapy adherence in resource‐limited settings at scale: a discussion of interventions and recommendations Comparison of atraumatic restorative treatment and conventional cavity preparations for glass-ionomer restorations in primary molars: one-year results. An ART field study in western Nepal. Do light cured ART conventional high-viscosity glass-ionomer sealants perform better than resin-composite sealants: a 4-year randomized clinical trial. Influence of residual caries and cervical gaps on the survival rate of class II glass ionomer restorations Glass ionomer ART sealant and fluoride-releasing resin sealant in fissure caries prevention – results from a randomized clinical 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 . Clinical trials are normally performed with well-known br and s of glass ionomer cement ( GIC ) , but the cost of these material s is high for public healthcare in less-affluent communities . Given the need to research cheaper material s , it seems pertinent to investigate the retention rate of a low-cost GIC applied as atraumatic restorative treatment ( ART ) sealants in two centers in Brazil . Four hundred and thirty-seven 6-to-8-year-old schoolchildren were selected in two cities in Brazil . The children were r and omly divided into two groups , according to the tested GIC applied in the first permanent molars . The retention rate was evaluated after 3 , 6 and 12 months . Kaplan-Meier survival analysis and the log-rank test were performed . The variables were tested for association with sealant longevity , using logistic regression analyses ( α = 5 % ) . The retention rate of sealants after 12 months was 19.1 % . The high-cost GIC br and presented a 2-fold-more-likely-to-survive rate than the low-cost br and ( p < 0.001 ) . Significant difference was also found between the cities where the treatments were performed , in that Barueri presented a higher sealant survival rate than Recife ( p < 0.001 ) . The retention rate of a low-cost GIC sealant br and was markedly lower than that of a well-known GIC sealant br and The aim was to test the null-hypothesis that there is no difference in the cumulative survival rate of retained composite resin ( CR ) sealants and a high-viscosity glass-ionomer Atraumatic Restorative Treatment ( ART ) sealant in first permanent molars calculated according to the traditional and the modified retention assessment criteria over a period of 3 years . This cluster-r and omized controlled clinical trial consisted of 123 schoolchildren , 6 - 7-years-old . At baseline , high-caries risk pits and fissures of fully erupted first permanent molars were treated with CR and ART sealants . Evaluations were performed after 0.5 , 1 , 2 and 3 years . Retention was scored for free-smooth surface and for each of three sections into which the occlusal surface had been divided . The modified criterion differed from the traditional in that it determined an occlusal sealant to be a failure when at least one section contained no visible sealant material . Data were analysed according to the PHREG model with frailty correction , Wald-test , ANOVA and t-test , using the Jackknife procedure . The cumulative survival rates for retained CR and ART sealants in free-smooth and occlusal surfaces for both criteria were not statistically significantly different over the 3 years . A higher percentage of retained CR sealants on occlusal surfaces was observed at longer evaluations . Cumulative survival rates were statistically significantly lower for the modified criterion in comparison to the traditional . The modified retention assessment criterion should be used in future sealant-retention studies Extraction is the most common dental treatment provided for people in rural and suburban areas in many less-industrialised countries . By comparison , restorative care is rarely provided . In order to improve such situations , a treatment technique has been developed based only on h and excavation of carious lesions and using glass-ionomer cement as a filling material and a sealant . This Atraumatic Restorative Treatment ( ART ) technique follows the concept of minimal intervention and does not require electrically driven equipment . This paper reports on the longevity of fillings and sealants placed using the technique under field conditions in rural Thail and .  Dental caries was treated using the ART technique in one village , whilst the population in a second village received restorative care ( amalgam fillings ) through mobile dental units . A third village was the control . After one year , 79 per cent of single surface ART fillings and 55 per cent of ART fillings of greater than one surface placed in deciduous teeth were judged successful . The success rate of ART fillings  in the permanent dentition ( mainly single surface fillings ) was 93 per cent and the retention rate for sealants was 78 per cent . Children were pleased at having received treatment by this technique and showed little fear . The ART technique is a promising caries treatment procedure for use in rural and sub-urban areas in less-industrialised countries BACKGROUND As the world population ages , the requirement for cost-effective methods of treating chronic disease conditions increases . In terms of oral health , there is a rapidly increasing number of dentate elderly with a high burden of maintenance . Population surveys indicate that older individuals are keeping their teeth for longer and are a higher caries risk group . Atraumatic Restorative Treatment ( ART ) could be suitable for patients in nursing homes or house-bound elderly , but very little research has been done on its use in adults . OBJECTIVES To compare the cost-effectiveness of ART  and a conventional technique ( CT )  for restoring carious lesions as part of a preventive and restorative programme for older adults . METHODS In this r and omized clinical trial , 82 patients with carious lesions were r and omly allocated to receive either ART or conventional restorations .  Treatment costs were measured based on treatment time , material s and labour . For the ART group , the cost of care provided by a dentist was also compared to the cost of having a hygienist to provide treatment . Effectiveness was measured using percentage of restorations that survived after a year . RESULTS Eighty-two patients received 260 restorations , that is , 128 ART and 132 conventional restorations . 91.1 % of the restorations were on one surface only . After a year , 252 restorations were assessed in 80 patients .  The average cost for ART and conventional restorations  was € 16.86 and € 28.71 respectively ; the restoration survival percentages were 91.1 % and 97.7 % , respectively . This result ed in a cost-effectiveness ratio of 0.18 ( ART ) and 0.29 ( CT ) . When the cost of a hygienist to provide ART was inserted in the analysis , the result ing ratio was 0.14 . CONCLUSIONS Atraumatic restorative treatment was found to be a more cost-effective alternative to treat older adults after 1 year , compared to conventional restorations , especially in out of surgery facilities and using alternative workforce such as hygienists . Atraumatic restorative treatment can be a useful tool to provide dental care for frail and fearful individuals who might not access dental treatment routinely The atraumatic restorative treatment technique ( ART ) is based on removing infected tooth material using only h and 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 re sources 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 h and instruments result ed 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 h and instruments required more time , this did not seem to affect the survival of restorations . The survival of glass ionomer cement restorations  made with h and 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 h and 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 h and 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 population Background Clinical studies are being conducted in less strict conditions in order to establish an adequate scientific basis for decision making . The aim of this pragmatic r and omized clinical trial is to evaluate the effectiveness of single and multiple-surfaces restorations performed following the Atraumatic Restorative Treatment ( ART ) premises compared with Conventional Treatment ( CT ) using bulk fill composite restorations in primary and permanent teeth . Methods / design A total of 1,214 5-to-13 year-old children with at least one single or multiple-surface dentin caries lesion in primary or permanent molars will be selected in public schools of Barueri-SP , Brazil . The participants will be r and omly assigned into 2 groups : CT ( caries removal with bur and restoration performed with Scotchbond ™ Universal Adhesive system associated with Filtek Bulk Fill – 3 M/ESPE ) and ART ( Caries removal with h and instruments and restoration with high viscosity glass ionomer cement Ketac Molar Easy Mix – 3 M/ESPE ) . Ten untrained dentists will perform the treatment in in dental offices located at public schools . The restorations will be evaluated after 6 , 12 and 24 months by an independent trained and calibrated examiner . The restoration and tooth survival , the cost-effectiveness analysis between the two groups and the operators ’ preferences regarding the techniques will be also evaluated . Kaplan-Meier survival analysis and log-rank test will be applied for the restoration and tooth survival . All the average event rates in the two groups will be modelled and compared with a Cox proportional hazard shared frailty model since there is an operator-cluster effect . The significance level for all analyses will be 5 % . Discussion Our hypothesis is that despite similar expected effectiveness between ART using high viscosity GIC and conventional treatment using bulk fill composite resin when treating single or multiple-surface in posterior primary and permanent teeth , ART will present superior cost-effectiveness . The results of this trial will support decision-making by clinicians and policy makers . Trial registration NCT02568917 . Registered on May 10th 2015 The null hypothesis tested was that there is no difference in the survival percentages of all restorations placed through the Atraumatic Restorative Treatment ( ART ) approach , with high-viscosity glass ionomer , and those produced through the traditional approach , with amalgam ( TA ) , in the permanent dentitions of children after 6.3 years . Using a parallel group design , we r and omly assigned a total of 370 children , aged 6 to 9 years , to the ART group and 311 children , also aged 6 to 9 years , to the TA group . Eight dentists placed a total of 1117 single- and multiple-surface restorations . The cumulative survival percentages  for ART glass-ionomer restorations were statistically significantly higher than those of amalgam restorations at all time intervals except the first ( p ≤ 0.044 ) . After 6.3 years , the cumulative survival percentages of ART and amalgam restorations were 66.1 % ( SE = 3.1 % ) and 57.0 % ( SE = 3.3 % ) , respectively . We concluded that the restorations produced with the ART approach , with high-viscosity glass ionomer , survived longer than those produced with the traditional approach , with amalgam , in the permanent teeth of young children OBJECTIVES Older dentate adults are a high caries risk group who could potentially benefit from the use of the atraumatic restorative treatment ( ART ) . This study aim ed to compare the survival of ART and a conventional restorative technique ( CT ) using rotary instruments and a resin-modified glass-ionomer for restoring carious lesions as part of a preventive and restorative programme for older adults after 2 years . METHODS In this r and omised controlled clinical trial , 99 independently living adults ( 65 - 90 years ) with carious lesions were r and omly allocated to receive either ART or conventional restorations . The survival of restorations was assessed by an independent and blinded examiner 6 months , 1 year and 2 years after restoration placement . RESULTS Ninety-six ( 67.6 % ) and 121 ( 76.6 % ) restorations were assessed in the ART and CT groups , respectively , after 2 years . The cumulative restoration survival percentages after 2 years were 85.4 % in the ART and 90.9 % in the CT group . No statistically significant between group differences were detected ( p=0.2050 , logistic regression analysis ) . CONCLUSIONS In terms of restoration survival , ART was as effective as a conventional restorative approach to treat older adults after 2 years . This technique could be a useful tool to provide dental care for older adults particularly in the non- clinical setting . ( TRIAL REGISTRATION NUMBER IS RCT N 76299321 ) . CLINICAL SIGNIFICANCE The results of this study show that ART presented survival rates similar to conventional restorations in older adults . ART appears to be a cost-effective way to provide dental care to elderly patients , particularly in out of surgery facilities , such as nursing homes The present study was aim ed 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 h and 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 re sources 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 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 r and omly 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 clinical ly , 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 associated with the restorations . Although the short-term clinical performance of the two glass ionomer cements was reasonable , the material s 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 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 . Material s 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 In this study , 1,325 school children from 7 farm schools were examined . Their mean age ( + /- SD ) was 10.5 + /- 3.0 ( range 6 - 11 ) years . At baseline , the mean DMFT score was 1.1 + /- 1.7 and 36.4 % of the children had caries . The prevalence of fluorosis among the children was 12.6 % . Curative treatment was offered to all the children . A total of 113 children ( 8.5 % ) with one-surface cavities on permanent teeth and without fluorosis were treated using the atraumatic restorative treatment ( ART ) approach . A total number of 163 cavities were included in the study , of which 82 were treated with Fuji IX glass-ionomer cement and 81 with Ketac-MOLAR ( h and mix ) . One year after treatment , restoration and sealant parts of ART fillings were examined . Caries status was also determined . The placing of the ART fillings and their evaluation were performed by different practitioners . A total number of 108 restorations  ( 58 with Fuji IX , 50 with Ketac-MOLAR ) were evaluated . Results of ART fillings showed a survival rate of 93.1 % with Fuji and 94.0 % with Ketac-MOLAR .  Retention of the sealant parts of ART fillings  was observed in 81 % of restorations with Fuji IX and 76 % with Ketac-MOLAR , not connected to the filled cavity . Caries was absent on all teeth restored with Fuji IX and noted in only one tooth restored with Ketac-MOLAR , not connected to the filled cavity . The retention rate after a 12-month period was acceptable and ART approach proved to be an appropriate technique for restoring teeth in this population group . There were no statistically significant differences between the survival rates of the two glass-ionomer restorative material s ( P > 0.05 ) 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 h and instruments , and conventional cavity preparation with rotary instruments . METHOD AND MATERIAL S 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 h and 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 PURPOSE The high-viscosity consistency of glass ionomer cement ( GIC ) contributes to its inappropriate adaptation , while the material 's premature exposure to humidity decreases its mechanical properties . This study 's purpose s were to : ( 1 ) investigate approximal atraumatic restorative treatment ( ART ) restorations ' survival in primary molars using two different insertion techniques and two surface protection material s ; and ( 2 ) compare the results of cities where treatments were performed . METHODS A total of 389 six- to seven-year-olds were selected from two cities in Brazil and r and omly assigned into four groups : ( 1 ) ART restorations plus petroleum jelly ( PJ ) ; ( 2 ) bilayer-ART restorations plus PJ ; ( 3 ) ART restorations plus nanofilled coating for GIC ( NC ) ; ( 4 ) bilayer-ART restorations plus NC . Restorations were evaluated after one , six , 12 , 18 , and 24 months . Kaplan-Meier survival analysis , log-rank test , and Cox regression analysis were performed . RESULTS Restorations ' cumulative survival was 46.4 percent . There was a higher survival of bilayer-ART restorations ( P=0.03 ) . No difference was observed between surface protection material s ( P=0.57 ) . Restorations made in Barueri were almost 2.5-fold more likely to survive than those from Recife ( P<0.001 ) . CONCLUSIONS The bilayer technique improves approximal ART restorations ' survival in primary molars . The nanofilled coating does not influence restorations ' survival rate , and the city where treatments were performed influences restoration survival 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 r and omly 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 st and ard 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 OBJECTIVE This study compares the quality of class I restorations  made with the atraumatic restorative treatment ( ART ) technique and conventional class I amalgam restorations . METHODS The study was carried out among secondary school students in Mzuzu , Malawi . First-year students in 1987 who needed at least two class I restorations were selected . Based on a split-mouth design , each participant received both ART and conventional restorations . The 89 pairs of class I cavities were divided r and omly into two groups , since two different cermet ionomer cement ( CIC ) filling material s were used . Impressions of the restorations and subsequent models were made shortly after restoration , after six months , one year , two years , and three years . The quality of the restorations was determined on the models following the US Public Health Service criteria . Bulk fracture , contour , marginal integrity , and surface texture of the restorations were recorded and evaluated separately . Survival rates were determined by the result ant score of all criteria . RESULTS Though conventional amalgam restorations performed better on all criteria , this difference was significant only for the contour criterion . The survival rates of ART restorations after three years ( 81.0 % ) were lower than those of amalgam restorations ( 90.4 % ) ( P=.067 ) . CONCLUSIONS The quality of ART class I restorations is competitive with that of conventional amalgam restorations 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 st and ard ART procedures and h and 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 OBJECTIVE To compare survival rates of Atraumatic Restorative Treatment ( ART ) restorations placed with and without conditioners in occlusal cariouspermanent teeth after two years . MATERIAL AND METHODS The study was an experimental study among children , mean age 13.1 + /- 3.0 years . Two types of ART restorations  were r and omly placed on 186 occlusal carious permanent teeth on contralateral sides using split mouth design . Ethical clearance to conduct the study was obtained from the UI/UCH Review Committee . ART was performed using GC Fuji IX GP and teeth that were conditioned with GC Dentine Conditioner .  Time taken to place restorations and average material cost were recorded . Follow-up of subjects to evaluate integrity of restorations was conducted at 6 monthly intervals by one independent examiner . Proportions and percentages were generated ; student t-test was used to compare means . Cumulative survival rates were determined by the coded scores and st and ard criteria for evaluating ART restorations . RESULTS There was no significant difference in the mean time for placing ART restorations  with or without conditioners and in the cumulative survival rates of both treatment types after 2 years ( p > 0.05 ) . CONCLUSION ART restorations placed without tooth conditioners can achieve similar result as those placed with conditioners BACKGROUND The high-viscosity consistency of glass ionomer cement ( GIC ) may lead to its incorrect adaptation into the cavity and therefore to restoration failure . AIM To compare two different insertion techniques for GIC in approximal atraumatic restorative treatment ( ART ) restorations and two different surface protection material s. DESIGN Approximal caries lesion in primary molars from 208 schoolchildren was r and omly assigned into four groups : G1 , conventional GIC insertion protected with petroleum jelly ( PJ ) ; G2 , bilayer technique protected with PJ ; G3 conventional GIC insertion protected with nano-filled particles coating for GIC ( NPC ) ; G4 , bilayer technique protected with NPC . Restorations were evaluated after 1 , 6 , 12 , 18 , 24 , and 36 months . Kaplan-Meier survival analysis and log-rank test were performed . Cox regression analysis ( α = 5 % ) was used to verify the influence of clinical factors . RESULTS Restoration survival was 52.8 % . Log-rank test indicated a better survival of the bilayer technique restorations , compared to conventional restorations ( P = 0.005 ) , whereas the coated conventional restorations presented higher survival than the uncoated ones ( P = 0.035 ) . Cox regression analysis showed no influence of any clinical tested variables . CONCLUSION The survival rate of the approximal ART restorations is positively influenced by the bilayer technique , and the application of nano-filled coating increases the longevity of the conventional approximal ART restorations 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 r and omized 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 BACKGROUND Laboratory studies show diverse behaviour of different br and s of glass-ionomer cements  ( GIC ) . AIM This study investigated the clinical performance [ survival rate ( SR ) ] of three GIC br and s applied to proximal atraumatic restorative treatment ( ART ) restorations . Additionally , the SR of the tooth was evaluated . DESIGN Proximal cavities of 262 primary molars were restored . The patients had been r and omly allocated to two operators and three GIC br and s :  Fuji IX , Hi-Dense , and Maxxion R. Restorations were evaluated after 1 , 6 , 12 , 18 , 24 , 30 , and 36 months . Failed restorations were , if possible , repaired or replaced . Linear regression analyses were used to evaluate the effect of GIC br and , operator , and surface of restoration . Kaplan-Meier survival analysis and log-rank test were performed for both restoration survival and tooth survival ( α = 5 % ) . RESULTS After 3 years , 82.4 % of the restorations were evaluated . The SR of the restorations was 24.4 % , and there was no difference among GIC br and s ( log-rank test , P = 0.6 ) . In the first 18 months , a significant operator effect and significantly higher failures in distal surfaces were found . The SR of the tooth was 81.7 % . CONCLUSIONS The SR of proximal ART restorations was relatively low when compared with the SR of the tooth . There are no differences in the performance among the GIC br and s used in the study Objective : To compare the clinical performance of two glass – ionomer cements , ChemFlex ( Dentsply DeTrey ) and Fuji IX GP ( GC ) , when used with the atraumatic restorative treatment ( ART ) approach in China . Methods : Eighty – nine school children aged between 6 and 14 years who had bilateral matched pairs of carious posterior teeth were included . A split – mouth design was used in which the two material s were r and omly placed on contralateral sides . The performance of the restorations was assessed directly and also indirectly from die – stone replicas at baseline and after 6 , 12 , and 24 months . Results : The 24–month cumulative survival rates of ART restorations  in the primary teeth were 93 and 90 % for the ChemFlex and Fuji IX GP class I restorations , respectively , while 40 and 46 % of class II restorations placed with the respective material s were satisfactory . In the permanent dentition , only class I restorations were involved and the cumulative survival rates were 95 and 96 % for ChemFlex and Fuji IX GP . For the primary teeth after 24 months , net mean occlusal wear was 87 µm for ChemFlex and 85 µm for Fuji IX GP . The occlusal wear in the permanent teeth was 75 µm for ChemFlex and 79 µm for Fuji IX GP . Conclusion : The clinical performance of both material s over a 24–month period was similar and the survival rates of class I ART restorations  in both primary and permanent teeth were high This study compared the survival of restorations produced through the atraumatic restorative treatment ( ART ) approach using glass-ionomer with those produced through the traditional approach using amalgam ( MTA ) in deciduous dentitions over a period of 3 years . Using a parallel group design , 835 grade 1 children , aged 6–7 years , participated . A total of 482 children were treated through the ART and 353 children through the MTA approach .  Eight dentists produced a total of 1,891 single- and multiple-surface restorations . After 3 years , 22.1 % of the restorations were lost for evaluation . There was a statistically significant difference in the combined survival of all single- and multiple-surface restorations between the two approaches in favour of the ART approach ( p = 0.04 ) . The study revealed a 3-year cumulative survival percentage of single-surface ART and MTA restorations of 86.1 and 79.6 % , respectively . The difference was statistically significant ( p = 0.03 ) . The main reasons for both single-surface ART and MTA restorations to fail was ‘ restoration missing ’ followed by ‘ gross marginal defect ’ . The 3-year cumulative survival percentages of multiple-surface ART and MTA restorations were 48.7 and 42.9 % , respectively . The difference was not statistically significant ( p > 0.05 ) . The 3-year survival percentages of single- and multiple- surface ART and MTA restorations varied widely amongst the 8 operators with an operator effect ( p = 0.001 ) for multiple-surface MTA restorations . It can be concluded that the ART approach using glass-ionomer yielded better results in treating dentinal lesions in deciduous teeth than did the traditional approach using amalgam after 3 years . It is recommended to select the ART approach to complement the other activities of the school oral health programme Background : Although Atraumatic restorative treatment ( ART ) approach has been in existence for a while , the reasons for the poor performance of multisurface ART restorations are not very clear . Aim : The aim of this study is to investigate the effects of oral hygiene , residual caries and cervical marginal-gaps on survival of proximal ART restorations . Setting s : Two rural divisions in Kenya were selected for the study . Design : A r and omized clinical trial . Material and Methods : The 804 children in the study had their baseline- and 2-year dental plaque levels documented . Each child received one proximal restoration in a primary molar using ART approach , together with trained and pre-tested operators/assistants , three glass ionomer cements (GIC)-br and s and two tooth-isolation methods . The restorations were clinical ly evaluated soon after placement and after 2 years . Post-restorative bite-wing radiographs taken soon after restoration were also evaluated . Statistical analysis : Statistical Package for Social Sciences ( SPSS ) version 14 computer programme was used and results tested using Pearson 's correlation , Cox Proportional Hazards regression analysis and Multiple Logistic regression models tests . Results : At baseline and after 2 years , the mean cumulative survival and plaque index changed from 94.4 % to 30.8 % and 2.34 ( St and ard Deviation , or SD of 0.46 ) to 1.92 ( SD 2.1 ) respectively , with higher plaque indices associated with higher restoration failures . Of the 507 radiographs evaluated , 48 ( 9.5 % ) , 63 ( 12.4 % ) and 9 ( 1.8 % ) restorations had residual caries ( RC ) , cervical marginal-gaps ( CMG ) and both RC/CMG respectively . Survival of the restorations with RC/CMG was significantly lower ( p = 0.003 ) compared to those with RC or without RC . Conclusion : Low survival of proximal restorations in the study was associated with the presence of cervical marginal-gaps Objective Good survival rates ( SR ) have been reported for occlusal-atraumatic restorative treatment ( ART ) restorations but not for approximal-ART restorations . The high-viscosity consistency of the glass ionomer cement ( GIC ) may lead to its incorrect adaptation into the cavity and thus to failure of the restoration . Because the use of a flowable GIC layer seemed to improve its adaptation in approximal restorations in vitro , we evaluated whether the use of an intermediate flowable GIC layer would improve the SR of approximal-ART restorations . Methods A total of 208 children ( 6–7 years old ) with at least one occluso-proximal carious lesion in a primary molar were selected and r and omly allocated to two groups : G1 , conventional technique , one-layer GIC ( powder/liquid ratio 1:1 ) ; and G2 , two-layer technique , consisting of a first layer of GIC with a flowable consistency ( powder/liquid ratio 1:2 ) and a second layer of a regular consistency . Restorations were made by final-year students and evaluated after 1 , 6 , 12 and 18 months . Restoration survival was evaluated using Kaplan – Meier survival and logrank test . Poisson regression analyses ( α = 5 ) were used to verify the influence of factors such as insertion technique , restoration surface and operators . Results The overall SR of the restorations after 18 months was 68 % . There was no difference in SR between the techniques , neither did the other factors influence the SR . Conclusions Over 18 months , the use of an intermediate flowable GIC layer in approximal-ART restorations does not improve the restoration survival . Clinical relevance This study suggests that the two-layer technique is not the answer for increasing approximal-ART restoration longevity Atraumatic restorative treatment ( ART ) is an approach to the management of carious lesions that uses only h and 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 h and 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 h and instruments were smaller than those produced with rotary instruments . Reported discomfort was associated 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 OBJECTIVE To compare survival rates and cost differentials between the atraumatic restorative treatment ( ART ) technique and amalgams by type of dental personnel in Ecuador , Panama , and Uruguay . METHODS Children 7 to 9 years of age in rural and urban schools with at least one lesion with initial cavitated enamel caries or a dentinal lesion on a first permanent molar were selected and r and omized into the ART ( intervention ) or amalgam ( control ) group . Restoration failure was evaluated at 12 and 24 months . Cooperation and pain experienced during the procedures were measured . Cumulative and incident failure of restorations at 12 and 24 months was calculated for dentists who placed ART or amalgam restorations and auxiliaries who placed ART restorations at 12 months only . RESULTS The total sample comprised 1 629 children . Study groups were similar by country , gender , and geographic location . Cumulative failure rate at 12 months varied by group : dentists ' amalgam , 0.9 % to 5.7 % ; dentists ' ART , 2.0 % to 10.5 % ; and auxiliaries ' ART , 5.7 % to 15.8 % . At 24 months , higher cumulative failures were observed for the dentists ' amalgam group compared with the dentists ' ART group in Ecuador and Panama but not in Uruguay . Amalgam was least likely to have the best level of cooperation and an auxiliary using ART was associated with the least pain . The cost of using the ART approach  for dental caries treatment , including retreatment , was roughly half that of using amalgam without retreatment . CONCLUSIONS Having auxiliary personnel perform ART will lead to treatment survival that is expected to be lower than dentists using amalgam or ART . In spite of the greater risk of failure , the rate is not unacceptable and potential cost savings are substantial PURPOSE The objectives of this clinical study were to : evaluate the survival of  occlusal atraumatic restorative treatment ( ART ) restorations  , on a longitudinal basis , in the primary molars of children in Mosul/Iraq ; and compare the success rate of ART restorations placed with and without cavity conditioning . METHODS One dentist placed 96 ART restorations in 48 6- to 7-year-olds who had bilateral matched pairs of carious primary molars . A split-mouth design was used to place restorations with and without cavity conditioning , which were assigned r and omly to contralateral sides . Restorations were evaluated after 6 and 12 months using the ART criteria . RESULTS The survival rate of ART restorations  placed with cavity conditioner was 89 % at the 6-month assessment and 74 % at the 12-month assessment . The success rates of ART restorations  placed without cavity conditioning in the 2 assessment s were 84 % and 67 % , respectively . There was no statistically significant difference between the ART restorations placed with and without cavity conditioner in both assessment s ( P>0.05 ) . The main cause of failure was the loss of restoration . CONCLUSIONS The 1-year success rate of occlusal ART restorations in primary molars was moderately successful . The ART technique 's cavity conditioning step was not proven to be better than not using it for Class I lesions Successful use of atraumatic restorative treatment ( ART ) in children has been reported , but little information is available regarding its use in older adults . The hypothesis of this study was that survival rates of root restorations placed by both ART and the conventional technique were similar . Root-surface caries lesions in 103 institutionalized elders in Hong Kong were treated r and omly by either : ( 1 ) the conventional approach — caries removed by dental burs , and the cavity filled with light-cured resin-modified glass ionomer ; or ( 2 ) the ART approach — caries removed by h and instruments , and the cavity filled with chemically cured high-strength glass ionomer . In total , 84 conventional and 78 ART restorations were placed . After 12 months , 63 conventional and 59 ART restorations were review ed , and the respective 12-month survival rates were 91.7 % and 87.0 % ( p > 0.05 ) . It is concluded that the survival rates of both types of root restorations were high and similar OBJECTIVES The aims of this study are to assess the feasibility of the  Atraumatic Restorative Treatment ( ART ) approach in primary teeth and to compare the ART approach with traditional amalgam restorations in primary molars . METHODS This study was conducted in a paediatric dentistry clinic in Kuwait between April 1999 and December 2001 . The ART and amalgam restorations were placed r and omly on comparable pairs of primary molars , if available . In addition , the ART approach was used for other primary teeth that had no pulpal involvement and no perceived pain before treatment . The restorations were assessed by both the ART evaluation criteria and USPHS criteria in August-September 2000 and in August-December 2001 . The mean follow-up period for the restorations was 8.3 months in the first assessment ( 2000 ) and 22 months in the second assessment ( 2001 ) . The assessment was possible for 35 children ( mean age = 5.7 years ) , 18 of whom had comparable pairs ( n = 35 pairs ) of restorations in their primary molars . In addition , 48 other ART restorations  were assessed in 2000 and 42 in 2001 . RESULTS In a 2-year follow-up , 89.6 % of all ART restorations were considered successful . The failure rate of the comparable pairs of ART and amalgam restorations was 5.7 % . There was no significant difference in success rate between ART and amalgam techniques . CONCLUSIONS Based on a 2-year follow-up evaluation , the class I ART restorations seemed to have a high success rate , indicating the appropriateness of the ART approach in primary teeth Four conventional glass-ionomer cements specifically developed for use with the atraumatic restorative treatment ( ART ) technique were compared with a resin-based sealant for marginal and surface dye penetration , material voids , and completeness of enamel fissure penetration .  Thirty sound permanent m and ibular molar teeth were r and omly divided into five groups . After delayed placement of the glass-ionomer cement sealants using st and ardized finger pressure , and conventional placement of the resin-based sealant using a dental probe , the teeth were first thermocycled then the crowns immersed in methylene blue dye before being sectioned . There were no statistically significant differences found between any of the five material s , apart from less marginal dye leakage being present for the resin-based sealant than for one of the glass-ionomer cements . The cements , however , showed better fissure penetration than did the sealant . Despite the delayed placement and higher viscosity , all of the glass-ionomer cements showed satisfactory penetration of the enamel fissures and minimal marginal and surface dye penetration , and material voids , when placed using firm finger pressure . The cements could prove to be useful in the dental treatment of apprehensive children OBJECTIVE The objectives of this clinical study were to : evaluate the survival of occlusal atraumatic restorative treatment ( ART ) restorations  , on a longitudinal basis , in the primary molars of children ; and compare the success rate of ART restorations placed in school environment and in hospital dental setup . STUDY DESIGN One dentist placed 120 ART restorations in 60 five- to seven year-olds who had bilateral matched pairs of carious primary molars . A split-mouth design was used to place restorations in school and in hospital dental setup , which were assigned r and omly to contralateral sides . Restorations were evaluated after 6 and 12 months using the ART criteria . RESULTS The survival rate of ART restorations  placed in school environment was 82.2 % at the 6-month assessment and 77.77 % at the 12-month assessment . The success rates of ART restorations  placed in hospital dental setup in the 2 assessment s were 87.7 % and 81.48 % , respectively . There was no statistically significant difference between the ART restorations  placed in school environment and hospital dental setup in both assessment s ( P > O.05 ) . The main cause of failure was the loss of restoration . CONCLUSIONS The one year success rate of occlusal ART restorations in primary molars was moderately successful . The ART technique 's done in hospital dental setup was not proven to be better than restorations placed in school environment Atraumatic Restorative Treatment ( ART ) has been adopted around the world to avoid unnecessary extraction s , especially in non-industrialized countries . The development of specific glass ionomer cements marketed for the ART technique has contributed to the technical success rate . In this study , Ketac-Molar ( 3 M ESPE , Dental Medzin , Germany ) was used to restore 150 Class I cavities in 118 Brazilian public school children , aged from 7 - 12 years . At baseline and at subsequent recalls , CPI probes with a ball-end of 0.5 millimeters ( mm ) were used to assess loss of restorative material , and photographic color transparencies of restorations were made . After six months , 83 patients returned for follow-up examinations , with 71.8 % of their restorations design ated as acceptable . After three years , 49 patients with 57 ART-restorations were evaluated , with 21.0 % of these restorations grade d as acceptable . Another 29.8 % of their restorations had been replaced by more permanent material s. The main objective of the ART technique is tooth retention ; this was achieved for 94.7 % of the restored teeth in a high caries risk population who returned for recalls OBJECTIVE To compare the level of pain among children treated according to the Atraumatic Restorative Treatment ( ART ) and the Conventional Restorative Treatment ( CRT ) .  STUDY DESIGN Forty children of both genders , 4- to 7-years old , presenting Class I cavitated dentin lesions in primary molars were r and omly allocated to 2 groups . One group ( CRT ) received conventional restorative treatment using rotary instruments , while in the other one ( ART ) h and instruments were used to perform the restorations . All children were treated by the same operator A high-viscosity glass-ionomer cement ( Fuji IX ) was used to restore the teeth in both groups . Children 's pain was measured at the end of the first restorative treatment session using the Wong-Baker FACES Pain Rating Scale ( dependent variable ) . Age , gender , treatment time and treatment group were independent variables . ANOVA and ANCOVA tests were used to analyze the data . RESULTS The CRT procedure took longer than the ART procedure ( p < 0.001 ) . Children from the ART group reported less pain than those from the CRT group ( p = 0.0037 ) . Four year olds reported more pain than 5- to 7-year olds ( p < 0.0001 ) in both groups . CONCLUSIONS Restorations placed using ART were less time consuming , children felt less pain when the ART approach was used , and younger children ( 4-years ) reported more pain than the older ones for both restorative treatments UNLABELLED 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 h and 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 r and omly 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 st and ard 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 AIM To evaluate the influence of the size of proximal cavities on the survival rate of the  atraumatic restorative treatment ( ART ) restorations . DESIGN A total of 804 children , aged 6 - 8 years , from a low socio-economic community , with an ART restorable proximal carious lesion in their primary molars , participated . Over a 3-week period , three ' experienced ' and four ' inexperienced ' operators r and omly paired with four ' experienced ' and four ' inexperienced ' assistants , made the restorations at site using h and instruments . They r and omly used Fuji IX , Ketac Molar Easymix and Ketac Molar Aplicap glass ionomer cements to restore the cavities , under r and omly selected rubber dam and cotton roll isolation methods . The fillings were independently evaluated by nine trained and calibrated evaluators . RESULTS After 1 year , the survival rate of the fillings evaluated in the study was 44.8 % . Irrespective of the other factors involved , restorations with the highest survival rate were of size between 2 and 3 mm ( mesio-distal , bucco-lingual , and depth ) or volumes 10.0 - 19.9 mm(3 ) ( Chi-square , P = 0.002 , KM mean survival of 345 days ) . CONCLUSIONS While the survival rates for class II ART restorations were still low , the choice of medium-sized proximal cavities gave better survival rates for this technique BACKGROUND The authors evaluated the 24-month performance of a packable resin-based composite/dentin bonding system and a high-viscosity glass ionomer cement ( GIC ) in restorations placed in primary molars with the atraumatic restorative treatment ( ART )  approach . METHODS Three dentists placed 419 restorations in 219 children aged 6 through 10 years who had bilateral matched pairs of carious posterior Class I and II primary teeth . They used a split-mouth design to place the two material s , which were assigned r and omly to contralateral sides . The authors evaluated the restorations according to U.S. Public Health Service Ryge criteria . RESULTS After 24 months , 96.7 percent of the Class I GIC restorations and 91 percent of the resin-based composite restorations survived , while the success rates for the Class II restorations were 76.1 percent and 82 percent for the GIC and resin-based composite restorations , respectively . The survival rate of the Class II resin-based composite restorations was 5.9 percent higher than that of the GIC restorations at the 24-month evaluation , but this difference was not statistically significant . However , the study results showed a statistically significant difference in survival rates between Class I and II restorations for both material s. CONCLUSION AND CLINICAL IMPLICATION S The two-year clinical performance of both material s was satisfactory for the restoration of Class I and II primary molars using the ART approach Atraumatic Restorative Treatment , ART , is a method of minimal caries intervention that uses only h and instruments . The aim of the present study was to explore a possible difference between the extent of discomfort experienced during dental treatment according to the ART approach and a method using rotary instruments .  The study was performed in Indonesia . A total of 403 children were r and omly divided in two groups . In each child , one class II restoration in a deciduous molar was made . One group received treatment using rotary instruments ( 750 r.p.m . ) . The other group was treated according to the ART approach . Glass ionomer cement was used for restoration in both groups . Discomfort scores were determined using both physiological measurements ( heart rate ) and behavioral observations ( Venham ) on specific moments during the treatment . Venham scores showed a marked difference between the two groups at most time points . Heart rate measurements were different at deep excavation . Also , a clear relation between Venham scores and heart rate measurements could be found at all time points . Confounding could be shown for operating dentist , gender of the patient and initial anxiety , not for age . No effect modification could be shown . It can be concluded that children treated according to the ART approach using h and instruments alone experience less discomfort than those treated using rotary instruments AIM To compare the survival rates of Class II Atraumatic Restorative Treatment ( ART ) restorations placed in primary molars using cotton rolls or rubber dam as isolation methods . METHODS A total of 232 children , 6 - 7 years old , both genders , were selected having one primary molar with proximal dentine lesion . The children were r and omly assigned into two groups : control group with Class II ART restoration made using cotton rolls and experimental group using rubber dam . The restorations were evaluated by eight calibrated evaluators ( Kappa > 0.8 ) after 6 , 12 , 18 and 24 months . RESULTS A total of 48 ( 20.7 % ) children were considered dropout , after 24 months . The cumulative survival rate after 6 , 12 , 18 and 24 months was 61.4 % , 39.0 % , 29.1 % and 18.0 % , respectively for the control group , and 64.1 % , 55.1 % , 40.1 % and 32.1 % , respectively for the rubber dam group . The log rank test for censored data showed no statistical significant difference between the groups ( P = 0.07 ) . The univariate Cox Regression showed no statistical significant difference after adjusting for independent variables ( P > 0.05 ) . CONCLUSION Both groups had similar survival rates , and after 2 years , the use of rubber dam does not increase the success of Class II ART restorations significantly A pragmatic r and omised controlled trial comparing a minimally invasive approach based on atraumatic restorative treatment ( ART ) procedures ( test ) was tested against the st and ard-care approach ( control ) to treat early childhood caries ( ECC ) in a primary -care setting in Perth , W.A. , Australia . Parent/child dyads with ECC were allocated to the test or control group using stratified block r and omisation . Children were examined at baseline and follow-up by two calibrated examiners blinded to group allocation status . Dental therapists trained in ART provided treatment to the test group and dentists treated the control group . Restoration quality was evaluated at follow-up using the ART criteria . Data were analysed on an intention-to-treat basis ; test of proportions , Wilcoxon rank test and logistic regression , controlling for clustering of teeth , were used . Two hundred and fifty-four children were r and omised ( test = 127 and control = 127 ) . There was no statistically significant difference in age , sex and baseline caries experience between the test and control groups . At follow-up ( mean interval 11.4 months , SD 3.1 ) , 220 children were examined ( test = 115 and control = 105 ) and 597 teeth ( test = 417 and control = 180 ) were evaluated for restoration quality , of which 16.8 % ( test ) and 6.7 % ( control ) were judged to have failed ( required replacement ; p < 0.01 ) . Intention-to-treat , multiple logistic regression found multisurface restorations ( OR = 10.4 ) had significantly higher odds of failure , while referral for specialist paediatric care had significantly lower odds of restoration failure ( OR = 0.2 ) . The ART-based approach enabled more children and teeth to be treated , and multisurface restoration and treatment in a primary -care setting had higher odds of restoration failure PURPOSE The aim of this study was to evaluate the performance of two different glass ionomer cements using the Atraumatic Restorative Treatment ( ART ) technique in permanent teeth . MATERIAL S AND METHODS A total of 473 ART restorations were placed in 208 schoolchildren ( 7 - 12 years of age ) by two previously trained operators , using high density and resin-modified glass ionomer cements . All the restorations were photographed at baseline and the patients were asked about postoperative sensitivity . After a period of 8 months , 193 patients were present after recall and 428 restorations were evaluated and photographed . Two independent examiners carried out the evaluation . RESULTS The results showed a success rate of 86.2 % for occlusal restorations with Fuji IX and 88.4 % for those restored with Fuji Plus . A total of 86.7 % of the approximal restorations with Fuji Plus were also judged to be successful after 8 months . No association was found between the material s and the clinical performance of the ART restorations in class I cavities . CONCLUSION The type of restorative material did not influence the success or failure rates in class I cavities within this period . Fuji IX showed promising performance for occlusal ART restorations and Fuji Plus is also a promising material for occlusal and approximal ART restorations OBJECTIVE To evaluate the clinical performance of atraumatic restorative treatment ( ART ) fillings using Fuji IX as a filling material in field conditions . DESIGN Longitudinal study of the ART fillings in permanent teeth of primary school children aged eight to fifteen years . SETTING Primary schools in Morogoro municipality , Tanzania . SUBJECTS AND METHODS St and ard 3 and 4 children in five primary schools r and omly selected from a list of 36 primary schools of Morogoro municipality were examined for dental caries and periodontal conditions . All 296 carious lesions that were indicated for restoration were treated using ART approach according to the instructions given in the manual for ART approach for the control of dental caries . Essential measurements for treated teeth and cavity were taken . The cavities were filled with Fuji IX glass ionomer cement as per manufacturer 's instructions . After one year , 238 restorations were evaluated using the criteria for evaluating ART restorations . MAIN OUTCOME MEASURE Clinical appearance of the surface of the restorations . RESULTS Ninety four per cent of the restorations evaluated were rated as good and intact , while 1.7 % were rated as having slight defects that needed no repair , giving a one year survival rate of 96.1 % . Mean working time was 14.5 minutes . CONCLUSIONS AND RECOMMENDATIONS The one-year survival rate of 96.1 % is high enough to recommend wide use of ART in Tanzania . Town and municipal councils should be encouraged to adopt ART in their school oral health programmes To investigate the effectiveness of 3 caries-preventive measures on high– and low – caries risk occlusal surfaces of first permanent molars over 3 y. This cluster-r and omized controlled clinical trial covered 242 schoolchildren , 6 to 7 y old , from low socioeconomic areas . At baseline , caries risk was assessed at the tooth surface level , through a combination of ICDAS II ( International Caries Detection and Assessment System ) and fissure depth codes . High – caries risk occlusal surfaces were treated according to daily supervised toothbrushing ( STB ) at school and 2 sealants : composite resin ( CR ) and atraumatic restorative treatment – high-viscosity glass-ionomer cement ( ART-GIC ) . Low – caries risk occlusal surfaces received STB or no intervention . Evaluations were performed after 0.5 , 1 , 2 , and 3 y. A cavitated dentine carious lesion was considered a failure . Data were analyzed according to the proportional hazard rate regression model with frailty correction , Wald test , analysis of variance , and t test , according to the jackknife procedure for calculating st and ard errors . The cumulative survival rates of cavitated dentine carious lesion – free , high – caries risk occlusal surfaces were 95.6 % , 91.4 % , and 90.2 % for STB , CR , and ART-GIC , respectively , over 3 y , which were not statistically significantly different . For low – caries risk occlusal surfaces , no statistically significant difference was observed between the cumulative survival rate of the STB group ( 94.8 % ) and the no-intervention group ( 92.1 % ) over 3 y. There was neither a difference among STB , CR , and ART-GIC on school premises in preventing cavitated dentine carious lesions in high – caries risk occlusal surfaces of first permanent molars nor a difference between STB and no intervention for low – caries risk occlusal surfaces of first permanent molars over 3 AIM : The objective of the study was to determine the influence of the experience of the operator and the assistant on the survival rate of proximal ART-restorations after 2 years when placed using two methods of tooth-isolation and three glass ionomer cement-br and s. STUDY DESIGN : A clinical intervention study . METHODS : Each of 804 children aged 6–8 years received one proximal restoration in their primary molars . The restorations were placed by ‘ experienced/inexperienced ’ operators r and omly paired with ‘ experienced/ inexperienced ’ assistants . The atraumatic restorative treatment ( ART ) approach was used with 3 br and s of glass ionomer cements ( GIC ) and 2 tooth-isolation methods ( rubber dam vs cotton rolls ) . Trained and calibrated evaluators evaluated the restorations , soon after placement and after 2 years . STSTISTICS : The data collected were analyzed using SPSS 14.0 , to determine and relate the survival rate of the restorations to the operator and assistant with respect to the other factors such as the restorative material used and the isolation method applied . RESULTS : After 2 years , the survival rate of the restorations was 30.8 % . In general , there were no statistical significant differences in the survival rate of the restorations made by the ‘ experienced ’ vs ‘ inexperienced ’ operators , but individually , the operator with more experience was associated with a significantly higher survival rate of the restorations . The experienced assistants were associated with significantly higher survival rates of the restorations . The most ‘ experienced ’ operator paired with any ‘ experienced ’ assistant and using rubber dam tooth-isolation method , was associated with a significantly higher survival rate of the restorations . CONCLUSION : The combination of the ‘ experienced ’ operator and assistant using rubber dam tooth-isolation method had the best chance of survival for proximal ART restorations , irrespective of the material -br and used AIM The aim is to investigate possible differences in discomfort during treatment with the atraumatic restorative treatment ( ART ) or the Conventional restorative method with and without local analgesia ( LA ) . METHODS The study group consisted of 6 and 7 year old children with no dental experience ( mean age 6.98 , SD + /- 0.52 ) r and omly divided into four treatment groups : Conventional method with and without LA and ART with and without LA . One or two proximal lesions in primary molars were treated . The heart rate and the behaviour ( Venham ) were measured . STATISTICS Statistical analysis was performed in SPSS version 10.0 . RESULTS In a first session 300 children were treated and 109 children for a second time in the same way as at the first visit . During the first session ART without LA gave the least discomfort while the Conventional method without LA gave the most discomfort . During the second treatment the least discomfort was observed with ART without LA and the most discomfort in the Conventional way with LA . CONCLUSION There is a constant preference for h and instruments ; the bur is increasingly accepted . The experience with LA is the reverse OBJECTIVES Oral health care is not of major interest in developing countries because of lack of infrastructure and professional manpower . Therefore , atraumatic restorative treatment ( ART ) was introduced by the World Health Organization to be performed by dental auxiliary personnel . The aim of this study was to evaluate the performance of ART depending on operator-experience in The Republic of The Gambia . METHODS One hundred twenty-eight newly inserted restorations  were followed up for 12 months using the clinical ART index in a prospect i ve and blinded study design . The patients were r and omly assigned to operators . The clinical performance was compared among three groups : trainees , experienced Community Oral Health Workers ( COHW ) , and professional dentists . The difference in success rates was calculated at a 95 percent confidence interval . RESULTS There was a statistically significant difference between trainees and dentists in performing leakage/gap-free one-surface restorations ( P < 0.05 ) . No significant differences were found between the two groups of auxiliaries ( trainees versus experienced COHWs , P > 0.05 ) . Finally , both groups -- experienced COHWs and dentists -- performed restorations not showing statistically significant differences ( P > 0.05 ) . CONCLUSIONS For The Republic of The Gambia -- especially for areas with underdeveloped medical infrastructure -- training and assignment to perform ART can be recommended for auxiliary dental staff of Community Oral Health Workers The aim of the present trial was to ( 1 ) compare the caries-preventive effect of glass ionomer sealants , placed according to the atraumatic restorative treatment ( ART ) procedure , with composite resin sealants over time and ( 2 ) investigate the caries-preventive effect after complete disappearance of sealant material . Forty-six boys and 57 girls , mean age 7.8 years , were r and omly divided into two treatment groups in a parallel-group study design . A light-polymerized composite resin sealant material and a high-viscosity glass ionomer were each placed in 180 fully erupted first molars in their respective treatment groups . Evaluation took place annually for 5 years by calibrated examiners . After 5 years , 86 % composite resin and 88 % glass ionomer sealants did not survive . Three categories of re-exposure periods for caries development in pits and fissures after complete loss of sealants were distinguished : 0–1 , 1–2 and 2–3 years . In the 2- to 3-year group , 13 and 3 % of pits and fissures previously sealed with composite resin and glass ionomer , respectively , were diagnosed as having developed a dentine lesion . The relative risks ( 95 % CI ) of dentine lesion development in surfaces sealed with glass ionomer compared to those sealed with composite resin after 3 , 4 and 5 years were 0.22 ( 0.06–0.82 ) , 0.32 ( 0.14–0.73 ) and 0.28 ( 0.13–0.61 ) , respectively . The relative risks of dentine lesion development in pits and fissures previously sealed with glass ionomer compared with composite resin over re-exposure periods of 1–2 and 2–3 years were 0.26 ( 0.14–0.48 ) and 0.25 ( 0.09–0.68 ) , respectively . We conclude that the caries-preventive effect of high-viscosity glass ionomer sealants , placed using the ART procedure , was between 3.1 and 4.5 times higher than that of composite resin sealants after 3–5 years . Furthermore , high-viscosity ( ART ) glass ionomer sealants appear to have a four times higher chance of preventing caries development in re-exposed pits and fissures of occlusal surfaces in first molars than light-cured composite resin sealant material over a 1- to 3-year period . A well- design ed clinical trial using different types of oral health personnel should be implemented to confirm these initial results OBJECTIVE Paediatric dental care under general anaesthesia among preschool children in Western Australia is increasing and costly . This study assessed cost-effectiveness of the atraumatic restorative treatment-based ( ART-based ) approach against the st and ard care ( SC ) approach to managing early childhood caries in a primary care setting based on a 1-year pragmatic r and omized controlled trial . METHODS Cost-effectiveness analysis , from the service provider perspective , was conducted . Outcomes include number of referral to specialists and dental treatments . One-way and probabilistic sensitivity analyses were undertaken to test the robustness of the cost-effectiveness estimates . RESULTS Six children in the ART-based group and 62 children in the SC group ( n = 127 each group ) were referred for paediatric dental specialist care . Children in the ART-based group received more dental services than those allocated to the SC group ( mean = 3.8 , SD 2.0 and mean = 1.8 , SD 1.8 , respectively , Wilcoxon rank-sum test , P < 0.01 ) . Total costs of the ART-based approach and the SC group were $ 137 860 and $ 178 217 , respectively . Based on probabilistic sensitivity analysis , $ 654 was saved per referral to specialist avoided and $ 36 was saved per additional dental treatment . The probability that the ART-based approach is cost-saving was 63 % . Specialist dental treatment fees had a big impact on the cost-effectiveness estimates . CONCLUSION The ART-based approach appears to be a worthwhile intervention because it result ed in fewer referred cases and enabled more treatments to be provided with cost-savings Objectives This study aim ed to test the hypothesis that there is no difference in the survival rates of molars treated according to the conventional restorative treatment ( CRT ) using amalgam , atraumatic restorative treatment ( ART ) using high-viscosity glass ionomer , and ultraconservative treatment ( UCT ) protocol after 3.5 years . Material s and methods Cavitated primary molars were treated according to CRT , ART , and UCT ( small cavities were restored with ART and medium/large cavities were daily cleaned with toothpaste/toothbrush under supervision ) . Molar extraction s result ing from toothache , sepsis , or pulp exposure were failures . The Kaplan – Meier method was used to estimate the survival curves . Results The numbers of treated teeth , among the 302 6–7-year-old children , were 341 ( CRT ) , 244 ( ART ) , and 281 ( for UCT group : 109 small ART , 166 open cavities , and 6 combinations ) . Protocol groups were similar at baseline regarding gender and mean decayed missing filled tooth score , but not regarding age and type of surface . The numbers of molars extracted were 22 ( CRT ) , 16 ( ART ) , and 26 ( UCT ) . Fistulae were most often recorded . After 3.5 years , the cumulative survival rate ± st and ard error for all molars treated was 90.9 ± 2.0 % with CRT , 90.4 ± 2.4 % with ART , and 88.6 ± 1.9 % with UCT ( p = 0.13 ) . Only a type of surface effect was observed over the 3.5-year period : survival rates for molars were higher for single- than for multiple-surface cavities . Conclusion There was no difference in the cumulative survival rates of primary molars treated according to the CRT , ART , and UCT protocol s over a 3.5-year period . Clinical relevance Keeping cavities in primary molars biofilm-free might be another treatment option alongside restoring such cavities through conventional and ART protocol PURPOSE To test the null-hypothesis that there was no difference in the survival percentages of Class II composite restorations in primary teeth produced through either ART or conventional approaches after 2 years . METHODS 157 children with 325 Class II cavitated dentin lesions were included in a split-mouth study design . A computer program r and omly assigned cavitated dentin lesions to treatment groups stratified for gender , operator , upper/lower jaw and left/right side of the mouth . Three operators placed resin composite ( Pertac II ) restorations using a self-etch adhesive ( Prompt L-Pop ) . Two independent examiners evaluated the restorations after 0.5 , 1 and 2 years using the modified Ryge criteria . A modification of the actuarial survival method was applied to estimate survival percentages . RESULTS There was no statistically significant difference ( P > 0.05 ) observed between the cumulative survival percentages of Class II composite restorations in primary teeth produced by the two approaches after 2 years ( ART : 34.9 % + /- 4.7 % ; conventional : 35.1 % + /- 4.7 % ) . The cumulative survival percentages of ART and conventional Class II restorations  of one of the operators were lower than for ART restorations of the other two operators and for conventional restorations of one of the operators ( P < or = 0.001 ) . The main reason for Class II composite restorations to fail over the 2-year period was complete loss of retention ; ART : 75 % ; conventional : 77 % . The null-hypothesis was accepted as there was no difference in the cumulative survival percentages of ART and conventional Class II composite restorations  in primary teeth after 2 years . It appears that the low survival results obtained may have been caused by poor bonding of the self-etch adhesive The present r and omised clinical trial was aim ed 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 material s were r and omly 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 With the purpose of checking , in vivo , the effect of atraumatic restorative treatment ( ART ) on the remaining demineralized dentin , 12 primary molars with deep occlusal lesions from children with ages ranging from 3 to 7 were evaluated . After lesion excavation , and before glass ionomer cement placement , dentin sample s were collected from the pulpal wall of the cavity . After 3 months , the restorations were removed and new sample s were collected . Six micro areas of each sample were analyzed by X-ray energy dispersion spectrometer . Sample s obtained before treatment were infected and intertubular dentin had a loosely organized collagen matrix , with well-defined collagen fibers . Following treatment , in addition to a drastic reduction of the amount of bacteria , the intertubular dentin was denser , with more compact and closely packed collagen fibers . An increased calcium concentration was observed in dentin collected after treatment ( p < 0.001 ) , suggesting tissue remineralization , but fluoride was not detected . We conclude that ART allows a one-session approach , with the purpose of creating more favorable conditions for the healing process Objective : The aim of this study was to evaluate the performance of a new glass ionomer filling material ( ChemFlex ™ ) using the atraumatic restorative treatment ( ART ) approach in class I cavities in the permanent dentition of Latvian schoolchildren . Methods : A total of 63 fillings ( 40 test and 23 control ) were placed using the ART technique in 41 schoolchildren in Riga at the Stomatology Institute of the Medical Academy of Latvia . These fillings were then blindly assessed after 2 years . Results : The complete success rate for both the test and the control material fillings were 92.5 and 94.9 % , respectively . Conclusion : The new glass ionomer filling has shown a good performance in terms of retention , marginal failure and fractures in class I cavities Pain during invasive treatment of dental caries is a common phenomenon , if no local analgesia has been used before cavity preparation . Atraumatic restorative technique ( ART ) is a suggested procedure which is at least less traumatic for the patient . Although the ART approach has been received well by both children and adults who belong to population groups hardly ever exposed to regular oral health care , it has not yet been proven that this particular procedure really causes less pain , compared to more conventional techniques with rotating instruments . In the present study , pain was reported in connection with tooth restoration in 19.3 percent of the cases , when the ART technique was used , which is significantly less than with a conventional restorative technique ( 35.7 percent ) . Finally the results show a clear relationship in the pain reports between the first and the following treatments in both ART and the conventional technique groups 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 ( 3 M ESPE , Seefeld , Germany ) . For comparison , they used high-copper-content GK Amalgam Alloy ( Advanced Technology & Material s 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 h and 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 Implication s. 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 AIM This was to evaluate the influence of two methods of tooth-isolation on the survival rate of proximal ART restorations in the primary molars . METHODS The study was conducted in two rural divisions in Kenya , with 7 operators r and omly paired to a group of 8 assistants . A total of 804 children each had one proximal cavity in a primary molar restored using the ART approach .  During restorations 2 isolation methods , rubber dam or cotton wool rolls , and 3 br and s of glass ionomer cements were used by the operators . The restorations were then followed for a period of 2 years . STATISTICS SPSS 14.0 was used to analyse and relate the data obtained to the method of isolation used . RESULTS After 2 years 30.8 % of the ART restorations had survived . Higher survival rates of the restorations were obtained when using rubber dam irrespective of the GIC material or the operator . CONCLUSION Generally the survival rate of the proximal restorations in the present study was very low , but the use of rubber dam result ed in a higher survival rate of the restorations Atraumatic restorative treatment ( ART ) and minimal intervention treatment ( MIT ) techniques were evaluated under field conditions in 5 regions of the Western Cape Province of South Africa , where caries prevalence exceeds 60 % and remains mostly untreated . The purpose of the study was to compare and evaluate results of  ART and MIT techniques in the primary dentition of 6 - 9 year-old schoolchildren using  glass-ionomer ( GI ) ( Fuji IX ) and compomer ( Dyract AP ) material s. At baseline 401 children were treated , and 1,119 restorations  placed by 5 calibrated dentists , 53 % with ART ( using h and instruments only ) and 47 % with MIT ( minimal use of slow h and -piece ) techniques . Evaluations were done with a CPI periodontal probe to measure marginal defects and to detect decay . A pain assessment for the restoration procedures indicated that 80 % of subjects experienced no pain , 18 % discomfort and slight pain , and 2 % required local anaesthetic . After one year 90.5 % of subjects and 80 % of restorations were followed up ( 11.1 % lost as a result of exfoliation ) ; of these restorations 86 % were clinical ly acceptable ( 84.1 % of the ART and 88 % of the MIT ) . With the art technique 82.7 % of GI restorations and 85.6 % , of compomer restorations were acceptable . With the MIT technique 86.5 % of GI restorations and 89.9 % of compomer restorations were acceptable . Success of restorations per region varied significantly : regions 1 and 2 - 90 % , region 3 - 80 % , region 4 - 70 % and region 5 - 95 % . There were no significant statistical differences in respect of material s or methods employed . ART and MIT techniques were well accepted as complementary caries approaches by operators . One-year results show that ART and MIT techniques were successful , substantiating its use for the primary dentition in areas with high caries prevalence . Longer-term assessment s are required 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 . Material s 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 r and omly 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 The purpose of this study was to evaluate the clinical performance of glass ionomer cement ( GIC ) restorations comparing two minimally invasive methods in permanent teeth after 12 months . Fifty pregnant women ( second trimester of pregnancy ) , mean age 22 ± 5.30 years , were treated by two previously trained operators . The treatment approaches tested were : chemomechanical method ( CarisolvTM ; MediTeam ) and atraumatic restorative treatment ( ART ) . A split-mouth study design was used in which the two treatments were r and omly placed in 50 matched pairs of permanent teeth . The chemomechanical method ( CM ) was the test group and the ART was the control group . The treatments were performed in Public Health Centers . The tested restorative material was a high-strength GIC ( Ketac Molar ; 3M/ESPE ) . The restorations were placed according to the ART guidelines . Two calibrated independent examiners evaluated the restorations in accordance with ART criteria . The interexaminer kappa was 0.97 . Data were analyzed using 95 % confidence interval on the binomial distribution and Fisher 's exact test at 5 % significance level . In a 12-month follow-up , 86 % of the restorations were evaluated . In the test group ( CM ) , 100 % ( CI=93.3 - 100 % ) of the restorations were considered successful . In the control group ( ART ) 97.6 % ( CI=87.4 - 99.9 % ) of the restorations were considered successful and 2.4 % unsuccessful ( marginal defect > 0.5 mm ) . There was no statistically significant difference between the 12-mounth success rate for both groups ( Fisher 's exact test : P=0.49 ) and between the two operators ( Fisher 's exact test : P=1.00 ) . Both minimally invasive methods , chemomechanical method and ART , showed a similar clinical performance after 12 months of follow up AIM To compare the clinical performance of two glass ionomer cements , Amalgomer CR and Fuji IX in small and medium cavities prepared using Atraumatic restorative treatment approach in India . STUDY DESIGN One hundred school children in the age group of 4 - 9 years who had bilateral matched pair of carious lesions in primary posterior teeth were included . A split mouth design was used in which two material s were r and omly placed in contralateral sides . The performance of the restorations was assessed after 1 year using Frenken 's criteria ( 1996 ) . Survival analysis of restoration was done using chi-square test . RESULTS The survival rate of Amalgomer CR and Fuji IX class I restorations were 97.4 % and 94.9 % , respectively . In class II cavities 95.1 % and 88.5 % of Amalgomer CR and Fuji IX restorations were successful . Amalgomer CR and Fuji IX showed a success of 94.2 % and 92.3 % in small sized class II cavities . Amalgomer CR showed a 100 % success for medium sized class I and II restorations . Whereas Fuji IX showed a 100 % and 66.7 % success in medium sized class I and II cavities . CONCLUSION The clinical performances of both material s were satisfactory at the end of 1 year and ART is suitable procedure to be done in a dental clinic for children Introduction Despite the widespread acceptance of conventional treatment using composite resin in primary teeth , there is limited evidence that this approach is the best option in paediatric clinics .  Atraumatic restorative treatment ( ART ) using high-viscosity glass ionomer cement has gradually become more popular because it performs well in clinical studies , is easy to h and le and is patient friendly . Therefore , the aim of this r and omised clinical trial study is to compare the restoration longevity of conventional treatment using composite resin with that of ART in posterior primary teeth . As secondary outcomes , cost-efficacy and patient self-reported discomfort will also be tested . Methods and analysis Children aged 3–6 years presenting with at least one occlusal and /or occlusal-proximal cavity will be r and omly assigned to one of two groups according to the dental treatment : ART ( experimental group ) or composite resin restoration ( control group ) . The dental treatment will be performed at a dental care trailer located in an educational complex in Barueri/SP , Brazil . The unit of r and omisation will be the child . A sample size of 240 teeth with occlusal cavities and 188 teeth with occlusal-proximal cavities has been calculated . The primary outcome will be restoration longevity , which will be clinical ly assessed after 6 , 12 , 18 and 24 months by two examiners . The duration of the dental treatment and the cost of all material s used will be considered when estimating the cost-efficacy of each treatment . Individual discomfort will be measured after each dental procedure using the Facial Scale of Wong-Baker . Ethics and dissemination This clinical trial was approved by the local ethics committee from the Faculty of Dentistry of the University of São Paulo ( registration no. 1.556.018 ) . Participants will be included after their legal guardians have signed an informed consent form containing detailed information about the research . Trial registration number www . clinical trials.gov , NCT02562456 ; Pre- results OBJECTIVE To evaluate the safety and effectiveness of a new glass ionomer restorative , ChemFlex , and to compare its clinical performance and wear to another popular material , Fuji IX GP , when used with the atraumatic restorative treatment ( ART ) approach in posterior teeth in school children . METHODS Ninety-two subjects aged between 6 and 14 years who had bilateral matched pairs of carious posterior teeth were selected . A split-mouth experimental design was used in which the two restorative material s were r and omly placed on contralateral sides . The restorations were assessed directly and also indirectly from color transparencies and die replicas . RESULTS After one year , the success rates of ART restorations  in the primary teeth were 96.6 % for ChemFlex restorations and 89.7 % for Fuji IX GP restorations placed in the Class I cavity preparations , whereas only 46.2 % ( ChemFlex ) and 61.5 % ( Fuji IX GP ) of Class II restorations were assessed as clinical ly satisfactory . In the permanent dentition , the success rates were 94.6 % and 98.2 % for ChemFlex and Fuji IX GP , respectively ; however , there was no statistically significant difference between the two restoratives for either the permanent or primary teeth . The mean occlusal wear after one year in the permanent teeth was 53.2 microns for ChemFlex and 56.3 microns for Fuji IX GP . Again , there were no statistically significant differences in wear between the two material s ( P > 0.05 ) . CONCLUSION The clinical performance of both ChemFlex and Fuji IX GP over a 12-month period was highly satisfactory and completely adequate for the ART technique , particularly in Class I cavities PURPOSE The purpose of this study was to evaluate the performance of multiple-surface restorations employing 2 different glass ionomer cements ( GICs ) and the Atraumatic Restorative Treatment ( ART ) approach in permanent molar teeth . METHODS This study examined 60 restorations--36 Class I restorations involving 2 or more tooth surfaces and 24 Class II restorations -- that were placed in 46 schoolchildren ( 9 - 16 years of age ) by 2 dentists using the ART approach . The restorations were r and omly divided into 2 groups : ( a ) 30 cavities were filled with high strength GIC ( Ketac Molar-3 M ESPE ) , and ( b ) 30 cavities were filled with resin-modified GIC ( Fuji VIII-GC Corp ) . Two independent calibrated examiners carried out the evaluations according to ART criteria . The interexaminer kappa was 0.92 . Data were su bmi tted to chi-square , McNemar , and Fisher 's tests . A difference was statistically significant if P<.05 . RESULTS In a 12-month follow-up , 59 restorations were evaluated . The success rates of the restorations were 100 % and 93 % for Fuji VIII and Ketac Molar , respectively . There was no statistically significant difference between GICs , cavity types , or operators . CONCLUSIONS Based on a 12-month follow-up evaluation , the clinical performance of the multiple-surface atraumatic restorative treatment restorations of both glass ionomer cements ( high-strength and resin-modified ) was considered satisfactory with a high success rate OBJECTIVE To determine the examiner 's accuracy in selecting proximal carious lesions in primary molars for restoration using the atraumatic restorative treatment ( ART ) approach . BASIC RESEARCH DESIGN Intervention study . CLINICAL SETTING AND PARTICIPANTS : A total of 804 six to eight year-olds from 30 rural schools in Kenya participated in the study . INTERVENTION Three examiners selected a total of 1,280 suitable proximal carious lesions in primary molars after examining 6,002 children from 30 schools r and omly selected out of 142 schools in two divisions . Seven operators r and omly paired on a daily basis with eight assistants restored the lesions . An explanation was provided for any cavity that was not restored . Pre- and post-operative  radiographs of the cavities were also taken for evaluation . MAIN OUTCOME MEASURES The examiner 's choice of suitable proximal cavities restorable using the ART approach  was related to the decision made to either restore or not during the operative stage . The radiographic findings of the selected cavities were also compared to the decision made by the operator . The results obtained were used to determine the examiner 's accuracy in selecting suitable proximal cavities for restoration using the ART approach . RESULTS The majority of the children recruited in the study were excluded due to absenteeism , pulpal-exposure or anxiety during the operative stage . Only 804 children received one restoration in their primary molars . The examiner 's accuracy in selecting suitable ART-restorable cavities  clinical ly was 94.9 % and based on radiographic analysis was 91.7 % . CONCLUSIONS A trained and diligent examiner has a very good chance of selecting proximal carious lesions restorable with the use of ART approach , without the threat of dental pulpal-involvement during the excavation of caries Background This article constitutes a partial up date of the original systematic review evidence by Yengopal et al. from 15 January 2008 ( published in the Journal of Oral Science in 2009 ) with primary focus on research quality in regard to bias risk in trials . Its aim is to up date the existing systematic review evidence from the English literature as to whether caries occurrence on pits and fissures of teeth sealed with either GIC or resin is the same . Methods In addition to the 12 trials included during the original systematic review , 5 new trials were identified during the data base search ( up to 26 August 2010 ) and 2 further trials were included from a h and search and reference check . Of these , 3 trials were excluded and 16 were accepted for data extraction and quality assessment . The quality of accepted trials was assessed , using up date d quality criteria , and the risk of bias was investigated in more depth than previously reported . In addition , the focus of quantitative synthesis was shifted to single data sets that were extracted from the accepted trials . Results Twenty-six dichotomous and 4 continuous data sets were extracted . Meta- analysis and cumulative meta- analysis were used in combining clinical ly homogenous data sets . The overall outcome of the computed data sets suggest no difference between the caries-preventive effects of GIC- and resin-based fissure sealants . Conclusions This overall outcome is in agreement with the conclusions of the original systematic review . Although the findings of the trials identified in this up date may be considered to be less affected by attrition- and publication bias , their risk of selection - and detection-/performance bias is high . Thus , verification of the currently available results requires further high quality r and omised control trials Background In many parts of the world , school-age children have high dental treatment needs ; however , there is often low , or no , dental care provision . Although Atraumatic Restorative Treatment ( ART ) was developed to address this , its survival rate in occluso-proximal lesions is low . An alternative , the Hall Technique ( HT ) has shown better relative outcomes for occluso-proximal lesions , but has not been directly compared to ART or tested in field setting s. This trial will compare ART and the HT for the most clinical ly- and cost-effective strategy for managing occluso-proximal lesions in primary molars , in a school setting , using low-technology and child-friendly dental techniques . Methods / Design This two-arm , parallel group , patient-r and omized controlled , superiority trial will have treatment provided in schools . Schoolchildren ( n = 124 , age 6–8 ) with at least one occluso-proximal carious primary molar lesion will have r and om allocation to treatment with ART or HT . Baseline measures and outcome data will be assessed through participant report , clinical examination and parent report/ question naires . The primary outcome is survival rate , a composite measure of absence of Minor Failures ( a defect in the restoration/crown , but not interfering with tooth health ) and Major Failures ( signs or symptoms of irreversible pulp damage , such as dental fistula/abscess , tooth fracture or failures that can not be repaired ) . Secondary outcomes are : ( 1 ) child-reported discomfort , ( 2 ) childrens ’ and ( 3 ) parents ’ concerns around dental appearance and ( 4 ) acceptability of treatments , ( 5 ) occlusal-vertical dimensions ( OVD ) changes , ( 6 ) plaque index , ( 7 ) gingival health , ( 8) decayed , missing , filled teeth in permanent teeth (DMFT)/decayed , missing , filled teeth in primary teeth ( dmft ) , ( 9 ) oral health-related- quality of life , reported by children and parents/caregivers , ( 10 ) the incremental cost-effectiveness , and ( 11 ) operator effect . A trained and calibrated examiner will evaluate the treated teeth after 1 week , then 1 , 6 , 12 , 24 and 36 months post treatment . Kaplan-Meier and Cox regression tests will be used to investigate the primary outcome . The Mann-Whitney or t test , Friedman test , paired t test or Wilcoxon test and Ordinal Logistic Regression Analysis will be used to analyze the secondary outcomes . Discussion The results of this trial will support decision-making by clinicians and policy-makers for managing occluso-proximal lesions in setting s with constrained re sources and limited dental access . Trial registration www . clinical trials.gov , NCT02569047 , registered 5 October 2015 BACKGROUND Failed restorations in primary teeth are not always re-restored . Is re-restoration not required anymore ? OBJECTIVE To compare survival rates of primary molars with intact and defective amalgam and ART restorations . METHODS A total of 649 restored primary molars , of which 162 were assessed with defective restorations for mechanical reasons , from a cluster-r and omised controlled clinical trial , were followed up over a period of 3.5 years . Restored primary molars , extracted because of dental sepsis or toothache , were considered a failure . Primary molars with defective restorations were followed up from the time they were assessed defective . Data were analysed using PHREG model with frailty correction , Wald test , t-test , and jackknife procedure . RESULTS The survival rate of primary molars with intact restorations ( 96.3 % ) was statistically significantly higher than that of primary molars with defective restorations ( 75.9 % ) over a 3-year period ( P < 0.0001 ) . Neither the effect of treatment protocol ( amalgam or ART ) ( P = 0.05 ) nor the type of surface ( single or multiple ) ( P = 0.73 ) was observed with respect to the survival rate of restored primary molars . CONCLUSIONS Survival rates for primary molars with intact and defective amalgam and ART restorations were high . The 3-year survival rate of primary molars with intact restorations was significantly higher than that of primary molars with defective restorations Abstract Introduction : Successful population ‐level antiretroviral therapy ( ART ) adherence will be necessary to realize both the clinical and prevention benefits of antiretroviral scale‐up and , ultimately , the end of AIDS . Although many people living with HIV are adhering well , others struggle and most are likely to experience challenges in adherence that may threaten virologic suppression at some point during lifelong therapy . Despite the importance of ART adherence , supportive interventions have generally not been implemented at scale . The objective of this review is to summarize the recommendations of clinical , research , and public health experts for scalable ART adherence interventions in re source ‐limited setting s. Methods : In July 2015 , the Bill and Melinda Gates Foundation convened a meeting to discuss the most promising ART adherence interventions for use at scale in re source ‐limited setting s. This article summarizes that discussion with recent up date s. It is not a systematic review , but rather provides practical considerations for programme implementation based on evidence from individual studies , systematic review s , meta‐analyses , and the World Health Organization Consoli date d Guidelines for HIV , which include evidence from r and omized controlled trials in low‐ and middle‐income countries . Interventions are categorized broadly as education and counselling ; information and communication technology‐enhanced solutions ; healthcare delivery restructuring ; and economic incentives and social protection interventions . Each category is discussed , including descriptions of interventions , current evidence for effectiveness , and what appears promising for the near future . Approaches to intervention implementation and impact assessment are then described . Results and discussion : The evidence base is promising for currently available , effective , and scalable ART adherence interventions for re source ‐limited setting s. Numerous interventions build on existing health care infrastructure and leverage available re sources . Those most widely studied and implemented to date involve peer counselling , adherence clubs , and short message service ( SMS ) . Many additional interventions could have an important impact on ART adherence with further development , including st and ardized counselling through multi‐media technology , electronic dose monitoring , de central ized and differentiated models of care , and livelihood interventions . Optimal targeting and tailoring of interventions will require improved adherence measurement . Conclusions : The opportunity exists today to address and resolve many of the challenges to effective ART adherence , so that they do not limit the potential of ART to help bring about the end of AIDS OBJECTIVE The purpose of this study was to compare the success rates of  glass-ionomer cement restorations placed with the atraumatic restorative treatment approach and conventional cavity preparation methods . METHOD AND MATERIAL S Two encapsulated , high-strength , esthetic conventional glass-ionomer cements were placed in 82 Class I and 53 Class II atraumatic restorative treatment and conventional cavity preparations  , and an encapsulated amalgam alloy was placed in 32 Class I conventional preparations , in vital primary molars of 60 Chinese children aged 7 to 9 years . RESULTS The atraumatic restorative treatment preparations , made with h and instruments only , took approximately 50 % longer to complete than did the preparations completed with conventional rotary instrumentation . After 1 year , there were no amalgam failures . For the glass-ionomer cement restorations , when the atraumatic restorative treatment method was used , significantly better survival rates were found for Class I ( 92.9 % ) than for Class II ( 64.7 % ) cavity preparations . There was also a strong trend for relatively better survival rates for the conventional cavity preparation method ( 86.7 % ) than for the atraumatic restorative treatment ( 64.7 % ) method for Class II cavity preparations . However , both the atraumatic restorative treatment and conventional methods appeared equally effective for Class I preparations . CONCLUSION In a clinic setting , the use of atraumatic restorative treatment h and instruments for cavity preparation is more time consuming , and the method may also provide less mechanical retention and /or bulk of glass-ionomer cement for some Class II preparations in primary molars than does the use of conventional rotary instruments AIM To evaluate the effectiveness of three different types of  glass ionomer restorations placed in children 's teeth using the ART technique two years after placement by either dentists or primary health care workers . SETTING The rural district of Palpa in western Nepal . METHOD An opportunistic non-r and omised field study , commenced in April 1997 . Three different glass ionomer restorative cements were used : Fuji IX ( GC ) , Dentsply Baseline ( DENTSPLY/DeTrey ) , and S.S. WhiteR ( S.S. White ) . The restorations were assessed two years later by an independent evaluator , who was blind to the type of restorations used and also blind to the operators . RESULTS Four primary health care workers and two dentists restored 163 primary and permanent teeth using h and instruments . One and two surface restorations were placed in 105 students ranging from 3 to 19 years of age from seven schools . After two years , 79 ( 75 % ) of the restorations survived and 27 ( 25 % ) failed , while 100 % of 21 evaluated single surface restorations placed on permanent molars with Fuji IX survived . There was no statistically significant difference in the survival of the restorations placed by dentists and placed by primary health care workers , which corroborates that both groups are both capable of performing the technique satisfactorily . CONCLUSIONS ART is very effective for one surface permanent molars using improved glass ionomer cements design ed for the ART technique 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 r and omized 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 Aim : To assess the influence of different variables on the survival of class II glass ionomer cements ( GIC ) in a clinical study among 6–7 year old schoolchildren in and around Dar es Salaam , Tanzania . Methods : 217 children were r and omly divided into three groups . In the conventional group , Class-II cavities were excavated with burs , in the ART group they were excavated with h and instruments and in the Carisolv ™ group excavation took place with a chemical solution and special blunt h and instruments . The preparations in all groups were restored with h and mixed GIC ( Fuji IX ) by 4 operators . After restoration , residual caries and cervical gaps were assessed on bite-wing radiographs . 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 . 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 GIC restorations compared to each variable alone Background The relative performance of ART sealant and fluoride-releasing resin sealant in preventing fissure caries in permanent molars was compared in a r and omized clinical trial conducted in southern China ( Clinical Trials.gov NCT01829334 ) . Methods After obtaining ethical approval , healthy schoolchildren who had permanent first molars with occlusal fissures which were sound but deep or presented with only incipient caries were recruited for the study . Included molars were r and omly allocated into one of four parallel study groups in units of left/right teeth per mouth . Two of the four groups adopted the methods of ART or fluoride-releasing resin sealant placement while the other two groups adopted the topical fluoride application methods .  Fissure status of the molars in each group was evaluated every 6 months . Development of dentine caries and sealant retention over 24 months in the molars in the two sealant-using groups was compared in this report . Outcome on cost-effectiveness of all four groups over 36 months will be reported elsewhere . Results At baseline , a total of 280 children ( 383 molars ) with mean age 7.8 years were involved for the two sealant groups . After 24 months , 261 children ( 357 molars ) were followed . Proportions of molars with dentine caries were 7.3 % and 3.9 % in the ART sealant and fluoride-releasing resin sealant groups , respectively ( chi-square test , p = 0.171 ) . Life-table survival analysis showed that sealant retention ( full and partial ) rate over 24 months for the resin sealant ( 73 % ) was significantly higher than that ( 50 % ) for the ART sealant ( p < 0.001 ) . Molar survival ( no development of dentine caries ) rates in the ART sealant ( 93 % ) and fluoride-releasing resin sealant ( 96 % ) groups were not significantly different ( p = 0.169 ) . Multilevel logistic regression ( GEE modeling ) accounting for the effects of data clustering and confounding factors confirmed this finding . Conclusions Though the retention of fluoride-releasing resin sealant was better than that of the ART sealant , their effectiveness in preventing fissure caries in permanent molars did not differ significantly over 24 months . ART sealants could be a good alternative when and where re sources for resin sealant placement are not readily available
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
Objective The aim of the present study is to up date 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 .