Atraumatic Restorative Treatment - ART

Case Study

Case Study: A Ten-Year evaluation of ART in Health Centers of Bauru,

Brazil
Childsmile is a community based program that was instituted in 2005 by the
National Health Service in Scotland in order to improve the oral health of children in
Scotland and reduce the inequalities in dental health and access to dental care.1 It
emphasizes prevention and in addition to community-wide fluoride toothpaste distribution
elements, targets high risk preschool children in home as well as in Nursery/School
settings.
The women received ART restorative care using glass-ionomer cement, dietary
counseling, oral hygiene instruction, professional prophylaxis and fluoride topical
applications. Cotton rolls and suction were used for moisture control. Single surface
and multiple surface ART restorations were placed; the mean number of restorations per
patient was 6.4. Previous evaluations of ART programs showed successful performance
for a three-year period.2,3
Program Evaluation
The U.S. Public Health Service (USPHS) criteria were used to evaluate each
restoration for quality.i Two trained dentists, not involved in placing restorations, carried
out the 10 year evaluations. Intra and inter examiner reliability was calculated at 0.92
and 0.96 respectively. Hence, agreement on the evaluation criteria was very high.
Using the USPHS criteria the 10-year survival of single and multiple surface ART
restorations were 86.5% and 57.6%, respectively. Total loss occurred in 9.3% of
restorations and 5.4% had marginal defects of various kinds. These survival rates are
similar to or superior to those achieved with amalgam restorations. 4,5,6,7
The program in Brazil confirms the potential of the ART restorative methods for
saving decayed permanent posterior teeth. Importantly, this project also showed a mean
increase in dental caries of only 2 tooth surfaces after 2 years. Hence, the caries risk of
these women had been markedly reduced, which demonstrated the potential of ART as
a part of a preventive therapy intervention that can reduce future disease.

www.allianceforacavityfreefuture.org | PAGE 1/3

 
  

This outreach program conducted by a school of dentistry demonstrates the

potential of ART for restoring and saving posterior permanent teeth in adults. The ART
restorations were effective which was documented by 10-year follow-up evaluations.
For additional information contact R.L. Zanata and co-workers at the Bauru
School of Dentistry, University of Sao Paulo, Bauru, SP, Brazil.

References:
1. Carvalho, T.S., et al., The atraumatic restorative treatment approach: an
"atraumatic" alternative. Med Oral Patol Oral Cir Bucal, 2009. 14(12): p. e668-73.
2. Mickenautsch, S., J.E. Frencken, and H.M. van't, Atraumatic restorative
treatment and dental anxiety in outpatients attending public oral health clinics in
South Africa. J Public Health Dent, 2007. 67(3): p. 179-84.
3. Rahimtoola, S., et al., Pain related to different ways of minimal intervention in the
treatment of small caries lesions. ASDC J Dent Child, 2000. 67(2): p. 123-7, 83.
4. Yip, H.K., et al., Selection of restorative materials for the atraumatic restorative
treatment (ART) approach: a review. Spec Care Dentist, 2001. 21(6): p. 216-21.
5. Frencken, J.E., et al., Effectiveness of Single-surface ART Restorations in the
Permanent Dentition: A Meta-analysis. Journal of Dental Research, 2004. 83(2):
p. 120-123.
6. Kalf-Scholte, S.M., et al., Atraumatic restorative treatment (ART): a three-year
clinical study in Malawi--comparison of conventional amalgam and ART
restorations. J Public Health Dent, 2003. 63(2): p. 99-103.
7. Phantumvanit, P., et al., Atraumatic restorative treatment (ART): a three-year
community field trial in Thailand--survival of one-surface restorations in the
permanent dentition. J Public Health Dent, 1996. 56(3 Spec No): p. 141-5;
discussion 161-3.
8. Taifour, D., et al., Comparison between restorations in the permanent dentition
produced by hand and rotary instrumentation--survival after 3 years. Community
Dent Oral Epidemiol, 2003. 31(2): p. 122-8.
9. Mandari, G.J. and M.I. Matee, Atraumatic Restorative Treatment (ART): the
Tanzanian experience. Int Dent J, 2006. 56(2): p. 71-6.
10. Rahimtoola, S. and E. van Amerongen, Comparison of two tooth-saving
preparation techniques for one-surface cavities. ASDC J Dent Child, 2002. 69(1):
p. 16-26, 11.
11. PAHO: Oral health of low income children. Procedures for Atraumatic Restorative
Treatment. In Final Report Pan American Health Organization, Washington DC;
2006.
12. Steele, J., ART for treating root caries in older people. Evid Based Dent, 2007.
8(2): p. 51.
13. van 't Hof, M.A., et al., The atraumatic restorative treatment (ART) approach for
managing dental caries: a meta-analysis. Int Dent J, 2006. 56(6): p. 345-51.

www.allianceforacavityfreefuture.org | PAGE 2/3

 
  

14. Kemoli, A.M. and W.E. van Amerongen, Influence of the cavity-size on the
survival rate of proximal ART restorations in primary molars. Int J Paediatr Dent,
2009. 19(6): p. 423-30.
15. Frencken, J.E., et al., Three-year survival of one-surface ART restorations and
glass-ionomer sealants in a school oral health programme in Zimbabwe. Caries
Res, 1998. 32(2): p. 119-26.
16. Mallow, P.K., C.S. Durward, and M. Klaipo, Restoration of permanent teeth in
young rural children in Cambodia using the atraumatic restorative treatment
(ART) technique and Fuji II glass ionomer cement. Int J Paediatr Dent, 1998.
8(1): p. 35-40.
17. Lopez, N., S. Simpser-Rafalin, and P. Berthold, Atraumatic restorative treatment
for prevention and treatment of caries in an underserved community. Am J Public
Health, 2005. 95(8): p. 1338-9.
18. Chalmers, J.M., Minimal intervention dentistry: part 2. Strategies for addressing
restorative challenges in older patients. J Can Dent Assoc, 2006. 72(5): p. 435-
40.
19. Mickenautsch, S., I. Munshi, and E.S. Grossman, Comparative cost of ART and
conventional treatment within a dental school clinic. SADJ, 2002. 57(2): p. 52-8.

20. Mickenautsch, S, Yengopal V, Banerjee A. Atraumatic restorative treatment

versus amalgam restoration longevity: a systematic review. Clin Oral Investig
2010; 14:233-40
21. Lo EC, Holmgren CJ, Hu D, van Palenstein Helderman W. Six-year follow up
atraumatic restorative treatment restorations placed in Chinese school children.
Community Dent Oral Epidemiol 2007; 35:387-92

                                                                                                               
 

www.allianceforacavityfreefuture.org | PAGE 3/3