Top

Clinical Oral Investigations

Published in:

Open Access 01-10-2012 | Review

Twenty-five-year atraumatic restorative treatment (ART) approach: a comprehensive overview

Authors: Jo E. Frencken, Soraya Coelho Leal, Maria Fidela Navarro

Published in: Clinical Oral Investigations | Issue 5/2012

Abstract

Background

The atraumatic restorative treatment (ART) approach was born 25 years ago in Tanzania. It has evolved into an essential caries management concept for improving quality and access to oral care globally.

Results

Meta-analyses and systematic reviews have indicated that the high effectiveness of ART sealants using high-viscosity glass ionomers in carious lesion development prevention is not different from that of resin fissure sealants. ART using high-viscosity glass ionomer can safely be used to restore single-surface cavities both in primary and in permanent posterior teeth, but its quality in restoring multiple surfaces in primary posterior teeth cavities needs to be improved. Insufficient information is available regarding the quality of ART restorations in multiple surfaces in permanent anterior and posterior teeth. There appears to be no difference in the survival of single-surface high-viscosity glass-ionomer ART restorations and amalgam restorations.

Discussion

The use of ART results in smaller cavities and in high acceptance of preventive and restorative care by children. Because local anaesthesia is seldom needed and only hand instruments are used, ART is considered to be a promising approach for treating children suffering from early childhood caries. ART has been implemented in the public oral health services of a number of countries, and clearly, proper implementation requires the availability of sufficient stocks of good high-viscosity glass ionomers and sets of ART instruments right from the start. Textbooks including chapters on ART are available, and the concept is being included in graduate courses at dental schools in a number of countries. Recent development and testing of e-learning modules for distance learning has increasingly facilitated the distribution of ART information amongst professionals, thus enabling more people to benefit from ART. However, this development and further research require adequate funding, which is not always easily obtainable. The next major challenge is the continuation of care to the frail elderly, in which ART may play a part.

Conclusion

ART, as part of the Basic Package of Oral Care, is an important cornerstone for the development of global oral health and alleviating inequality in oral care.

Wilson AD, Mclean JW (1988) Glass-ionomer cement. Quintessence Publishing Co., Inc., Chicago

Mount G (1994) An atlas of glass-ionomer cements: a clinician's guide. Martin Dunitz, London

Myburgh NG, Hobdell MH, Lalloo R (2004) African countries propose a regional oral health strategy: the Dakar report from 1998. Oral Dis 10:129–137PubMedCrossRef

Holmgren CJ, Pilot T (1996) Preliminary research agenda for minimal intervention techniques for caries. J Public Health Dent 56:164–165PubMedCrossRef

Holmgren CJ, Frencken JE (1999) Painting the future for ART. Community Dent Oral Epidemiol 27:449–453PubMedCrossRef

Holmgren CJ, Figueiredo M (2009) Two decades of ART: improving on success through further research. J Appl Oral Sci 17:122–133PubMedCrossRef

Frencken JE, Holmgren CJ (1999) Atraumatic restorative treatment for dental caries. STI book b.v, Nijmegen

Imparato JCP (2005) Tratamento Restaurador Atraumático (ART): Técnicas de Mínima Intervenção para o Tratamento de Doença Cárie Dentária. Editora Maio, Curitiba, Brasil

Frencken JE, Holmgren CJ (2001) The atraumatic restorative treatment (ART) approach. In: Albrektsson T, Bratthall D, Glantz PO, Lindhe J (eds) Tissue preservation in caries treatment. Quintessenz Verlag-GMBH, Berlin

10.

Hiremath SS (2007) Preventive dentistry and community dentistry. Elsevier, New Delhi

11.

Frencken JE, van Amerongen WE (2008) The atraumatic restorative treatment (ART) approach to manage dental caries. In: Fejerskov O, Kidd E (eds) Dental caries: the disease and its management. Blackwell, Oxford

12.

Frencken JE (2012) Tratamento restaurador atraumático (ART): um conceito contemporâneo para o manejo da cárie dentária. In: De Toledo OA (ed) Odontopediatria Fundamentos para a prática clínica. Premier, Sao Paulo

13.

Frencken JE, Leal SC (2010) The correct use of the ART approach. J Appl Oral Sci 18:1–4PubMedCrossRef

14.

Navarro MF, Modena KCS, Freitas MCCA, Fagundes TC (2009) Transferring ART research into education in Brazil. J Appl Oral Sci 17:99–105PubMedCrossRef

15.

Ruiz O, Frencken JE (2009) ART integration in oral health care systems in Latin American countries as perceived by directors of oral health. J Appl Oral Sci 17:106–113PubMedCrossRef

16.

Mickenautsch S, Rudolpf MJ (2001) Implementation of the ART approach in South Africa: an activity report. S Afr Dent J 56:327–329

17.

Mickenautsch S, Rudolph MJ, Ogunbodede EO, Frencken JE (1999) The impact of the ART approach on treatment profile in a mobile dental system (MDS) in South Africa. Int Dent J 49:132–138PubMedCrossRef

18.

Mickenautsch S, Rudolph MJ (2002) Undergraduate training in the atraumatic restorative treatment (ART) approach—an activity report. S Afr Dent J 57:355–357

19.

Schriks MC, van Amerogen WE (2003) Atraumatic perspectives of ART: psychological and physiological aspects of treatment with and without rotary instruments. Community Dent Oral Epidemiol 31:15–20PubMedCrossRef

20.

Rahimtoola S, van Amerogen WE, Maher R, Groen H (2000) Pain related to different ways of minimal intervention in the treatment of small caries lesions. ASDC 67:123–127

21.

de Menezes Abreu DM, Leal SC, Frencken JE (2009) Self-report of pain in children treated according to the atraumatic restorative treatment and the conventional restorative treatment–a pilot study. J Clin Pediatr Dent 34:151–155PubMed

22.

de Menezes Abreu DM, Leal SC, Mulder J, Frencken JE (2011) Pain experience after conventional, atraumatic, and ultraconservative restorative treatments in 6- to 7-yr-old children. Eur J Oral Sci 119:163–168PubMedCrossRef

23.

Topaloglu-Ak A, Eden E, Frencken JE (2007) Perceived dental anxiety among schoolchildren treated through three caries removal approaches. J Appl Oral Sci 15:235–240PubMedCrossRef

24.

Mickenautsch S, Frencken JE, van’t Hof M (2007) Atraumatic restorative treatment and dental anxiety in outpatients attending public oral health clinics in South Africa. J Public Health Dent 67:179–184PubMedCrossRef

25.

de Menezes Abreu DM, Leal SC, Mulder J, Frencken JE (2011) Dental anxiety in 6–7-year-old treated in accordance with conventional restorative treatment, ART and ultra-conservative treatment protocols. Acta Odontol Scand 69:410–416PubMedCrossRef

26.

Xia B, Wang CL, Ge LH (2011) Factors associated with dental behaviour management problems in children aged 2–8 years in Beijing, China. Int J Paediatr Dent 21:200–209PubMedCrossRef

27.

Celiberti P, Francescut P, Lussi A (2006) Performance of four dentine excavation methods in deciduous teeth. Caries Res 40:117–123PubMedCrossRef

28.

Banerjee A, Kidd EAM, Watsen TF (2000) In vitro evaluation of five alternative methods of carious dentine excavation. Caries Res 34:144–150PubMedCrossRef

29.

Rahimtoola S, van Amerongen E (2002) Comparison of two tooth saving preparation techniques for one surface cavities. J Dent Child 69:16–26

30.

Leal SC, Abreu DMM, Frencken JE (2009) Dental anxiety and pain related to ART. J Appl Oral Sci 17:84–88PubMed

31.

Van’t Hof MA, Frencken JE, van Palenstein Helderman WH, Holmgren CJ (2006) The ART approach for managing dental caries: a meta-analysis. Int Dent J 56:345–351CrossRef

32.

De Amorim RG, Leal SC, Frencken JE (2012) Survival of ART sealants and ART restorations: a meta-analysis. Clin Oral Invest 16:429–441CrossRef

33.

Deepa G, Shobha T (2010) A clinical evaluation of two glass ionomer cements in primary molars using atraumatic restorative treatment technique in India: 1 year follow up. Int J Paediatr Dent 20:410–418PubMedCrossRef

34.

Roshan NM, Sakeenabi B (2011) Survival of occlusal ART restorations in primary molars placed in school environment and hospital dental setup-one year follow-up study. Med Oral Patol Oral Cir Bucal 16:e973–e977PubMed

35.

Ibiyemi O, Bankole OO, Oke GA (2011) Assessment of atraumatic restorative treatment (ART) on the permanent dentition in a primary care setting in Nigeria. Int Dent J 61:2–6PubMedCrossRef

36.

Zanata RL, Fagundes TC, Freitas MC, Lauris JR, Navarro MF (2011) Ten-year survival of ART restorations in permanent posterior teeth. Clin Oral Investig 15:265–271PubMedCrossRef

37.

Ryge G (1980) Clinical criteria. Int Dent J 30:347–358PubMed

38.

Mickenautsch S, Yengopal V, Banerjee A (2010) Atraumatic restorative treatment versus amalgam restoration longevity: a systematic review. Clin Oral Investig 14:233–240PubMedCrossRef

39.

Ersin NK, Candan U, Aykut A, Oncag O, Eronat C, Kose T (2006) A clinical evaluation of resin-based composite and glass ionomer cement restorations placed in primary teeth using the ART approach: results at 24 months. J Am Dent Assoc 137:1529–1536PubMed

40.

Frencken JE, van’t Hof MA, van Amerongen WE, Holmgren CJ (2004) Effectiveness of single-surface ART restorations in the permanent dentition: a meta-analysis. J Dent Res 83:120–123PubMedCrossRef

41.

World Health Organization (2010) Future use of materials for dental restoration. WHO Document production services, Geneva, Switzerland, p 11

42.

Taifour D, Frencken JE, Beiruti N, Van’t Hof MA, Truin GJ (2002) Effectiveness of glass-ionomer (ART) and amalgam restorations in the deciduous dentition—results after 3 years. Caries Res 36:437–444PubMedCrossRef

43.

Lo ECM, Holmgren CJ, Hu D, Wan H, van Palenstein Helderman W (2007) Six-year follow-up of atraumatic restorative treatment restorations placed in Chinese school children. Community Dent Oral Epidemiol 35:387–392PubMedCrossRef

44.

Frencken JE, van’t Hof MA, Taifour D, Al-Zaher I (2007) Effectiveness of the ART and traditional amalgam approach in restoring single-surface cavities in posterior teeth of permanent dentitions in school children after 6.3 years. Community Dent Oral Epidemiol 35:207–214PubMedCrossRef

45.

Farag A, van der Sanden WJM, Abdelwahab H, Mulder J, Frencken JE (2009) 5-Year survival of ART restorations with and without cavity disinfection. J Dent 37:468–474PubMedCrossRef

46.

Mickenautsch S, Yengopal V (2011) Absence of carious lesions at margins of glass-ionomer cement and amalgam restorations: an update of systematic review evidence. BMC Res Notes 4:58PubMedCrossRef

47.

Mejàre I, Lingström P, Petersson LG, Holm A-K, Twetman S, Källestål C, Nordenram G, Lagerlöf F, Söder B, Norlund A, Axelsson S, Dahlgren H (2003) Caries-preventive effect of fissure sealants: a systematic review. Acta Odontol Scand 61:321–330PubMedCrossRef

48.

Ahovuo-Saloranta A, Hiiri A, Nordblad A, Worthington H, Mäkelä M (2004) Pit and fissure sealants for preventing dental decay in the permanent teeth of children and adolescents. Cochrane Database Syst Rev.

49.

Ahovuo-Saloranta A, Hiiri A, Nordblad A, Mäkelä M, Worthington H (2008) Pit and fissure sealants for preventing dental decay in the permanent teeth of children and adolescents. Cochrane Database Syst Rev.

50.

Beiruti N, Frencken JE, van’t Hof MA, van Palenstein Helderman WH (2006) Caries-preventive effect of resin-based and glass ionomer sealants over time: a systematic review. Community Dent Oral Epidemiol 34:403–409PubMedCrossRef

51.

Mickenautsch S, Yengopal V (2011) Caries-preventive effect of glass ionomer and resin-based fissure sealants on permanent teeth: an update of systematic review evidence. BMC Res Notes 4:22PubMedCrossRef

52.

Simonsen RJ (2002) Pit and fissure sealants: review of the literature. Pediatr Dent 24:393–414PubMed

53.

Locker D, Jokovic A, Kay EJ (2003) Prevention. Part 8: the use of pit and fissure sealants in preventing caries in the permanent dentition of children. Br Dent J 195:375–378PubMedCrossRef

54.

Chen X, Du M, Fan M, Mulder J, Huysmans MC, Frencken JE (2011) Effectiveness of two new types of sealants: retention after 2 years. Clin Oral Investig; epub

55.

Beiruti N, Frencken JE, van’t Hof MA, Taifour D, van Palenstein Helderman WH (2006) Caries-preventive effect of a one-time application of composite resin and glass ionomer sealants after 5 years. Caries Res 40:52–59PubMedCrossRef

56.

Mejàre I, Mjör IA (1990) Glass ionomer and resin-based fissure sealants: a clinical study. Scand J Dent Res 98:345–350PubMed

57.

Övrebö RS, Raadal M (1990) Microleakage in fissures sealed with resin or glass ionomer cement. Scand J Dent Res 98:66–69PubMed

58.

Williams B, Laxton L, Holt RD, Winter GB (1996) Fissure sealants: a 4-year clinical trial comparing an experimental glass polyalkenoate cement with a bis glycidyl methacrylate resin used as fissure sealants. Br Dent J 180:104–108PubMedCrossRef

59.

Torppa-Saarinen E, Seppå L (1990) Short-term retention of glass-ionomer fissure sealants. Proc Finn Dent Soc 86:83–88PubMed

60.

Frencken JE, Wolke J (2010) Clinical and SEM assessment of ART high-viscosity glass-ionomer sealants after 8–13 years in 4 teeth. J Dent 38:59–64PubMedCrossRef

61.

Papacchini F, Goracci C, Sadek FT, Monticelli F, Garcia-Godoy F, Ferrari M (2005) Microtensile bond strength to ground enamel by glass-ionomers, resin-modified glass-ionomers, and resin composites used as pit and fissure sealants. J Dent 33:459–467PubMedCrossRef

62.

Eden E, Topaloglu-Ak A, Frencken JE, van’t Hof MA (2006) Survival of self-etch adhesive class II composite restorations using ART and conventional cavity preparations in primary molars. Am J Dent 19:359–363PubMed

63.

Topaloglu-Ak A, Eden E, Frencken JE, Oncag O (2009) Two years survival rate of class II composite resin restorations prepared by ART with and without a chemomechanical caries removal gel in primary molars. Clin Oral Investig 13:325–332PubMedCrossRef

64.

Louw AJ, Sarvan I, Chikte UME, Honkala E (2002) One-year evaluation of atraumatic restorative treatment and minimum intervention techniques on primary teeth. S Afr Dent J 57:366–371

65.

Cefaly DF, Barata TJ, Bresciani E, Fagundes TC, Lauris JR, Navarro MF (2007) Clinical evaluation of multiple-surface ART restorations: 12 month follow-up. J Dent Child 74:203–208

66.

Ercan E, Dulgergil T, Soyman M, Dalli M, Yildirim I (2009) A field-trial of two restorative materials used with atraumatic restorative treatment in rural Turkey: 24-month results. J Appl Oral Sci 17:307–314PubMedCrossRef

67.

Faccin ES, Ferreira SH, Kramer PF, Ardenghi TM, Feldens CA (2009) Clinical performance of ART restorations in primary teeth: a survival analysis. J Clin Pediatr Dent 33:295–298PubMed

68.

Bonifácio CC, Kleverlaan CJ, Raggio DP, Werner A, de Carvalho RC, van Amerongen WE (2009) Physical-mechanical properties of glass ionomer cements indicated for atraumatic restorative treatment. Aust Dent J 54:233–237PubMedCrossRef

69.

Carvalho TS, van Amerongen WE, de Gee A, Bönecker M, Sampaio FC (2011) Shear bond strengths of three glass ionomer cements to enamel and dentine. Med Oral Patol Oral Cir Bucal 16:e406–e410PubMedCrossRef

70.

Shintome LK, Nagayassu MP, Di Nicoló R, Myaki SI (2009) Microhardness of glass ionomer cements indicated for the ART technique according to surface protection treatment and storage time. Braz Oral Res 23:439–445PubMedCrossRef

71.

Davies GN (1998) Early childhood caries—a synopsis. Community Dent Oral Epidemiol 26:106–116PubMed

72.

Lo ECM, Holmgren CJ (2001) Provision of atraumatic restorative treatment (ART) restoration to Chinese pre-school children—a 30-month evaluation. Int J Paediatr Dent 11:3–10PubMedCrossRef

73.

Tanaai DQ (2002) Dental attendance and anxiety among public and private school children in Jordan. Int Dent J 52:25–29CrossRef

74.

Pilot T (1999) Introduction—ART from a global perspective. Community Dent Oral Epidemiol 27:421–422PubMedCrossRef

75.

Honkala S, Honkala E (2002) Atraumatic dental treatment among Finnish elderly persons. J Oral Rehabil 29:435–440PubMedCrossRef

76.

Hu JY, Chen XC, Li YQ, Smales RJ, Yip KH (2005) Radiation-induced root surface caries restored with glass-ionomer cement placed in conventional and ART cavity preparations: results at two years. Aust Dent J 50:186–190PubMedCrossRef

77.

Lo EC, Luo Y, Tan HP, Dyson JE, Corbet EF (2006) ART and conventional root restorations in elders after 12 months. J Dent Res 85:929–932PubMedCrossRef

78.

Frencken JE (2009) Evolution of the the ART approach: highlights and achievements. J Appl Oral Sci 17:78–83PubMedCrossRef

79.

Mickenautsch S, Frencken JE, Van’t Hof M (2007) Factors inhibiting the implementation of the atraumatic restorative treatment approach in public oral health services in Gauteng Province, South Africa. J Appl Oral Sci 15:1–8PubMed

80.

Hermosillo VH, Quintero LE, Guerrero ND, Suarez DD, Hernandez MJ, Holmgren CJ (2009) The implementation and preliminary evaluation of an ART strategy in Mexico: a country example. J Appl Oral Sci 17:114–121PubMedCrossRef

81.

Kikwilu EN, Frencken J, Mulder J (2009) Impact of atraumatic restorative treatment (ART) on the treatment profile in pilot government dental clinics in Tanzania. BMC Oral Health 9:14PubMedCrossRef

82.

Chher T, Hak S, Courtel F, Durward C (2009) Improving the provision of the Basic Package of Oral Care (BPOC) in Cambodia. Int Dent J 59:47–52PubMed

83.

Frencken JE, Holmgren CJ, van Palenstein Helderman WH (2002) Basic Package of Oral Care. WHO Collaborating Centre, Nijmegen, the Netherlands

84.

Horowitz AM (1996) Introduction to the symposium on minimal intervention techniques for caries. J Public Health Dent 56:133–134PubMedCrossRef

85.

Camargo LB, Aldrigui JM, Imparato JC, Mendes FM, Wen CL, Bonecker M et al (2011) E-learning used in a training course on atraumatic restorative treatment (ART) for Brazilian dentists. J Dent Educ 75:1396–1401PubMed

86.

Camargo LB, Fell C, Bonini GC, Marquezan M, Imparato JC, Mendes FM et al (2011) Paediatric dentistry education of atraumatic restorative treatment (ART) in Brazilian dental schools. Eur Arch Paediatr Dent 12:303–307PubMed

87.

Fejerskov O, Kidd E (2008) Dental Caries. The disease and its clinical management. Markono Print Media Pte Ltd, Singapore

88.

Holmgren CJ, Figueredo MC (2009) Two decades of ART: improving on success through further research. J Appl Oral Sci 17:122–134PubMedCrossRef

89.

Holmgren CJ, Frencken JE (2009) Conclusions from the symposium: two decades of ART: success through research. J Appl Oral Sci 17:134–136PubMedCrossRef

Title: Twenty-five-year atraumatic restorative treatment (ART) approach: a comprehensive overview
Authors: Jo E. Frencken
Soraya Coelho Leal
Maria Fidela Navarro
Publication date: 01-10-2012
Publisher: Springer-Verlag
Published in: Clinical Oral Investigations / Issue 5/2012
Print ISSN: 1432-6981
Electronic ISSN: 1436-3771
DOI: https://doi.org/10.1007/s00784-012-0783-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Twenty-five-year atraumatic restorative treatment (ART) approach: a comprehensive overview

Abstract

Background

Results

Discussion

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Results

Discussion

Conclusion

Please log in to get access to this content

Other articles of this Issue 5/2012

Depth of cure and mechanical properties of nano-hybrid resin-based composites with novel and conventional matrix formulation

Long-term bonding to eroded dentin requires superficial bur preparation

The use of endodontically treated and/or fiber post-retained teeth as abutments for fixed partial dentures

Plaque-left-behind after brushing: intra-oral reservoir for antibacterial toothpaste ingredients

Image resolution and exposure time of digital radiographs affects fractal dimension of periapical bone

Implant rehabilitation in patients with oral lichen planus: an overview