Atraumatic restorative treatment versus conventional restorative treatment for managing dental caries
Open accessAbstract
BACKGROUND: Dental caries is a sugar-dependent disease that damages tooth structure and, due to loss of mineral components, may eventually lead to cavitation. Dental caries is the most prevalent disease worldwide and is considered the most important burden of oral health. Conventional treatment methods (drill and fill) involve the use of rotary burs under local anaesthesia. The need for an electricity supply, expensive handpieces and highly trained dental health personnel may limit access to dental treatment, especially in underdeveloped regions.To overcome the limitations of conventional restorative treatment, the Atraumatic Restorative Treatment (ART) was developed, mainly for treating caries in children living in under-served areas of the world where resources and facilities such as electricity and trained manpower are limited. ART is a minimally invasive approach which involves removal of decayed tissue using hand instruments alone, usually without use of anaesthesia and electrically driven equipment, and restoration of the dental cavity with an adhesive material (glass ionomer cement (GIC), composite resins, resin-modified glass-ionomer cement (RM-GICs) and compomers). OBJECTIVES: To assess the effects of Atraumatic Restorative Treatment (ART) compared with conventional treatment for managing dental caries lesions in the primary and permanent teeth of children and adults. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 22 February 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 1), MEDLINE Ovid (1946 to 22 February 2017), Embase Ovid (1980 to 22 February 2017), LILACS BIREME Virtual Health Library (Latin American and Caribbean Health Science Information database; 1982 to 22 February 2017) and BBO BIREME Virtual Health Library (Bibliografia Brasileira de Odontologia; 1986 to 22 February 2017). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: We included randomised controlled trials (RCTs) with at least six months' follow-up that compared the effects of ART with a conventional restorative approach using the same or different restorative dental materials to treat caries lesions. DATA COLLECTION AND ANALYSIS: Two review authors independently screened search results, extracted data from included studies and assessed the risk of bias in those studies. We used standard methodological procedures expected by Cochrane to evaluate risk of bias and synthesise data. Where pooling was appropriate we conducted meta-analyses using the random-effects model. We assessed the quality of the evidence using GRADE criteria. MAIN RESULTS: We included a total of 15 eligible studies randomising 3760 participants in this review. The age of participants across the studies ranged from 3 to 101 years, with a mean of 25.42 years. 48% of participants were male. All included studies were published between 2002 and 2016. Two of the 15 studies declared that the financial support was from companies that manufacture restorative material. Five studies were individually randomised parallel-group studies; six were cluster-randomised parallel-group studies; and four were randomised studies that used a split-mouth design. Eleven studies evaluated the effects of ART on primary teeth only, and four on permanent teeth. The follow-up period of the included studies ranged from 6 months to 36 months. We judged all studies to be at high risk of bias.For the main comparison of ART compared to conventional treatment using the same material: all but two studies used high-viscosity glass ionomer (H-GIC) as the restorative material; one study used a composite material; and one study used resin-modified glass ionomer cement (RM-GIC)).Compared to conventional treatment using H-GIC, ART may increase the risk of restoration failure in the primary dentition, over a follow-up period from 12 to 24 months (OR 1.60, 95% CI 1.13 to 2.27, five studies; 643 participants analysed; low-quality evidence). Our confidence in this effect estimate is limited due to serious concerns over risk of performance and attrition bias. For this comparison, ART may reduce pain during procedure compared with conventional treatment (MD -0.65, 95% CI -1.38 to 0.07; 40 participants analysed; low-quality evidence)Comparisons of ART to conventional treatment using composite or RM-GIC were downgraded to very low quality due to indirectness, imprecision and high risk of performance and attrition bias. Given the very low quality of the evidence from single studies, we are uncertain about the restoration failure of ART compared with conventional treatment using composite over a 24-month
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Personalized risk assessment models such as CAMBRA enable targeted preventive strategies, leading to improved long-term oral health outcomes.
“Moreover, personalized risk assessment models like CAMBRA enable targeted preventive strategies, leading to improved long-term oral health outcomes [18,19].”
From Minimally Invasive Techniques for Managing Dental Caries in Children: Efficacy, Applications, and Future Directions (2025) · cites this paper as [18]
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- Authors
- Dorri, M., Martinez-Zapata, M. J., Walsh, T., Marinho, V. C., Sheiham deceased, A., & Zaror, C.
- Affiliations
- University Of Bristol Dental Hospital (GB)
- CIBER Epidemiología y Salud Pública (CIBERESP); Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau); Sant Antoni Maria Claret 167 Pavilion 18 Barcelona Catalunya Spain 08025
- University of Manchester (GB)
- Queen Mary University of London; Clinical and Diagnostic Oral Sciences, Barts and The London School of Medicine and Dentistry; Turner Street Whitechapel London UK E1 2AD
- University College London Medical School; London UK
- Universidad de La Frontera (CL)
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- Wiley
- Published
- 2017-12-28
- Volume
- 2018
- Issue
- 3
- Pages
- CD008072-CD008072
- ISSN
- 1361-6137 (ISSN-L)
- 1465-1858
- PMC
- PMC6486021
- OpenAlex
- W2137267222
- Cited by
- 135
- References
- 96
- Citations by year
- 2026: 8 · 2025: 16 · 2024: 12 · 2023: 19 · 2022: 22 · 2021: 14 · 2020: 25 · 2019: 7 · 2018: 6 · 2016: 2 · 2015: 2 · 2013: 1
- FWCI
- 2.57
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Bristol Research (University of Bristol) (publishedVersion, other-oa)
- Research Explorer (The University of Manchester) (submittedVersion, other-oa)
- Explore Bristol Research (submittedVersion, other-oa)
- Funders
- Departamento Administrativo de Ciencia, Tecnología e Innovación (COLCIENCIAS)
- Universitat Autònoma de Barcelona
- Topics
- Health Sciences › Dentistry › Orthodontics › Dental materials and restorations
- Health Sciences › Dentistry › Periodontics › Dental Health and Care Utilization
- Health Sciences › Dentistry › Oral Surgery › Endodontics and Root Canal Treatments
- Keywords
- atraumatic restorative treatment, dental caries, minimally invasive dentistry, glass ionomer cement, resin-modified glass ionomer cement, compomer, primary teeth, permanent teeth, children, adults, restorative materials, secondary caries, access to dental care, underserved populations
- MeSH terms
- Adult, Child, Dental Caries, Female, Glass Ionomer Cements, Humans, Male, Tooth, Deciduous, Toothache, Randomized Controlled Trials as Topic, Dentition, Permanent, Dental Restoration Failure, Dental Atraumatic Restorative Treatment
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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