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Cited by 135Dental materials and restorationsDental Health and Care UtilizationEndodontics and Root Canal Treatments

The DOI matches its Crossref record; 94 of the 96 references it cites were found in a registry or an index.

Atraumatic restorative treatment versus conventional restorative treatment for managing dental caries

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Dorri, Mojtaba, Martinez-Zapata, Maria José, Walsh, Tanya, Marinho, Valeria CC, Sheiham deceased, Aubrey, Zaror, Carlos·2017·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd008072.pub2PMC PMC6486021
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Abstract

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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Research works printed but not linked: 12

  1. Ling, 2003, Evaluation of effects of Atraumatic Restorative Treatment and cooperation degree in primary teeth, Stomatology, 23, 290
  2. Miranda, 2005, Randomized controlled clinical study comparing atraumatic restorative treatment with conventional amalgam treatment in primary molars: evaluation after 6 and 12 months [Estudo clínico randomizado e controlado comparando o tratamento restaurador atraumátic
  3. Gemert-Schriks, 2007, Discomfort during atraumatic restorative treatment (ART) versus conventional restorative treatment, Ned Tijdschr Tandheelkd, 114, 213
  4. Andrade P Atraumatic and chemical-mechanical methods: a controlled clinical trial of caries progression Thesis
  5. Barata T Clinical evaluation of two minimally invasive methods: chemi-mechanical and mechanical Thesis. Faculdade de Odontologia de Bauru, Universidade de São Paulo. 2007
  6. Hui-min, 2005, Clinical observation of using different material in the elderly decayed tooth ART technique, Practical Clinical Medicine, 6, 105
  7. Mizuno, 2011, Clinical and radiographic analysis of the chemical-mechanical caries removal and ART: a pilot study, Odontoestomatología, 13, 29
  8. Lefebvre C Manheimer E Glanville J Chapter 6: Searching for studies. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011 Available from handbook.cochrane.org
  9. Mickenautsch, 2012, Failure rate of atraumatic restorative treatment using high-viscosity glass-ionomer cement compared to that of conventional amalgam restorative treatment in primary and permanent teeth: a systematic review update, Journal of Minimum Intervention in Dentistry, 5, 63
  10. Nordic Cochrane Centre, The Cochrane Collaboration Review Manager 5 (RevMan 5) 2014
  11. Schünemann HJ Oxman AD Vist GE Higgins JPT Deeks JJ Glasziou P Chapter 12: Interpreting results and drawing conclusions. In: Higgins JPT, Green S (editors), Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011 Available from handbook.cochrane.org
  12. Sterne JAC Egger M Moher D (editors) Chapter 10: Addressing reporting biases. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions . Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011 Available from handbook.cochrane.org

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Metadata

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)
ORCID
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
DOI
10.1002/14651858.cd008072.pub2
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
FWCI
2.57
Type
journal article
Language
en
Open access
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 › General Dentistry › Dental materials and restorations
  • Health Sciences › Dentistry › General Dentistry › 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

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