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Survival of atraumatic restorative treatment (ART) sealants and restorations: a meta-analysis

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de Amorim, Rodrigo G., Leal, Soraya C., Frencken, Jo E.·2012·Clinical Oral Investigations
DOI 10.1007/s00784-011-0513-3PMC PMC3308010
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Abstract

UNLABELLED: The purpose of this study is to perform a systematic investigation plus meta-analysis into survival of atraumatic restorative treatment (ART) sealants and restorations using high-viscosity glass ionomers and to compare the results with those from the 2005 ART meta-analysis. Until February 2010, four databases were searched. Two hundred four publications were found, and 66 reported on ART restorations or sealant survival. Based on five exclusion criteria, two independent reviewers selected the 29 publications that accounted for the meta-analysis. Confidence intervals (CI) and or standard errors were calculated and the heterogeneity variance of the survival rates was estimated. Location (school/clinic) was an independent variable. The survival rates of single-surface and multiple-surface ART restorations in primary teeth over the first 2 years were 93% (CI, 91-94%) and 62% (CI, 51-73%), respectively; for single-surface ART restorations in permanent teeth over the first 3 and 5 years it was 85% (CI, 77-91%) and 80% (CI, 76-83%), respectively and for multiple-surface ART restorations in permanent teeth over 1 year it was 86% (CI, 59-98%). The mean annual dentine lesion incidence rate, in pits and fissures previously sealed using ART, over the first 3 years was 1%. No location effect and no differences between the 2005 and 2010 survival rates of ART restorations and sealants were observed. The short-term survival rates of single-surface ART restorations in primary and permanent teeth, and the caries-preventive effect of ART sealants were high. CLINICAL RELEVANCE: ART can safely be used in single-surface cavities in both primary and permanent teeth. ART sealants have a high caries preventive effect.

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Crossref · 10.1007/s00784-011-0513-3

Cites

82 of 82 references verified0 citation errors · 0 not checkable

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  • Glass ionomer cement is more susceptible to premature deterioration, particularly in individuals who apply considerable masticatory forces.

    “This limitation makes it more susceptible to premature deterioration, particularly in individuals who apply considerable masticatory forces [44].”

    From Minimally Invasive Techniques for Managing Dental Caries in Children: Efficacy, Applications, and Future Directions (2025) · cites this paper as [44]

    The Discussion (page unavailable in our copy) links glass ionomer fracture toughness to restoration survival and reports lower survival for some glass-ionomer formulations. It does not say that deterioration is premature or that it is particularly likely in people who exert considerable masticatory forces. (LLM, conf=0.80)

    Experimental — accuracy not yet measured

  • ART is particularly sensitive to technique, requiring optimal moisture control during application to ensure optimal bonding and longevity of restorations.

    “ART is particularly sensitive to technique, requiring optimal moisture control during application to ensure optimal bonding and longevity of restorations [44].”

    From Minimally Invasive Techniques for Managing Dental Caries in Children: Efficacy, Applications, and Future Directions (2025) · cites this paper as [44]

    The Discussion reports an operator effect on the quality of ART restorations and sealants, supporting the general point that technique matters. It does not say that optimal moisture control during application is required for bonding or restoration longevity; the Discussion instead links low survival in one setting to a poor-quality self-etch bonding system. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • Atraumatic restorative treatment has a decreased success rate in multi-surface lesions, where increased mechanical stress on restorations can lead to premature failure.

    “A primary challenge is the decreased success rate noted in multi-surface lesions, where increased mechanical stress on restorations can lead to premature failure [44].”

    From Minimally Invasive Techniques for Managing Dental Caries in Children: Efficacy, Applications, and Future Directions (2025) · cites this paper as [44]

    The Results (ART restorations; page unavailable) report higher two-year annual failure rates for multiple-surface than single-surface restorations in primary teeth (19% versus 3.5%). The Discussion describes lower short-term survival for multiple-surface restorations in primary teeth, but calls the evidence for permanent teeth inconclusive. It mentions a proposed technique that keeps a restoration out of occluding contact, but does not establish that increased mechanical stress causes premature failure. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • ART has a lower success rate in multi-surface lesions because increased mechanical stress on restorations can lead to premature failure.

    “success rate noted in multi-surface lesions, where increased mechanical stress on restorations can lead to premature failure [44].”

    From Minimally Invasive Techniques for Managing Dental Caries in Children: Efficacy, Applications, and Future Directions (2025) · cites this paper as [44]

    The Results report higher annual failure rates for multiple-surface than single-surface ART restorations in primary teeth (19% versus 3.5% over two years). The Discussion mentions a proposed technique that keeps a multiple-surface restoration out of occluding contact, but does not establish that increased mechanical stress causes premature failure. It also calls the evidence for multiple-surface restorations in permanent teeth inconclusive. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Patient compliance, the operator's expertise, and environmental conditions including moisture control during placement are critical elements influencing the longevity of atraumatic restorative treatment restorations.

    “However, factors such as patient compliance, the operator's expertise, and environmental conditions, including moisture control during placement, are acknowledged as critical elements influencing the longevity of restorations [44].”

    From Minimally Invasive Techniques for Managing Dental Caries in Children: Efficacy, Applications, and Future Directions (2025) · cites this paper as [44]

    The Discussion (page unavailable) says poor oral hygiene may affect ART restoration survival and reports an operator effect on restoration quality. It does not identify patient compliance or environmental conditions, including moisture control during placement, as factors influencing longevity. The claim also states these factors more definitively than the paper states the oral-hygiene point. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

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Cites

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Research works printed but not linked: 3

  1. [3]Loh KH An ART technique in the mobile dental squad in Malaysia: a four-year review Malaysian Dent J 2003 24 95 101
  2. [59]van Den Dungen GM Huddleston Slater AE van Amerongen WE ART of conventioneel? Onderzoeksresultaten van proximale restauraties in tijdelijke molaren Ned Tijdschr Tandheelk 2004 111 345 349 15495501
  3. [69]Oliveira LMC (2000) Avaliação de um programa de tratamento restaurador atraumático em crianças institucionalizadas. PhD Thesis, Rio de Janeiro, p 168

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Authors
de Amorim, R. G., Leal, S. C., & Frencken, J. E.
Affiliations
  • Universidade de Brasília (BR)
  • Radboud University Medical Center (NL)
Corresponding author
Frencken, Jo E.
ORCID
Leal, Soraya C.
Venue
Clinical Oral Investigations
Publisher
Springer Science and Business Media LLC
Published
2011-01-28
Volume
16
Issue
2
Pages
429-441
ISSN
  • 1432-6981 (ISSN-L)
  • 1436-3771
DOI
10.1007/s00784-011-0513-3
PMC
PMC3308010
OpenAlex
W2114683488
Cited by
213
References
82
Citations by year
2026: 3 · 2025: 3 · 2024: 6 · 2023: 8 · 2022: 13 · 2021: 20 · 2020: 31 · 2019: 23 · 2018: 20 · 2017: 15 · 2016: 16 · 2015: 15 · 2014: 14 · 2013: 16 · 2012: 8
FWCI
2.26
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • Clinical Oral Investigations (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Radboud Repository (Radboud University) (submittedVersion)
Topics
  • Health Sciences › Dentistry › Orthodontics › Dental materials and restorations
  • Health Sciences › Dentistry › Oral Surgery › Endodontics and Root Canal Treatments
  • Health Sciences › Dentistry › Periodontics › Dental Health and Care Utilization
Keywords
atraumatic restorative treatment, restoration, high-viscosity glass ionomer, primary teeth, permanent teeth, dental caries prevention, pit and fissure sealants
MeSH terms
Dental Caries, Dental Clinics, Dental Fissures, Dentin, Glass Ionomer Cements, Humans, Schools, Dental, Tooth, Deciduous, Survival Analysis, Dental Restoration Failure, Dental Atraumatic Restorative Treatment

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