Running head: ATRAUMATIC RESTORATIVE TREATMENT (ART)

Atraumatic Restorative Treatment (ART)

Lamar Institute of Technology

Tara King
Hollie Schroeder

ATRAUMATIC RESTORATIVE TREATMENT (ART)

Atraumatic Restorative Treatment (ART) is a restoration technique that

we, as a prospective dental hygienist, would like to start seeing in every day
practice. We hope that by presenting the advantages and benefits of this
technique, it will help encourage fearful and lower class patients to partake
in necessary treatment. Our goal, as a clinician, is to achieve maximum oral
health amongst all of our patients with this treatment.
ART was developed to serve communities in developing countries that
are low economically, who have an insufficient water supply, a lack of
electricity, and an absence of conventional dental equipment. Low-income
communities are at an extremely high risk for caries and bad oral health
because of their lack of access to dental services, finances, and knowledge
of the role oral health plays in their overall health. (Estupinan-Day, Tellez,
Kaur, Milner, Solari; p. 237). There have been numerous studies throughout
the past several years on the potential and success of ART. In 2005, a dentist
by the name of Eduardo Bresciani conducted two evaluations on the success
rate of 155 class I restorations on permanent molars. The first evaluation was
on postoperative sensitivity. With ART, only 2.7% of the participants had
sensitivity with the procedure, that is a success rate of 97.3%. The next
study was based on the restorations durability at 12 and 30 months.
Successfully, the results concluded of 91% and 79%, respectively (Alfaya, p.
160). Another example of a rewarding study was made by pediatric dentists
E.C. Lo & C.J. Holmgren with 95 Chinese children aged 5 & 6 years old. 93%
of the children claimed to have no discomfort or pain during the treatment.

ATRAUMATIC RESTORATIVE TREATMENT (ART)

In conclusion of the study, 86% of these patients approved of the technique

and agreed to have dental treatment in the future. (Carvalho, Ribeiro,
Bonecker, Pinherio, Colares; p. e669). Mickenautsch and Yengopal said,
Although developed for use in the less industrialized parts of the world, ART
has now been accepted as part of the minimum intervention philosophy in
developed countries. (Mickenautsch, Yengopal, Banerjee; p. 233).
ART, which is a minimally invasive procedure, involves two different
components: sealants for carious-prone pits and fissures, and restorations for
the carious lesions. To place the ART sealant, an application of a highviscosity glass-ionomer is pushed into the pits and fissures of a tooth using
finger pressure (Frencken, p.78). Glass ionomer cement (GIC), is presently
found to be the ART restorative material of choice because it simplifies the
restorative process and helps the dentin and pulp complex react to the caries
process. The major difference in placing an amalgam restoration and an ART
restoration is that the ART technique involves hand instruments, not rotary
instruments. Here is a breakdown of the restorative procedure. First, the
infected dentin is removed with hand instruments. Next as the GIC is being
placed, a seal is administered between the GIC, what is left of the enamel
margin, and the dentin infected by caries that lines the cavitys surface.
Then, the GIC attaches to the enamel and dentin essentially by the calcium
bonding to the minerals of the tooth structure. This attachment results in an
adaptive seal. Lastly, as the material gradually extracts fluoride ions into the
bordering tooth tissue, the GIC are able to stop or reduce the progression of

ATRAUMATIC RESTORATIVE TREATMENT (ART)

carious lesions (Mickenautsch, Yengopal, Banerjee; p. 233-234). Studies show

that the average time for the ART procedure is only 19.80 minutes while the
amalgam restoration takes 34.07 minutes (Alfaya, p. 161).
After all the studies and procedures done involving the atraumatic
restorative treatment technique, many advantages have been documented.
The major advantage is that it provides less discomfort for patients, which
decreases the anxiety and fear level tremendously that comes along with
dental treatment (Carvalho, Ribeiro, Bonecker, Oinheiro, Colares; p. e668).
Because of the use of hand instruments, ART eliminates the need for
anesthesia, expensive and loud instruments, unnecessary removal of healthy
dental tissue, and injury to the pulp. Glass ionomer cement that fills in the
carious lesion helps with remineralization of the tooth by releasing fluoride
when it bonds (Estupinan-Day, Tellez, Kaur, Milner, Solari; p. 238). The
degree of wear on an ART restoration using high viscosity glass ionomer is
low. They have been proven to be more cost-effective after two years than
amalgam restorations. The rate of survival, for a single surface ART
restoration in primary and permanent posterior teeth, meets the ADA
qualifications and are shown to be high. Lastly, a great advantage of the ART
is, besides it being a great restorative treatment for all ages, it is also a
preventive treatment that can be done by dental operating personnel, such
as dental therapists, along with dentists (Frencken, p.81-82).
Jo E. Frencken said, ART has been introduced in public and private
health services of both developing and developed countries and this process

ATRAUMATIC RESTORATIVE TREATMENT (ART)

is ongoing. To learn more about atraumatic restorative treatment and

bringing it into their offices, dental professionals will need to participate in
well conducted, however, lengthy, ART courses (Frencken, p. 81). By
educating why, how, and all the advantages of ART, we hope dental
professionals will take action and begin using this beneficial technique in
their practice.

References

Caro, T. E., Aguilar, A. A., Saavedra, J. H., Alfaya, T. A., Franca, C. M., Fernandes, K. P., ...
Bussadori, S. K. (2012). Comparison of operative time, costs, and self-reported pain in
children treated with atraumatic restorative treatment and conventional restorative
treatment. Clin Exp Med Lett, 53, 159-163. http://dx.doi.org/Retrieved from
Carvalho, T., Ribeiro, T., Bonecker, M., Morais Pinheiro, E., & Colares, V. (2009, December 1).
The atraumatic restorative treatment approach: An atraumatic alternative. Med Oral
Patol Oral Cir Bucal, 14, 668-673. http://dx.doi.org/10.4317/medoral.14.e668

ATRAUMATIC RESTORATIVE TREATMENT (ART)

Estupinan-Day, S., Tellez, M., Kaur, S., Milner, T., & Solari, A. (2013). Rev Panam Salud
Publica. Managing dental caries with atraumatic restorative treatment in children:
successful experience in three Latin American countries, 33, 237-243. Retrieved from
Frencken, J. E. (2009). Evolution of the ART approach: highlights and achievements. J Appl
Oral Sci, 17, 78-83. Retrieved from www.scielo.br/jaos
Holmgren, C., Roux, D., & Domejean, S. (2013, January 11). Minimal intervention dentistry:
part 5. Atraumatic restorative technique (ART) - a minimum intervention and minimally
invasive approach for the management of dental caries. British Dental Journal, 214, 1118. http://dx.doi.org/10.1038/sj.bdj.2012.1175
Mickenautsch, S., Yengopal, V., & Banerjee, A. (2010, May 25). Atraumatic resorative treatment
versus amalgam restoration longevity: a systematic review. Clin Oral Invest, 14, 233-240.
http://dx.doi.org/10.1007/s00784-009-0335-8