Atraumatic Restorative Therapy

After selectively removing the carious tooth substance with hand instruments, the cavity is filled with conventional self-hardening glass ionomer cement (GIC). Pain and anxiety are significantly lower in both children and adults who receive ART therapy compared to conventional therapy.

The long term effectiveness of ART is lower than for restorations performed under well-equipped conditions, as GIC runs a higher risk of failure compared to other filling materials or stainless steel crowns. But as optimal treatment are sometimes not available, ART might be a feasible approach: In a meta-analysis of 5 ART effectiveness studies, 4 of the 5 studies found no statistical difference in survival between glass ionomer cements applied with ART and traditional amalgam restorations in children both being mostly performed under compromised conditions in developing countries [1].  Similar results have been reported in older adults (mean age 78.6 years). A recent systematic review saw low-quality evidence that ART using H-GIC may have a higher risk of restoration failure than conventional treatment for caries lesions in primary teeth [2]. Especially class II restorations with GIC carry a risk of unacceptable high failure rates.

There are no studies suggesting the use of ART increases the risk of adverse side effects for patients during or after treatment.

Cost analyses heavily depend on the selected models. ART costs less than conventional amalgam restorations. Program costs can be 50% less than amalgam and composite resin restorative procedures in a traditional clinical setting. On the other hand, the relatively high failure rate of GIC restorations, especially for multi-surface lesions, decreases the long term cost effectiveness of ART as this creates elevated retreatment costs.

ART was developed primarily for use in community and school-based programs in developing countries. Because electricity is not needed, and the equipment is portable and easily set up, the ART methodology is particularly appropriate when treating single surface lesions in schools, nursing homes and community settings.