Clinical Oral Investigations

, Volume 14, Issue 3, pp 233–240 | Cite as

Atraumatic restorative treatment versus amalgam restoration longevity: a systematic review

  • Steffen MickenautschEmail author
  • Veerasamy Yengopal
  • Avijit Banerjee


The aim was to report on the longevity of restorations placed using the atraumatic restorative treatment (ART) approach compared with that of equivalent placed amalgam restorations. Five databases were systematically searched for articles up to 16 March 2009. Inclusion criteria: (1) titles/abstracts relevant to the topic; (2) published in English; (3) reporting on 2-arm longitudinal in vivo trials; (4) minimum follow-up period of 12 months. Exclusion criteria: (1) insufficient random or quasi-random allocation of study subjects; (2) not all entered subjects accounted for at trial conclusion; (3) subjects of both groups not followed up in the same way. Fourteen from the initial search of 164 articles complied with these criteria and were selected for review. From these, seven were rejected and seven articles reporting on 27 separate datasets, accepted. Only identified homogeneous datasets were combined for meta-analysis. From the 27 separate computable dichotomous datasets, four yielded a statistically significant improvement of longevity of ART versus amalgam restorations: posterior class V, 28% over 6.3 years; posterior class I, 6% after 2.3 years and 9% after 4.3 years; posterior class II, 61% after 2.3 years. Studies investigating restorations placed in the primary dentition showed no significant differences between the groups after 12 and 24 months. In the permanent dentition, the longevity of ART restorations is equal to or greater than that of equivalent amalgam restorations for up to 6.3 years and is site-dependent. No difference was observed in primary teeth. More trials are needed in order to confirm these results.


Atraumatic restorative treatment Amalgam Longevity Systematic review Meta-analysis Glass ionomer cement 


Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Frencken JE, Pilot T, Songpaisan Y, Phantumvanit P (1996) Atraumatic restorative treatment (ART): rationale, technique, and development. J Public Health Dent 56:135–140CrossRefPubMedGoogle Scholar
  2. 2.
    Burke FJ, McHugh S, Shaw L, Hosey MT, Macpherson L, Delargy S, Dopheide B (2005) UK dentists' attitudes and behaviour towards atraumatic restorative treatment for primary teeth. Br Dent J 199:365–369CrossRefPubMedGoogle Scholar
  3. 3.
    Czarnecka B (2006) The use of ART technique in modern dental practice: a personal view. J Dent 34:620CrossRefGoogle Scholar
  4. 4.
    Honkala E, Behbehani J, Ibricevic H, Kerosuo E, Al-Jame G (2003) The atraumatic restorative treatment (ART) approach to restoring primary teeth in a standard dental clinic. Int J Paediat Dent 13:172–179CrossRefGoogle Scholar
  5. 5.
    Seale NS, Casamassimo PS (2003) Access to dental care for children in the United States. A survey of general practitioners. J Am Dent Assoc 134:1630–1640PubMedGoogle Scholar
  6. 6.
    Tyas MJ, Anusavice KJ, Frencken JE, Mount GJ (2000) Minimal intervention dentistry—a review. FDI commission project 1–97. Int Dent J 50:1–12PubMedGoogle Scholar
  7. 7.
    Ziraps A, Honkala E (2002) Clinical trial of a new glass ionomer for an atraumatic restorative treatment technique in class I restorations placed in Latvian school children. Med Princ Pract 11:44–47CrossRefPubMedGoogle Scholar
  8. 8.
    van‘t Hof M, Frencken JE, van Palenstein Helderman WH, Holmgren CJ (2006) The atraumatic restorative treatment (ART) approach for managing dental caries: a meta-analysis. Int Dent J 56:345–351Google Scholar
  9. 9.
    Ericson D, Kidd EAM, McComb D, Mjor I, Noack MJ (2003) Minimally invasive dentistry—concept and techniques in cariology. Oral Health Prev Dent 1:59–72PubMedGoogle Scholar
  10. 10.
    Yoshida Y, Van Meerbeek B, Nakayama Y, Snauwaert J, Hellemans L, Lambrechts P, Vanherle G, Wakasa K (2000) Evidence of chemical bonding at biomaterial-hard tissue interfaces. J Dent Res 79:709–771CrossRefPubMedGoogle Scholar
  11. 11.
    Mickenautsch S, Yengopal V, Leal SC, Oliveira LB, Bezerra AC, Bönecker M (2009) Absence of carious lesions at margins of glass-ionomer and amalgam restorations: a meta- analysis. Eur J Paediatr Dent 10:41–46PubMedGoogle Scholar
  12. 12.
    Fuks AB (2002) The use of amalgam in pediatric dentistry. Pediatr Dent 24:448–455PubMedGoogle Scholar
  13. 13.
    Mackert JR Jr (2004) Wahl MJ (2004) Are there acceptable alternatives to amalgam? J Calif Dent Assoc 32:601–610PubMedGoogle Scholar
  14. 14.
    Frencken JE, Hof MA Van ’t, Van Amerongen WE, Holmgren CJ (2004) Effectiveness of single-surface ART restorations in the permanent dentition: a meta-analysis. J Dent Res 83:120–123CrossRefPubMedGoogle Scholar
  15. 15.
    Sutherland SE (2001) Evidence-based dentistry: part V. Critical appraisal of the dental literature: papers about therapy. J Can Dent Assoc 67:442–445PubMedGoogle Scholar
  16. 16.
    Ahovuo-Saloranta A, Hiiri A, Nordblad A, Worthington H, Mäkelä M (2004) Pit and fissure sealants for preventing dental decay in the permanent teeth of children and adolescents. Cochrane Database of Systematic Reviews Issue 3: CD001830. doi: 10.1002/14651858.CD001830.pub2
  17. 17.
    The Cochrane Collaboration (2006) Cochrane handbook for systematic reviews of interventions 4.2.6. The Cochrane Collaboration pp 79-89Google Scholar
  18. 18.
    The Cochrane Collaboration (2006) Cochrane handbook for systematic reviews of interventions 4.2.6. The Cochrane Collaboration, pp 136-145Google Scholar
  19. 19.
    Frencken JE, Holmgren CJ (1999) Atraumatic restorative treatment for dental caries. STI Book b.v, Nijmegen, p 58Google Scholar
  20. 20.
    Neto RG, Santiago SL, Mendonça JS, Passos VF, Lauris JRP, Navarro MF (2008) One year clinical evaluation of two different types of composite resins in posterior teeth. J Contemp Dent Pract 4:26–33Google Scholar
  21. 21.
    Thompson SG (1994) Why sources of heterogeneity in meta-analysis should be investigated. BMJ 309:1351–1355PubMedGoogle Scholar
  22. 22.
    Frencken JE, Taifour D, Van’t Hof MA (2006) Survival of ART and amalgam restorations in permanent teeth of children after 6.3 years. J Dent Res 85:622–626CrossRefPubMedGoogle Scholar
  23. 23.
    Frencken JE, Van’t Hof MA, Taifour D, Al-Zaher I (2007) Effectiveness of ART and traditional amalgam approach in restoring single-surface cavities in posterior teeth of permanent dentitions in school children after 6.3 years. Community Dent Oral Epidemiol 35:207–214CrossRefPubMedGoogle Scholar
  24. 24.
    Gao W, Peng D, Smales RJ, Yip KH (2003) Comparison of atraumatic restorative treatment and conventional restorative procedures in a hospital clinic: evaluation after 30 months. Quintessence Int 34:31–37PubMedGoogle Scholar
  25. 25.
    Kalf-Scholte SM, van Amerongen WE, Smith AJ, van Haastrecht HJ (2003) Atraumatic restorative treatment (ART): a three-year clinical study in Malawi—comparison of conventional amalgam and ART restorations. J Public Health Dent 63:99–103PubMedGoogle Scholar
  26. 26.
    Mandari GJ, Truin GJ, van’t Hof MA, Frencken JE (2001) Effectiveness of three minimal intervention approaches for managing dental caries: survival of restorations after 2 years. Caries Res 35:90–94CrossRefPubMedGoogle Scholar
  27. 27.
    Mandari GJ, Frencken JE, van’t Hof MA (2003) Six-year success rates of occlusal amalgam and glass-ionomer restorations placed using three minimal intervention approaches. Caries Res 37:246–253CrossRefPubMedGoogle Scholar
  28. 28.
    Phantumvanit P, Songpaisan Y, Pilot T, Frencken JE (1996) Atraumatic restorative treatment (ART): a three-year community field trial in Thailand—survival of one-surface restorations in the permanent dentition. J Public Health Dent 56:141–145CrossRefPubMedGoogle Scholar
  29. 29.
    Rahimtoola S, van Amerongen E (2002) Comparison of two tooth-saving preparation techniques for one-surface cavities. ASDC J Dent Child 69:16–26PubMedGoogle Scholar
  30. 30.
    Taifour D, Frencken JE, Beiruti N, van ’t Hof MA, Truin GJ (2002) Effectiveness of glass-ionomer (ART) and amalgam restorations in the deciduous dentition: results after 3 years. Caries Res 36:437–444CrossRefPubMedGoogle Scholar
  31. 31.
    Taifour D, Frencken JE, Beiruti N, Van’t Hof MA, Truin GJ, van Palenstein Helderman WH (2003) Comparison between restorations in the permanent dentition produced by hand and rotary instrumentation--survival after 3 years. Community Dent Oral Epidemiol 31:122–128CrossRefPubMedGoogle Scholar
  32. 32.
    Yip KH, Smales RJ, Gao W, Peng D (2002) The effects of two cavity preparation methods on the longevity of glass ionomer cement restorations: an evaluation after 12 months. J Am Dent Assoc 133:744–751PubMedGoogle Scholar
  33. 33.
    Yip HK, Smales RJ, Yu C, Gao XJ, Deng DM (2002) Comparison of atraumatic restorative treatment and conventional cavity preparations for glass-ionomer restorations in primary molars: one-year results. Quintessence Int 33:17–21PubMedGoogle Scholar
  34. 34.
    Yu C, Gao XJ, Deng DM, Yip HK, Smales RJ (2004) Survival of glass ionomer restorations placed in primary molars using atraumatic restorative treatment (ART) and conventional cavity preparations: 2-year results. Int Dent J 54:42–66PubMedGoogle Scholar
  35. 35.
    The Cochrane Collaboration (2006) Cochrane handbook for systematic reviews of interventions 4.2.6. The Cochrane Collaboration, pp 97-99Google Scholar
  36. 36.
    Ericson D, Zimmerman M, Raber H, Götrick B, Bornstein R, Thorell J (1999) Clinical evaluation of efficacy and safety of a new method for chemo-mechanical removal of caries. A multi-centre study. Caries Res 33:171–177CrossRefPubMedGoogle Scholar
  37. 37.
    Ngo HC, Mount G, Mc Intyre J, Tuisuva J, Von Doussa RJ (2006) Chemical exchange between glass-ionomer restorations and residual carious dentine in permanent molars: an in vivo study. J Dent 34:608–613CrossRefPubMedGoogle Scholar
  38. 38.
    Smales RJ, Ngo HC, Yip KH, Yu C (2005) Clinical effects of glass ionomer restorations on residual carious dentin in primary molars. Am J Dent 18:188–193PubMedGoogle Scholar
  39. 39.
    ten Cate JM, van Duinen RNB (1995) Hypermineralization of dentinal lesions adjacent to glass-ionomer cement restorations. J Dent Res 74:1266–1271CrossRefPubMedGoogle Scholar
  40. 40.
    Chalmers TC, Matta RJ, Smith H Jr, Kunzler AM (1977) Evidence favoring the use of anticoagulants in the hospital phase of acute myocardial infarction. N Engl J Med 297:1091–1096PubMedCrossRefGoogle Scholar
  41. 41.
    Schulz KF, Chalmers I, Hayes RJ, Altman DG (1995) Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. J Am Med Assoc 273:408–412CrossRefGoogle Scholar
  42. 42.
    Frencken JE, Holmgren CJ (1999) Atraumatic restorative treatment for dental caries. STI Book b.v, Nijmegen, pp 76–81Google Scholar
  43. 43.
    Mickenautsch S, Grossman E (2006) Atraumatic restorative treatment (ART): factors affecting success. J Appl Oral Sci 14:34–36CrossRefPubMedGoogle Scholar
  44. 44.
    Moher D, Schulz KF, Altman DG (2001) The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. Lancet 357:1191–1194CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Steffen Mickenautsch
    • 1
    Email author
  • Veerasamy Yengopal
    • 1
  • Avijit Banerjee
    • 2
  1. 1.Division of Public Oral HealthUniversity of the WitwatersrandJohannesburgSouth Africa
  2. 2.Department of Conservative DentistryKing’s College London Dental Institute, Guy’s Dental HospitalLondonUK

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