ART技术充填第一恒磨牙浅、中龋的近期疗效观察

目的 比较非创伤修复治疗（atraumatic restorative treatment,ART）与传统银汞合金充填第一恒磨牙He面、颊面浅中龋的治疗效果。方法 对初一学生203颗第一恒磨牙浅中龋进行ART修复，对199颗同年龋组的第一恒磨牙标准备洞后进行银汞合金充填。结果 ART修复10个月后复查，成功率为94.08%；传统银汞合金充填10个月后成功率为97.47%，两组间无显著差异（P＞0.05）。结论 ART是一种较好的龋病治疗方法，可避免汞污染，不受诊疗条件的限制，利于社区、农村、学校推广，提高龋病充填率。     

银汞、GIC充填乳牙龋的临床观察

目的 比较银汞、普通GIC和Ketac-Cem GIc在乳牙龋充填的效果，探讨Ketac-Cem GIC作为充填材料是否理想。方法 选择57例4～6岁双侧同名牙患乳磨牙he面中龋儿童为实验组1，一侧用银汞进行常规备洞充填，一侧为KC GIC直接充填。选择55例患儿为实验组2，一侧为银汞常规备洞充填，一侧为普通GIC直接充填。选择55例患儿为实验组3，一侧为普通GIC直接充填，一侧为KC GIC直接充填。临床观察时间2年。结果 实验组1中银汞充填体组脱落和继发龋发生率为26．3％。KC GIC为7％。实验组2中银汞脱落和继发龋为21．8％。GIC为12．7％。实验组3中KC GIC常规备洞组脱落和继发龋发生率为5．5％。普通GIC充填组为10．9％。结论 普通GIC、银汞和KC GIC用于乳牙龋充填治疗时，KC GIC可以更有效防止微渗漏和继发龋的发生。     

非创伤充填技术与光固化封闭术成本-效果比较

目的 比较非创伤充填技术（ART）与传统窝沟封闭术在实验窝沟封闭方面的成本-效果差异。方法 选择上海市两所小学7-8岁儿童211名，口腔内至少有1对第一恒磨牙无龋。每名儿童一侧在恒磨牙用ART技术充填，充填时仅用手工器械和棉花卷，不使用橡皮障隔湿，充填材料为玻璃离子粘固粉；另一侧用光固化封闭剂封闭窝沟，使用便携式牙科治疗器上的吸引器吸取唾液，并用棉卷隔湿，记录每个牙封闭所用去的树脂材料和花费的共同卷数及操作时间，8个月后检查两种材料在牙面上的保留情况。结果 使用传统窝沟封闭术组，原始投资额为47500元/台，而ART组为100元/套；操作时间在传统窝沟封闭术组每牙需3.54min，而ART组需3.18min，传统窝沟封闭术组在原始投资额和操作时间方面都显著高于ART组，而传统窝沟封闭术组所用树脂材料的费用显著低于ART组。在封闭剂的保留率方面，ART组高于传统的窝沟封闭组。结论 对于缺乏投资设备的地区，对儿童采用ART技术封闭窝沟，能用较少投入和较短时间达到龋病预防目的。     

非创伤性修复与乳牙龋病治疗的研究现状

非创伤性修复治疗（Atraumatic Restorative Treatment, ART）是指使用手用器械清除软化的、完全脱矿的龋坏牙体组织,然后用有粘接性的口腔修复材料充填龋洞,并同时封闭容易患龋的点隙窝沟的一种治疗方法,其常用的具有代表性的材料之一为富士IX玻璃离子水门汀（GIC富士IX）。氟化氨银（Silver Diamine Fluoride, SDF）是一种银基龋病预防材料,在龋病预防技术（Arrest of Caries Technique, ACT）起着至关重要的作用。ART是当前龋病治疗的微创技术之一、GIC富士IX为ART的代表性材料、SDF能增加ART的成功率,这三者与龋病治疗之间有密切的联系。本综述的目的是建立一个由ART、GIC富士IX、SDF组成的牙本质龋双层修复系统。     

牙科恐惧症患儿新生恒磨牙龋ART治疗的临床研究

目的：探讨ART＋Ketac—Molar释氟玻璃离子材料治疗模式对牙科恐惧症患儿新生恒磨牙继发龋发生率的影响。方法：选择7～9岁的112名具有极度牙科治疗恐惧症的儿童192颗新生恒磨牙为试验组,同年龄段的82名儿童141颗新生恒磨牙为对照组,试验组用ART＋Ketac--Molar释氟玻璃离子材料治疗,对照组常规银汞合金充填。结果：2年后试验组回访继发龋发生率19．8％;对照组继发龋发生率15．5％。两组比较无显著性差异。结论：新生恒磨牙龋坏采用ART＋Ketac--Molar释氟玻璃离子材料治疗模式与常规银汞充填效果无明显差异,本方法适合于有牙科恐惧症的患儿龋齿治疗。     

口腔内科学——龋病及牙体硬组织非龋性疾病

Cariostat与龋蚀现状及发展的关系；银汞、GIC充填乳牙龋的临床观察；牙齿楔状缺损与侧方He工作侧咬合接触关系的调查；玻璃离子夹层对光固化复合树脂修复楔形缺损疗效的影响；靶向融合防龋DNA疫苗pGJA-P免疫兔的实验研究；儿童第一恒磨牙大面积缺损的早期修复治疗；     

乳磨牙龋非创伤性充填疗效观察

非创伤性充填技术(ART)适用于恒牙和乳牙无牙髓病变的中、小龋洞充填。我们对ART充填乳磨牙He面龋(Ⅰ类洞)和邻He面龋(Ⅱ类洞)的临床效果进行评价,现报告如下。     

光固化流体树脂与非创伤性充填窝沟封闭成本效果评价

[摘要] 目的 比较光固化流体树脂与非创伤性充填(ART)封闭技术在实施窝沟封闭方面防龋成本及保留率的差异。方法 选择上海市两所小学7～10岁儿童267名,口腔内至少有2个第一恒磨牙无龋及有较深窝沟。随机选择每名儿童第一恒磨牙一侧用ART技术进行窝沟封闭,其它的第一恒磨牙用光固化流体树脂进行窝沟封闭,使用便携式牙科椅吸取唾液,并用棉卷隔湿。两种方法在操作时记录每个牙封闭所用去的棉卷数和操作时间。1年后检查两种材料在牙面上的保留情况。所有操作均在学校内施行,检查由两名医师使用镰形探针进行检查。结果使用ART封闭技术进行窝沟封闭操作时间每牙需3.18 min,而光固化流体树脂组需3.32 min(P<0.01),所用棉花卷数和重复次数无差异(P>0.05)。在封闭剂的保留率方面,光固化流体树脂组保留率高于ART封闭组(P<0.01)。结论 用光固化流体树脂和ART技术进行窝沟封闭都能用较短操作时间达到龋病预防目的 ,适合在学校开展应用。     

银合金粉玻璃离子充填材料治疗恒磨牙深龋的疗效

目的：评价银合金粉玻璃子充填材料对恒磨牙深龋充填治疗的临床效果。方法：临床上选取937例共1032颗牙髓活力正常的深龋恒磨牙，采用银玻璃离子材料充填治疗。结果：随访3年，其中995颗牙治疗成功，37颗牙治疗失败，成功率为96.41％。结论：银玻璃离子材料充填治疗恒磨牙深龋是一种较理想的材料。     

流体树脂应用于恒磨牙预防性充填术3年效果评价

目的探讨光固化流体树脂对年轻恒磨牙窝沟龋预防性充填治疗的疗效。方法对56例7～14岁患儿两侧同名磨牙分别采用两种不同的预防性树脂充填方法。试验组:112颗面窝沟龋在磨除龋坏牙体组织后联用后牙复合树脂与流体树脂对龋坏部位和未龋坏窝沟区域进行预防性充填治疗。对照组:112颗面窝沟龋在磨除龋坏牙体组织后采用传统窝沟封闭剂加后牙复合树脂,评价两组3个月、1年、3年的保留成功率。结果随访3年后发现采用Wave Flow流动复合树脂加后牙复合树脂进行预防性树脂充填治疗,充填成功率高达87.5%,对照组仅为67.7%,两组成功率比较具有非常显著性差异。结论光固化流体树脂加后牙复合树脂对年轻恒磨牙的窝沟龋治疗疗效确切,值得临床推广应用。     

The effects of two cavity preparation methods on the longevity of glass ionomer cement restorations: an evaluation after 12 months

BACKGROUND: The authors undertook a study to evaluate the effect of two cavity preparation methods on the initial survival of two more-viscous glass ionomer cements, or GICs, placed in the occlusal surfaces of permanent molar teeth. METHODS: Three dentists placed 149 restorations in 68 adult patients in a hospital clinic. They used either atraumatic restorative treatment, or ART, or conventional cavity preparation methods to place two encapsulated esthetic conventional GICs: Fuji IX GP (GC International Corp., Tokyo) and Ketac-Molar Aplicap (3M ESPE, Seefeld, Germany). For comparison, they used high-copper-content GK Amalgam Alloy (Advanced Technology & Materials Co. Ltd., Beijing) in conventional preparations. They evaluated the restorations using both direct and indirect observation methods. RESULTS: Cavity preparations for which the authors used ART hand instruments took approximately twice as long to complete as did those for which they used conventional rotary instruments. After 12 months, no restorations had failed, but restorations comprising both GICs showed early losses of adjacent sealant material. Both GICs also showed relatively high restoration wear. At 12 months, the mean cumulative net occlusal wear for Fuji IX GP was 77 +/- 47 micrometers, and for Ketac-Molar 83 +/- 51 microm, without statistical significance (P > .05). Color matching improved significantly with time (P < .001), without significant differences in color between the two GICs by 12 months (P = .09). The amalgam alloy had minor surface tarnishing and marginal discrepancies increased with time (P < .00 1). CONCLUSIONS: All of the occlusal restorations were rated as satisfactory after 12 months. The method of cavity preparation did not affect the restoration performance of the GICs. However, their deterioration requires long-term monitoring. Clinical Implications. The more viscous GICs appear initially suitable for restricted use in clinical practice when placed using either of two cavity preparation methods in the occlusal surfaces of permanent molar teeth in adults.     

Survival of glass ionomer restorations placed in primary molars using atraumatic restorative treatment (ART) and conventional cavity preparations: 2-year results

OBJECTIVE: To compare the survival of glass ionomer cement (GIC) restorations placed in a dental clinic setting using both the atraumatic restorative treatment (ART) approach with hand instruments, and conventional cavity preparation with rotary instruments. METHOD AND MATERIALS: Two encapsulated high-strength conventional GICs (Fuji IX GP, Ketac-Molar Aplicap) were placed in 82 Class I and 53 Class II preparations and one encapsulated non-gamma 2 amalgam alloy (GK-amalgam) was placed in 32 Class I preparations, in the primary molars of 60 Chinese children with a mean age of 7.40 +/- 1.24 (SD) years. Thus, 9 treatment groups were formed. RESULTS: After two years, there were no significant survival differences found among 7 of the 9 treatment groups (p = 0.99). However, two groups comprising Fuji IX GP and Ketac-Molar Aplicap placed in Class II cavities prepared using the ART approach showed significantly lower restoration survivals (p < 0.001). Only 3 of the 72 initially sealed fissures adjacent to the restorations appeared to retain any GIC material. CONCLUSIONS: In a clinic setting, both the ART hand instrument and conventional rotary instrument methods were equally suitable for high Class I restoration survival, but not for Class II restoration survival where the conventional cavity preparation method was preferable.     

How effective is ART in the management of dental caries?

The ART approach involves excavating cavitated dentine caries with hand instruments, then restoring the cavity and sealing any associated fissures and pits with an adhesive restorative material, resulting in a sealant restoration. Until recently, ART has mainly been used under field conditions, and thus the adhesive restorative material used has been glass ionomer which does not require mixing machines and curing lights. Since the inception of ART, a growing number of studies world-wide have taken place. A total of four studies have reported 3-year survival percentages for one-surface ART restorations. The highest 3-year survival percentage in permanent teeth was 88%, which is comparable to the 85% survival of one-surface amalgam restorations placed under the same field conditions after 3 years. The outcomes depend to some extent on the material used, operator experience and presence of caries. The presence of caries as a reason for failure was higher in the early than in the most recent studies. Only one study has reported on the use of ART restorations in the deciduous dentition. It is concluded that: a very large proportion of dentine lesions in the permanent teeth can be treated using the ART approach; the 3-year survival rate of the more recently placed one-surface ART restorations in permanent teeth was higher than that of ART restorations placed in the beginning; the survival of one-surface ART restorations in the permanent dentition with newer glass ionomers is comparable to that of one-surface conventional restorations placed using amalgam in a comparable setting after 3 years; more studies of longer duration are needed to confirm these findings; ART should be considered a caries treatment modality that benefits people; and educational courses need to be organised before the approach is applied in the clinic.     

Amalgam and ART restorations in children: a controlled clinical trial

Objectives

The aims of this study were to compare 2-year cumulative survival rates of amalgam and atraumatic restorative treatment (ART) restorations in primary molars and to investigate the determinants of the survival rate of restorations.

Materials and methods

A controlled clinical trial using a parallel group design was carried out on 258 children aged 6–7 years old, allocated to two treatment groups: conventional restorative treatment using amalgam and ART using high-viscosity glass ionomer. A total of 364 amalgam restorations and 386 ART restorations were placed by three pedodontists in 126 and 158 children, respectively, and were evaluated after 0.5, 1, and 2 years. Restorations were placed in vital primary molars with neither pain nor signs of pulp involvement. The survival analysis was conducted using the proportional hazard rate regression model with frailty correction.

Results

The 2-year cumulative survival rates for all amalgam (77.3 %) and ART (73.5 %) restorations were not statistically significantly different, but there was an effect of “type of surface” (single/multiple) and “cavity filling time” on the survival rates. Both amalgam and ART single-surface restorations had higher survival rates than multiple-surface restorations of the same material. Secondary caries was responsible for 36 and 38 % of failures in amalgam and ART restorations, respectively. Mean time for restoring all type of cavities with amalgam and ART restorations was 13.6 and 13.7 min, respectively.

Conclusions

Amalgam and ART restorations presented similar survival rates over a 2-year period for all, single-surface, and multiple-surface restorations.

Clinical relevance

In the cause of finding alternatives to amalgam, ART restorations using high-viscosity glass ionomer might be a suitable option for managing cavitated dentine carious lesions in vital primary molars.     

Comparison of atraumatic restorative treatment and conventional restorative procedures in a hospital clinic: evaluation after 30 months.

OBJECTIVE: The purpose of this study was to evaluate two glass-ionomer cements placed in the occlusal surfaces of permanent molar teeth, using two cavity preparation methods. METHOD AND MATERIALS: Three dentists placed 149 restorations for 68 patients in a hospital clinic. Atraumatic restorative treatment or conventional cavity preparation methods were used for two encapsulated, high-strength conventional glass-ionomer cements: Fuji IX GP and Ketac-Molar. Non-gamma 2 amalgam alloy was used in conventional preparations for comparison. RESULTS: The restorative procedures were uneventful, but cavity preparations made with atraumatic restorative treatment hand instruments took approximately twice as long as did conventional rotary instrumentation. After 30 months, only one glass-ionomer cement restoration had failed. Both glass-ionomer cements showed high early losses of sealant material, but caries was not detected in the exposed fissures. Both glass-ionomer cements also showed relatively high restoration wear. At 30 months, the mean cumulative net occlusal wear was 119 +/- 12 mm for Fuji IX GP and 96 +/- 13 mm for Ketac-Molar; the difference was not statistically significant. Color matching improved significantly by 6 months; there was no significant difference in color match between the two glass-ionomer cements by 12 months. Minor surface tarnishing and marginal discrepancies were present in the amalgam restorations and increased with time. CONCLUSION: The occlusal restorations performed satisfactorily over periods of up to 30 months. However, the continued deterioration of the cements requires longer-term studies to be undertaken.     

The physical and adhesive properties of dental cements used for atraumatic restorative treatment

Atraumatic Restorative Treatment (ART), a recently reported field dentistry technique, involves removal of carious debris using only hand instruments and placement of a glassionomer cement (GIC) restoration. While small ART-GIC restorations are effective short-term replacements for lost tooth form, many larger ART-GIC restorations are defective after two years. Presently, resin-modified GICs (R-M GIC) are available which require no special activation equipment and handle easily in field settings. This study measured the com- pressive, tensile, and shear bond strengths to enamel and dentin of a conventional ART-GIC (Fuji IX) and two R-M GICs (Fuji Plus and Advance) at a powder-to-liquid ratio of 3.6:1. The compressive strengths of the GICs tested were significantly different. Fuji IX had the highest compressive strength, and Advance had the lowest strength (p < 0.05). The tensile strength of the R-M GICs was greater than that of the ART-GIC. Fuji Plus showed the highest shear bond strength to enamel and dentin and was significantly different from both Fuji IX and Advance. A clinical protocol is presented followed by case reports where the ART technique was used for management of acute caries in a modern dental setting.     

Atraumatic restorative treatment (ART): a three-year clinical study in Malawi--comparison of conventional amalgam and ART restorations

OBJECTIVE: This study compares the quality of class I restorations made with the atraumatic restorative treatment (ART) technique and conventional class I amalgam restorations. METHODS: The study was carried out among secondary school students in Mzuzu, Malawi. First-year students in 1987 who needed at least two class I restorations were selected. Based on a split-mouth design, each participant received both ART and conventional restorations. The 89 pairs of class I cavities were divided randomly into two groups, since two different cermet ionomer cement (CIC) filling materials were used. Impressions of the restorations and subsequent models were made shortly after restoration, after six months, one year, two years, and three years. The quality of the restorations was determined on the models following the US Public Health Service criteria. Bulk fracture, contour, marginal integrity, and surface texture of the restorations were recorded and evaluated separately. Survival rates were determined by the resultant score of all criteria. RESULTS: Though conventional amalgam restorations performed better on all criteria, this difference was significant only for the contour criterion. The survival rates of ART restorations after three years (81.0%) were lower than those of amalgam restorations (90.4%) (P=.067). CONCLUSIONS: The quality of ART class I restorations is competitive with that of conventional amalgam restorations.     

Glass ionomer cements used as fissure sealants with the atraumatic restorative treatment (ART) approach: review of literature

AIM: To review the success of newer, more-viscous aesthetic conventional glass ionomer cements (GICs), that have been marketed specifically for the atraumatic restorative (ART) technique or approach, when used as pit and fissure sealants. As part of this approach, enamel fissures adjacent to the ART restorations are conditioned with poly (acrylic) acid (PAA) and then usually sealed with a GIC, using the finger-press method. RESULTS: The newer GICs appear in vitro to penetrate adequately and seal occlusal fissures in permanent molar teeth, and clinical studies of the ART approach over three years have found sealant retention (full and partial) to be approximately 70%, with fissure caries approximately 0-4%. In two studies, fissure caries was significantly reduced in sealed as compared with unsealed teeth over three years. CONCLUSIONS: Although the results appear to be better with the newer than with earlier conventional GIC products, the ART studies have generally involved populations at low-risk to caries, and further improvements in the mechanical properties of the cements are required for optimal long-term clinical success. Etching the enamel fissures with phosphoric acid, instead of conditioning with PAA, before GIC sealant placement warrants clinical investigation.     

Six-year success rates of occlusal amalgam and glass-ionomer restorations placed using three minimal intervention approaches

The present randomised clinical trial was aimed at comparing three minimally invasive restorative treatment approaches for managing dental caries in occlusal surfaces using a non-gamma-2 amalgam and a low-viscosity glass-ionomer as the restorative material. The treatment approaches tested in parallel groups were: conventional in a university setting, modified-conventional and ultraconservative (Atraumatic Restorative Treatment, ART) approaches in a field setting. A split-mouth design was used in which the two restorative materials were randomly placed in 430 matched contralateral pairs of permanent molar teeth. A total of 152 children from five primary schools were recruited and treated by a dental therapist. The restorations were evaluated after 6 years by 2 calibrated independent examiners. The 6-year successes for all occlusal amalgam and glass-ionomer restorations were 72.6 and 72.3%, respectively. There were no statistically significant differences observed between the successes for both amalgam and glass-ionomer restorations placed either by the ART (68.6%, with 95% CI = 61-76%) approach or by the conventional (74.5%, with 95% CI = 65-82%) and the modified-conventional (75.8%, with 95% CI = 67-83%) approaches after 6 years. There was also no statistically significant difference observed between the successes of occlusal ART restorations with glass-ionomer (67.1%, with 95% CI = 56-77%) and occlusal conventional restorations with amalgam (74%, with 95% CI = 61-85%) after 6 years. 'Restoration fracture/marginal defects' and 'loss of material' were the most common causes for failure. The former was more often recorded in amalgam restorations and the latter in glass-ionomer restorations. Secondary caries was observed for 2% of glass-ionomer and for 10% of amalgam restorations. This difference was statistically significant (p = 0.001). The ART approach using glass-ionomer performed equally well as conventional restorative approaches using electrically driven equipment and amalgam for treating dentinal lesions in occlusal surfaces after 6 years.     

Atraumatic Restorative Treatment (ART): a Three-year Community Field Trial in Thailand—Survival of One-surface Restorations in the Permanent Dentition

This study compares the Atraumatic Restorative Treatment (ART) technique to conventional amalgam restorations in the management of dental caries. The present report is limited to the results for one-surface restorations in the permanent dentition over a three-year period. A community field trial was carried out in rural villages in northeastern Thailand. Dental caries was treated using the ART technique in one village where 144 persons were treated with 241 restorations. In a second village, 205 conventional amalgam restorations were provided to 138 persons using mobile dental equipment. Both ART and amalgam restorations were performed by one dentist and two dental nurses without administering local anesthesia. Clinical evaluation was carried out one, two, and three years after placement. The longevity of the restorations was determined by computing the estimated cumulative survival rates according to the life table method. The survival rates of ART restorations (93%, 83%, 71% in years one, two, and three, respectively) were close to those for amalgam restorations (98%, 94%, 85%); however, differences were statistically significant. No statistically significant differences were observed between ART restorations in children and adults, or between those placed by the dentist and dental nurses. Survival rates were lower for occlusal surface restorations compared to those in other surfaces. ART is a feasible approach for the management of dental caries, especially for one-surface lesions in the permanent dentition. Because of its simplicity as a minimal intervention technique, ART can make the control of dental caries available to all people irrespective of their economic and living conditions.