Comparison of two tooth-saving preparation techniques for one-surface cavities

The atraumatic restorative treatment technique (ART) is based on removing infected tooth material using only hand instruments and filling the subsequently cleaned cavity with adhesive material such as glass ionomer. As its name suggests, the ART technique should be atraumatic during treatment, as well as for the tooth itself as for the patient. It was primarily developed for treating people living in underserved areas of the world where resources and facilities such as electricity and trained manpower are limited. Many studies have evaluated the ART technique and the results have supported its application. However, a very limited number of studies have compared ART with more conventional techniques. For that reason, a study was conducted in Pakistan, to compare the ART technique with another more conventional treatment technique. The results of this study show that the preparations with hand instruments resulted in smaller sized cavities and therefore may be less traumatic to the tooth. It was also associated with less pain reactions compared to the more conventional technique. Although preparations with hand instruments required more time, this did not seem to affect the survival of restorations. The survival of glass ionomer cement restorations made with hand instruments was comparable with single surface amalgam restorations made with a more conventional technique. Recurrent caries was not associated with any glass ionomer cement restorations made with hand instruments. The retention rate of glass ionomer sealants was low, however one dentist had a sealant retention rate of 81.5 percent that suggests that this procedure can be performed satisfactorily in conjunction with a glass ionomer cement restoration. Operator variances did seem to affect the restorations. Survival of glass ionomer restorations made with both hand and rotary instruments varied for different operators. Similarly, the retention of fissure sealant also varied amongst operators. Operator differences also influenced the extent of tooth substance lost due to cavity preparation. The ART technique is a feasible approach towards the treatment of dental caries especially of one-surface lesions for underserved populations.