The ART approach: clinical aspects reviewed

The success of ART as a caries management approach is supported by more than 20 years of scientific evidence. ART follows the contemporary concepts of modern cariology and restorative dentistry. It challenges treatment concepts such as step-wise excavation and the need for complete removal of affected dentine. The ART approach so far has mainly used high-viscosity glass-ionomer as the sealant and restorative material. Cariostatic and remineralization properties have been ascribed to this material which requires further research to establish its clinical relevance. The adhesion of high-viscosity glass-ionomer to enamel in pits and fissures is apparently strong, as its remnants, blocking the pits and fissures, have been considered a possible reason for the low prevalence of carious lesion development after the glass-ionomer has clinically disappeared from it. Encapsulated high-viscosity glass-ionomers may lead to higher restoration survival results than those of the hand-mixed version and should, therefore, not be neglected when using ART. Similarly, the use of resin-modified glass-ionomer with ART should be researched. The effectiveness of ART when compared to conventional caries management approaches has been shown in numerous studies. Proper case selection is an important factor for long-lasting ART restoration survival. This is based on the caries risk situation of the individual, the size of the cavity opening, the strategic position of the cavitated tooth and the presence of adequate caries control measures. As the operator is one of the main causes for failure of ART restorations, attending a well-conducted ART training course is mandatory for successful implementation of ART

Compressive strength of two newly developed glass-ionomer materials for use with the Atraumatic Restorative Treatment (ART) approach in class II cavities.

Contains fulltext : 81628.pdf (publisher's version ) (Closed access)OBJECTIVES: The null-hypotheses tested were that no difference in compressive strength of ART class II cavities exists between those restored with (1) glass-carbomer and a commonly used glass-ionomer; (2) KMEM and the commonly used glass-ionomer and; (3) glass-carbomer and KMEM. METHODS: 100 molar teeth, stratified by size, were randomly allocated to the four test groups. Large ART class II cavities were drilled and restored with Clearfil photoposterior (negative control), Fuji IX (positive control), Glass-carbomer and Ketac Molar Easymix (KMEM) (experimental groups). Half of the samples in each test group were 5000 times thermocycled between 5 degrees C and 55 degrees C, with a 30s dwell time in each bath and a transfer time of 10s. The restorations were statically tested at the marginal ridge until failure, using a rounded rectangular testing rod at crosshead speed of 1.0mm/min. ANOVA and Student's t-test were applied to test for differences between the dependent variable (compressive strength at the final breaking point) and the independent variables (thermocycling and restorative material). RESULTS: Restorations of Clearfil photoposterior had a statistically significant higher mean compressive strength value at final breaking point than those of the three glass-ionomers tested (p=0.0001). No thermocycling effect was observed (p=0.19). ANOVA between the three glass-ionomer materials and mean compressive strength at final breaking point showed no statistically significant difference (p=0.09). SIGNIFICANCE: Class II ART cavities restored with the newly launched Glass-carbomer and Ketac Molar Easymix were not significantly more fracture resistant than comparable restorations using the conventional glass-ionomer Fuji IX

Mechanical performance of encapsulated restorative glass-ionomer cements for use with Atraumatic Restorative Treatment (ART)

Contains fulltext : 119138.pdf (publisher's version ) (Open Access)The Atraumatic Restorative Treatment (ART) approach was suggested to be a suitable method to treat enamel and dentine carious lesions in patients with disabilities. The use of a restorative glass-ionomer with optimal mechanical properties is, therefore, very important. OBJECTIVE: To test the null-hypotheses that no difference in diametral tensile, compressive and flexural strengths exists between: (1) The EQUIA system and (2) The Chemfil Rock (encapsulated glass-ionomers; test materials) and the Fuji 9 Gold Label and the Ketac Molar Easymix (hand-mixed conventional glass-ionomers; control materials); (3) The EQUIA system and Chemfil Rock. MATERIAL AND METHODS: Specimens for testing flexural (n = 240) and diametral tensile (n=80) strengths were prepared according to standardized specifications; the compressive strength (n=80) was measured using a tooth-model of a class II ART restoration. ANOVA and Tukey B tests were used to test for significant differences between dependent and independent variables. RESULTS: The EQUIA system and Chemfil Rock had significantly higher mean scores for all the three strength variables than the Fuji 9 Gold Label and Ketac Molar Easymix (alpha=0.05). The EQUIA system had significant higher mean scores for diametral tensile and flexural strengths than the Chemfil Rock (alpha=0.05). CONCLUSION: The two encapsulated high-viscosity glass-ionomers had significantly higher test values for diametral tensile, flexural and compressive strengths than the commonly used hand-mixed high-viscosity glass-ionomers

Stable benefits of bilateral over unilateral cochlear implantation after two years: A randomized controlled trial

Objectives/HypothesisTo investigate hearing capabilities and self-reported benefits of simultaneous bilateral cochlear implantation (BiCI) compared with unilateral cochlear implantation (UCI) after a 2-year follow-up and to evaluate the learning effect of cochlear implantees over time. Study DesignMulticenter randomized controlled trial. MethodsThirty-eight postlingually deafened adults were included in this study and randomly allocated to either UCI or simultaneous BiCI. Our primary outcome was speech intelligibility in noise, with speech and noise coming from straight ahead (Utrecht-Sentence Test with Adaptive Randomized Roving levels). Secondary outcomes were speech intelligibility in noise with spatially separated sources, speech intelligibility in silence (Dutch phoneme test), localization capabilities and self-reported benefits assessed with different quality of hearing and quality of life (QoL) questionnaires. This article describes the results after 2 years of follow-up. ResultsWe found comparable results for the UCI and simultaneous BiCI group, when speech and noise were both presented from straight ahead. Patients in the BiCI group performed significantly better than patients in the UCI group, when speech and noise came from different directions (P = .01). Furthermore, their localization capabilities were significantly better. These results were consistent with patients' self-reported hearing capabilities, but not with the questionnaires regarding QoL. We found no significant differences on any of the subjective and objective reported outcomes between the 1-year and 2-year follow-up. ConclusionsThis study demonstrates important benefits of simultaneous BiCI compared with UCI that remain stable over time. Bilaterally implanted patients benefit significantly in difficult everyday listening situations such as when speech and noise come from different directions. Furthermore, bilaterally implanted patients are able to localize sounds, which is impossible for unilaterally implanted patients. Level of Evidence1b Laryngoscope, 127:1161-1168, 201