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

Caries experience of Egyptian adolescents: does the atraumatic restorative treatment approach offer a solution?

Contains fulltext : 95704.pdf (publisher's version ) (Open Access)OBJECTIVES: To assess the prevalence and severity of dental caries amongst Egyptian adolescents and the prevalence of carious lesions treatable through the atraumatic restorative treatment (ART) approach. SUBJECTS AND METHODS: Using a convenient sample procedure, two secondary schools with a dental clinic were selected (967 students, average age: 13.7 +/- 0.8 years, range: 12-15). Dental caries was diagnosed using the ART caries criteria, and plaque and calculus were assessed using the Green and Vermillion criteria amongst students grades 1-3 in the dental clinic by 3 calibrated examiners. The effect of the independent variables gender, age, tooth surface, jaw side (left or right) and type of jaw (mandible/maxilla) on dependent caries experience variables and D(2) and D(3) variables were tested using ANOVA. RESULTS: The prevalence of dental caries including enamel lesion (D(2)MFT) amongst the 967 students was 51.4% and that of dental caries excluding enamel lesions (D(3)MFT) was 38.1%. The mean D(2)MFT and D(3)MFT scores were 1.5 and 0.8, respectively. The percentage of teeth filled and extracted was low. Female students had statistically significantly higher mean D(3)MFT/S and D(2)MFT/S scores than males (p < 0.0001). The prevalence of cavitated carious lesions (D(3)) treatable through ART was 48% for score 2 and 28% for score 3. CONCLUSIONS: Most of the cavitated lesions were found untreated despite the presence of a dental clinic and a dentist on the school premises. The majority of cavitated lesions without pulp involvement could be treated using the preventive and restorative components of the ART approach

Effectiveness of two new types of sealants: retention after 2 years

Item does not contain fulltextThe hypotheses tested were: survival rate of fully and partially retained glass-carbomer sealants is higher than those of high-viscosity glass-ionomer, with and without energy supplied, and that of resin composite; survival rate of fully and partially retained sealants of high-viscosity glass-ionomer with energy supplied is higher than those without energy supplied. The randomized clinical trial covered 407 children, with a mean age of 8 years. The evaluation took place after 0.5, 1 and 2 years. Survival of sealant material in occlusal and in smooth surfaces, using the traditional categorization (fully and partially retained versus completely lost sealants) and the modified categorization (fully and more than 2/3 of the sealant retained versus completely lost sealants), were dependent variables. The Kaplan-Meier survival method was used. According to both categorizations of partially retained sealants, the survival of completely and partially retained resin composite sealants in occlusal and in smooth tooth surfaces was statistically significantly higher, and those of glass-carbomer sealants lower, than those of sealants of the other three groups. There was no statistically significant difference in the survival rates of completely and partially retained high-viscosity glass-ionomer sealants with and without energy supplied in occlusal and in smooth surfaces. After 2 years, glass-carbomer sealant retention was the poorest, adding energy to high-viscosity glass-ionomer sealant did not increase the retention rate and resin composite sealants were retained the longest. We suggest the use of the modified categorization of partially retained sealants in future studies. It seems not necessary to cure high-viscosity glass-ionomer sealants. The use of glass-carbomer sealants cannot be recommended yet

The cariogenic dental biofilm: good, bad or just something to control?

This paper discusses the role of dental biofilm and adjunctive therapies in the management of dental caries. Dental biofilm is a site of bacterial proliferation and growth, in addition to being a location of acid production. It also serves as a reservoir for calcium exchange between the tooth and saliva. The salivary pellicle, a protein-rich biofilm layer, regulates the reaction between tooth surface, saliva and erosive acids. The protective effects of this pellicle on enamel are well established. However, understanding the effects of the pellicle/biofilm interaction in protecting dentin from erosive conditions requires further research. Saliva interacts with the biofilm, and is important in reducing the cariogenic effects of dental plaque as acidogenic bacteria consume fermentable carbohydrates producing acids that may result in tooth demineralization. Adequate supplies of healthy saliva can provide ingredients for successful remineralization. Strategies for managing the cariogenic biofilm are discussed with emphasis on the effectiveness of over-the-counter (OTC) products. However, since many toothpaste components have been altered recently, new clinical trials may be required for true validation of product effectiveness. A new generation of calcium-based remineralizing technologies may offer the ability to reverse the effects of demineralization. Nevertheless, remineralization is a microscopic subsurface phenomenon, and it will not macroscopically replace tooth structure lost in a cavitated lesion. Optimal management of cavitations requires early detection. This, coupled with advances in adhesive restorative materials and microsurgical technique, will allow the tooth to be restored with minimal destruction to nearby healthy tissue