Highlighted review: Atraumatic restorative treatment versus conventional restorative treatment for managing dental caries

Mojtaba Dorri, Maria José Martinez-Zapata, Tanya Walsh, Valeria CC Marinho, Aubrey Sheiham (deceased), Carlos Zaror

Plain language summary: Atraumatic restorative treatment (hand instruments only) compared with conventional treatment for managing tooth decay

Review question
The aim of this review is to evaluate the effects of a minimally invasive approach, namely Atraumatic Restorative Treatment (ART), for the treatment of tooth decay in children and adults (primary and permanent teeth).

Background
Dental caries (tooth decay) has been considered the most common global disease. Conventional methods (drill and fill) involve the use of electric drills to clear away decayed areas of tooth before filling. Local anaesthetic (painkiller) is normally injected to prevent pain during the procedure. Conventional treatments require highly trained dental health personnel, access to electricity, appropriate tools and are more expensive. These factors may limit access especially in underdeveloped regions of service provision.

Atraumatic Restorative Treatment (ART) is an alternative approach for managing dental decay, which involves removal of decayed tissue using hand instruments alone, usually without the use of anaesthesia (injected painkiller) and electrical equipment.

Study characteristics
This review searched the available evidence that was up to date at 22 February 2017. We found 15 relevant studies including 3760 participants with an average age of 25 years (range 3 to 101) where 48% were male. The follow-up period in the trials ranged from 6 to 36 months. Two of the 15 studies declared financial support from companies that made tooth-filling material. In addition, we found four ongoing studies.

Key results
There is low-quality evidence to suggest that primary teeth treated with the ART approach using high viscosity glass ionomer cement may be more likely than those receiving conventional treatment with the same material to result in restoration failure. In the treatment of primary teeth, ART may reduce pain experience compared with conventional treatment.

The evidence available for evaluating the differences between ART and conventional treatments using other restorative materials or in permanent teeth is very low quality so we cannot draw any conclusions. None of the included studies reported on negative side effects or costs.

Quality of the evidence
The available evidence is low- to very low-quality. It is likely that further high-quality research may change our findings. There are four ongoing studies that may provide more information in the future.

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Citation: Dorri M, Martinez-Zapata MJ, Walsh T, Marinho VCC, Sheiham (deceased) A, Zaror C. Atraumatic restorative treatment versus conventional restorative treatment for managing dental caries. Cochrane Database of Systematic Reviews 2017, Issue 12. Art. No.: CD008072. DOI: 10.1002/14651858.CD008072.pub2.