Atraumatic restorative treatment (ART) consists of removing demineralised tooth tissues with hand instruments only, restoring the prepared cavity and sealing the adjacent pits and fissures with an adhesive filling material. This relatively painless, no-handpiece, minimal intervention approach to controlling dental caries is described. ART was applied in an oral health care programme in Zimbabwe that was carried out amongst secondary school students from 1994 to 1997. A new glass ionomer (Fuji IX) was used as the restorative and sealant material. Sealants were placed in high caries risk students using the 'press-finger' technique. A total of 297 one-surface ART restorations and 95 glass ionomer sealants were placed in 142 and 66 students, respectively. After 3 years, the lost-to-follow-up percentages for one-surface ART restorations and glass ionomer sealants were 30.6% and 30.5%, respectively. Actuarial (life table) analysis resulted in 3-year survival rates of one-surface ART restorations of 88.3% (95% CI: 92.4%-84.2%), ranging from 94.3% to 65.4% per operator. A total of 28 ART restorations placed in 25 students failed. Reasons for failure related to the material and the operator (11 restorations or 5.3% each), and to caries adjacent to the restoration (one restoration or 0.5%). Reasons for failure were not recorded for five restorations (2.3%). Sealants were placed on surfaces diagnosed as early enamel lesions. After 3 years, 71.4% (95% CI: 81.7%-61.1%) of the fully and partially retained sealants survived with a range of 100% to 55.6% per operator. Of the sealed surfaces 96.3% (95% CI: 100%-92.2%) survived 3 years without developing caries. Experienced operators placed better ART restorations than inexperienced operators. This study has demonstrated that ART with a glass ionomer restorative material and sealants provided high quality preventive and restorative dental care to this student population. ART has become one of the treatment modalities available to oral health workers in managing dental caries.

An oral health care programme in secondary schools using the atraumatic restorative treatment (ART) technique for dental caries was started in 1993. Glass-ionomer was used as the restorative and sealant material. Sealants were placed using the ‘press finger’ technique. Results after 1 year revealed a survival percentage for one-surface ART restorations of 93.4 whilst the complete and partial retention percentages for sealants were 60.3 and 13.4, respectively. No caries was observed in teeth restored using ART, and only 0.8% of surfaces diagnosed as having early enamel lesions at the start of the programme and sealed consequently had progressed into active dentinal lesions after 1 year. The sealant retention percentage and the survival percentage of ART restorations were influenced by an operator effect. The majority of restorations were carried out without administering local anaesthesia. The mean treatment time for one-surface ART restorations was 22.1 min (range per operator of 19.8–23.6 min), whilst the mean time for placing sealants was 9.4 min (range per operator of 8.2–10.8 min). Post-operative sensitivity was reported for 6% of the teeth restored. 95% of the students were satisfied with ART as a treatment modality. It is concluded that ART may in part be the answer to the unavailability of restorative care for many population groups globally.

An oral health care programme in secondary schools using the atraumatic restorative treatment (ART) approach for dental caries was started in 1993. Glass ionomer (restorative type II, 1) was used as the restorative and sealant material. Sealants were placed using the ‘press-finger’ technique. Results after 3 years revealed a survival percentage for one-surface ART restorations of 85.3 (95% CL: 89.7–80.9%), which ranged from 96.1 to 69.3% per operator. Failures were related to ‘unacceptable marginal defects’ (8.1%), ‘falling out’ (6.1%) and ‘excessive wear’ (2.5%). Of the 33 failed one-surface ART restorations, 17 were material-related, 7 had caries and no information was available for 9 restorations. Sealants were placed only on surfaces diagnosed as early enamel lesions and on some small dentinal lesions. After 3 years, 50.1% (95% CL: 55.1–45.1%) of the fully and partially retained sealants survived with a range of 68.5–25.9% per operator. Regardless of the low rate of retention, the sealed surfaces had a 4 times lower chance of developing caries than unsealed surfaces with early enamel lesions over the 3-year period. The retention of sealants and the survival of one-surface ART restorations were influenced by an operator effect. The mean treatment time for one-surface ART restorations without chairside assistance was 22.1 min (range per operator of 19.8–23.6 min), whilst the mean time for placing sealants was 9.3 min (range per operator of 8.2–10.8 min). It is concluded that the ART approach and the use of glass-ionomer sealants have made preventive and restorative dental care available for this student population and further that ART seems to be appropriate for population groups currently not receiving preventive and restorative dental care.

The one-time training of teachers in aspects of oral health was ineffective in lowering plaque levels over a period of 3.5 years. Considering the low caries increment observed over the study period, the effect of the oral health programme on caries levels in the study group was inconclusive.

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