Caries management through the Atraumatic Restorative Treatment (ART) approach and glass-ionomers: update 2013.

The conception, of what was termed later, the Atraumatic Restorative Treatment (ART) approach, took place in 1985. From that date onwards, emphasis was placed on researching various aspects of ART in the fields of behavioural, clinical, laboratory and public health science with the aim to improve this caries management philosophy through constructing a strong foundation for its evidence-based use. This editorial presents the rational and evidence of the ART approach, now 29 years later. Atraumatic Restorative Treatment (ART) is a minimal intervention approach to both prevent dental caries and to stop its further progression. It consists of two components: the sealing of caries-prone pits and fissures, including those with enamel caries lesions (ART sealants), and restoring cavitated dentin carious lesions with sealant-restorations (ART restorations). The placement of an ART sealant involves the use of a high-viscosity glass-ionomer that is pushed into the pits and fissures under finger pressure. An ART restoration involves the creation of sufficient access to the cavity for the removal of soft, completely demineralised (decomposed) carious tooth tissue with hand instruments only. This is followed by restoration of the cavity with an adhesive dental material that simultaneously seals any remaining pits and fissures that remain at risk.1 In the early years, a medium-viscosity glass-ionomer was the material available. The application of this type of glass-ionomer to stress-bearing tooth surfaces led dental material manufacturers in the mid-nineties to develop a more wear-resistant glass-ionomer. These so-called highviscosity glass-ionomers remain, for the moment, the most appropriate material for ART whether in hand-mixed or capsulated form. ART is less anxietyand pain-provoking compared to the traditional restorative treatment, and the need for local anesthesia is relatively rare if the ART protocol is carried out correctly.2 The ART approach enables caries control to be performed not only in the dental surgery but also in outreach situations (schools, homes, villages) since no electricity or running water is required for its delivery.