title: The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials Clinical Trial of a New Glass Ionomer for an Atraumatic Restorative Treatment Technique in Class I Restorations Placed in Latvian School Children Six-Year Success Rates of Occlusal Amalgam and Glass-Ionomer Restorations Placed Using Three Minimal Intervention Approaches Survival of glass ionomer restorations placed in primary molars using atraumatic restorative treatment (ART) and conventional cavity preparations: 2-year results. One year clinical evaluation of two different types of composite resins in posterior teeth. Access to dental care for children in the United States: a survey of general practitioners. The effects of two cavity preparation methods on the longevity of glass ionomer cement restorations: an evaluation after 12 months. Comparison of atraumatic restorative treatment and conventional restorative procedures in a hospital clinic: evaluation after 30 months. Evidence favoring the use of anticoagulants in the hospital phase of acute myocardial infarction. Hypermineralization of Dentinal Lesions Adjacent to Glass-ionomer Cement Restorations Effectiveness of Glass-Ionomer (ART) and Amalgam Restorations in the Deciduous Dentition: Results after 3 Years The atraumatic restorative treatment (ART) approach to restoring primary teeth in a standard dental clinic. Effectiveness of Three Minimal Intervention Approaches for Managing Dental Caries: Survival of Restorations after 2 Years Atraumatic restorative treatment (ART): a three-year clinical study in Malawi--comparison of conventional amalgam and ART restorations. Comparison of atraumatic restorative treatment and conventional cavity preparations for glass-ionomer restorations in primary molars: one-year results. Comparison of two tooth-saving preparation techniques for one-surface cavities. Chemical exchange between glass-ionomer restorations and residual carious dentine in permanent molars: an in vivo study. Effectiveness of ART and traditional amalgam approach in restoring single-surface cavities in posterior teeth of permanent dentitions in school children after 6.3 years. Survival of ART and Amalgam Restorations in Permanent Teeth of Children after 6.3 Years
abstract: To comprehend the results of a r and omised controlled trial ( RCT ) , readers must underst and its design , conduct , analysis , and interpretation . That goal can be achieved only through total transparency from authors . Despite several decades of educational efforts , the reporting of RCTs needs improvement . Investigators and editors developed the original CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to help authors improve reporting by use of a checklist and flow diagram . The revised CONSORT statement presented here incorporates new evidence and addresses some criticisms of the original statement . The checklist items pertain to the content of the Title , Abstract , Introduction , Methods , Results , and Discussion . The revised checklist includes 22 items selected because empirical evidence indicates that not reporting this information is associated with biased estimates of treatment effect , or because the information is essential to judge the reliability or relevance of the findings . We intended the flow diagram to depict the passage of participants through an RCT . The revised flow diagram depicts information from four stages of a trial ( enrolment , intervention allocation , follow- up , and analysis ) . The diagram explicitly shows the number of participants , for each intervention group , included in the primary data analysis . Inclusion of these numbers allows the reader to judge whether the authors have done an intention- to-treat analysis . In sum , the CONSORT statement is intended to improve the reporting of an RCT , enabling readers to underst and a trial 's conduct and to assess the validity of its results Objective : The aim of this study was to evaluate the performance of a new glass ionomer filling material ( ChemFlex ™ ) using the atraumatic restorative treatment ( ART ) approach in class I cavities in the permanent dentition of Latvian schoolchildren . Methods : A total of 63 fillings ( 40 test and 23 control ) were placed using the ART technique in 41 schoolchildren in Riga at the Stomatology Institute of the Medical Academy of Latvia . These fillings were then blindly assessed after 2 years . Results : The complete success rate for both the test and the control material fillings were 92.5 and 94.9 % , respectively . Conclusion : The new glass ionomer filling has shown a good performance in terms of retention , marginal failure and fractures in class I cavities The present r and omised clinical trial was aim ed at comparing three minimally invasive restorative treatment approaches for managing dental caries in occlusal surfaces using a non-gamma-2 amalgam and a low-viscosity glass-ionomer as the restorative material . The treatment approaches tested in parallel groups were : conventional in a university setting , modified-conventional and ultraconservative ( Atraumatic Restorative Treatment , ART ) approaches in a field setting . A split-mouth design was used in which the two restorative material s were r and omly placed in 430 matched contralateral pairs of permanent molar teeth . A total of 152 children from five primary schools were recruited and treated by a dental therapist . The restorations were evaluated after 6 years by 2 calibrated independent examiners . The 6-year successes for all occlusal amalgam and glass-ionomer restorations were 72.6 and 72.3 % , respectively . There were no statistically significant differences observed between the successes for both amalgam and glass-ionomer restorations placed either by the ART ( 68.6 % , with 95 % CI = 61–76 % ) approach or by the conventional ( 74.5 % , with 95 % CI = 65–82 % ) and the modified-conventional ( 75.8 % , with 95 % CI = 67–83 % ) approaches after 6 years . There was also no statistically significant difference observed between the successes of occlusal ART restorations  with glass-ionomer ( 67.1 % , with 95 % CI = 56–77 % ) and occlusal conventional restorations with amalgam ( 74 % , with 95 % CI = 61–85 % ) after 6 years . ‘ Restoration fracture/marginal defects ’ and ‘ loss of material ’ were the most common causes for failure . The former was more often recorded in amalgam restorations and the latter in glass-ionomer restorations .  Secondary caries was observed for 2 % of glass-ionomer and for 10 % of amalgam restorations . This difference was statistically significant ( p = 0.001 ) . The ART approach using glass-ionomer performed equally well as conventional restorative approaches using electrically driven equipment and amalgam for treating dentinal lesions in occlusal surfaces after 6 years OBJECTIVE To compare the survival of  glass ionomer cement ( GIC ) restorations placed in a dental clinic setting using both the atraumatic restorative treatment ( ART ) approach with h and instruments , and conventional cavity preparation with rotary instruments . METHOD AND MATERIAL S Two encapsulated high-strength conventional GICs ( Fuji IX GP , Ketac-Molar Aplicap ) were placed in 82 Class I and 53 Class II preparations and one encapsulated non-gamma 2 amalgam alloy ( GK-amalgam ) was placed in 32 Class I preparations , in the primary molars of 60 Chinese children with a mean age of 7.40 + /- 1.24 ( SD ) years . Thus , 9 treatment groups were formed . RESULTS After two years , there were no significant survival differences found among 7 of the 9 treatment groups ( p = 0.99 ) . However , two groups comprising Fuji IX GP and Ketac-Molar Aplicap placed in Class II cavities prepared using the ART approach showed significantly lower restoration survivals ( p < 0.001 ) . Only 3 of the 72 initially sealed fissures adjacent to the restorations appeared to retain any GIC material . CONCLUSIONS In a clinic setting , both the ART h and instrument and conventional rotary instrument methods were equally suitable for high Class I restoration survival , but not for Class II restoration survival where the conventional cavity preparation method was preferable AIM The aim of this study was to assess the clinical performance of two adhesive restorative systems ( Single Bond/Filtek P-60 and Single Bond/Filtek Z-250 ) in posterior teeth using a modified United States Public Health Service ( USPHS ) system . METHODS AND MATERIAL S A total of 70 restorations were placed in molars and premolars in 30 patients ( 14 females and 16 males ; 18 - 40 years ) by one operator . All restorations were directly evaluated by two examiners at baseline , six months , and 12 months using the following modified USPHS rating criteria : marginal integrity , marginal discoloration , surface texture , contour , postoperative sensitivity , and recurrent caries . RESULTS At six and 12 months all restorations were available for evaluation of marginal discoloration , surface texture , contour , postoperative sensitivity , and recurrent caries that remained with 100 % Alpha-ratings at recalls for both restorative systems . Marginal integrity for P-60 was scored as 94.3 % and 91.4 % Alpha at six and 12 months , respectively , and rates for Z-250 were 100 % and 97.1 % Alpha at six and 12 months , respectively . Statistical analysis was completed with Fisher 's exact and McNemar Chi-square tests at a significance level of 5 % ( P<0.05 ) . CONCLUSION All restorations were clinical ly satisfactory and no significant differences were found among them . CLINICAL SIGNIFICANCE Posterior resin composite restorations placed under appropriate conditions provide a satisfactory clinical performance BACKGROUND In response to concern that inadequate dental school training may create a barrier to access to care for children , the authors conducted a survey concerning general practitioners ' practice patterns involving child patients . METHODS The authors requested a list of 4,970 r and omly chosen general practitioners from the American Dental Association Survey Center . They then sent those dentists a written survey asking whether and in what numbers they treat children ; the ages and caries levels of any children they do treat ; their perceptions of their educational experiences in pediatric dentistry , and their perceived needs for continuing education in pediatric dentistry . They analyzed data using chi2 . RESULTS Ninety-one percent of the general dentists surveyed treated children , but those younger than 4 years of age , with high levels of caries , and whose care is funded by Medicaid were represented in very low numbers . The types of patients treated and procedures performed by the respondents were significantly ( P < or = .05 ) associated with the intensity of the respondents ' educational experiences , except for the number and types of Medicaid patients they treated . CONCLUSIONS These data indicate that the vast majority of general practitioners treat children in their practice s , but there still are groups of children for whom access to dental care is a problem . PRACTICE IMPLICATION S Very young children , children with high levels of caries and Medicaid-covered children have difficulty finding dental care in the general practice community BACKGROUND The authors undertook a study to evaluate the effect of two cavity preparation methods on the initial survival of two more-viscous glass ionomer cements , or GICs , placed in the occlusal surfaces of permanent molar teeth . METHODS Three dentists placed 149 restorations in 68 adult patients in a hospital clinic . They used either atraumatic restorative treatment , or ART , or conventional cavity preparation methods to place two encapsulated esthetic conventional GICs : Fuji IX GP ( GC International Corp. , Tokyo ) and Ketac-Molar Aplicap ( 3 M ESPE , Seefeld , Germany ) . For comparison , they used high-copper-content GK Amalgam Alloy ( Advanced Technology & Material s Co. Ltd. , Beijing ) in conventional preparations . They evaluated the restorations using both direct and indirect observation methods . RESULTS Cavity preparations for which the authors used ART h and instruments took approximately twice as long to complete as did those for which they used conventional rotary instruments . After 12 months , no restorations had failed , but restorations comprising both GICs showed early losses of adjacent sealant material . Both GICs also showed relatively high restoration wear . At 12 months , the mean cumulative net occlusal wear for Fuji IX GP was 77 + /- 47 micrometers , and for Ketac-Molar 83 + /- 51 microm , without statistical significance ( P > .05 ) . Color matching improved significantly with time ( P < .001 ) , without significant differences in color between the two GICs by 12 months ( P = .09 ) . The amalgam alloy had minor surface tarnishing and marginal discrepancies increased with time ( P < .00 1 ) . CONCLUSIONS All of the occlusal restorations were rated as satisfactory after 12 months . The method of cavity preparation did not affect the restoration performance of the GICs . However , their deterioration requires long-term monitoring . Clinical Implication s. The more viscous GICs appear initially suitable for restricted use in clinical practice when placed using either of two cavity preparation methods in the occlusal surfaces of permanent molar teeth in adults OBJECTIVE The purpose of this study was to evaluate two glass-ionomer cements placed in the occlusal surfaces of permanent molar teeth , using two cavity preparation methods . METHOD AND MATERIAL S Three dentists placed 149 restorations for 68 patients in a hospital clinic .  Atraumatic restorative treatment or conventional cavity preparation methods were used for two encapsulated , high-strength conventional glass-ionomer cements : Fuji IX GP and Ketac-Molar . Non-gamma 2 amalgam alloy was used in conventional preparations for comparison . RESULTS The restorative procedures were uneventful , but cavity preparations made with atraumatic restorative treatment h and instruments took approximately twice as long as did conventional rotary instrumentation . After 30 months , only one glass-ionomer cement restoration had failed . Both glass-ionomer cements showed high early losses of sealant material , but caries was not detected in the exposed fissures . Both glass-ionomer cements also showed relatively high restoration wear . At 30 months , the mean cumulative net occlusal wear was 119 + /- 12 mm for Fuji IX GP and 96 + /- 13 mm for Ketac-Molar ; the difference was not statistically significant . Color matching improved significantly by 6 months ; there was no significant difference in color match between the two glass-ionomer cements by 12 months . Minor surface tarnishing and marginal discrepancies were present in the amalgam restorations and increased with time . CONCLUSION The occlusal restorations performed satisfactorily over periods of up to 30 months . However , the continued deterioration of the cements requires longer-term studies to be undertaken Since the last comprehensive review of anticoagulation in acute myocardial infa rct ion four additional r and omized control trials have been reported . The overwhelming majority of all trials favored anticoagulation .  Rates of thromboembolism were higher in the control , and hemorrhagic complications in the anticoagulated group . Pooling of all r and omized control trials gives mean case fatality rates of 19.6 % for the control and 15.4 % for the anticoagulated group , a relative reduction of 21 % ( P less than 0.05 or less than 0.001 , depending on the analytic method ) . Five of six r and omized control trials reported " no effect " because the difference favoring anticoagulation was not statistically significant . However , sample sizes in these " negative " papers were too small to protect against missing a 21 % reduction in true case fatality rate due to anticoagulation ( beta greater than 0.10 ) . All patients who present no specific contraindication should receive  anticoagulants  during hospitalization for infa rct ion Previous reports have shown a release of fluoride from glass-ionomer cement ( GIC ) restorations into the oral fluids . Fluoride in the ambient fluids has a caries-preventive effect by enhancing remineralization and inhibiting demineralization of the dental hard tissues . Therefore , the current investigation was undertaken to determine whether GIC fillings could contribute to the remineralization of caries lesions in dentin . Small circular preparations were made in disks of dentin which had incipient caries-like lesions in the remaining tissue . The preparations were filled with amalgam or composite material s ( as controls ) or with GIC . The specimens thus contained a restoration close to a dentinal caries-like lesion . The specimens were placed contralaterally in the buccal surfaces of removable partial dentures and were worn intra-orally by volunteers for a 12-week experimental period , after which the specimens were sectioned and analyzed by microradiography . All specimens with GIC restorations exhibited hypermineralization in the tissue bordering the filling and in the wall of the preparation which had been in contact with the restoration . The ( caries-like ) lesions were remineralized , even under conditions of heavy plaque formation . In contrast , specimens with amalgam or composite restorations showed further extensive demineralization . This study demonstrates a significant remineralization potential exerted by the fluoride-releasing GIC restorative material . Consequently , the choice of the restorative material might be crucial for the occurrence or prevention of recurrent caries around restorations This study compared the survival of restorations produced through the atraumatic restorative treatment ( ART ) approach using glass-ionomer with those produced through the traditional approach using amalgam ( MTA ) in deciduous dentitions over a period of 3 years . Using a parallel group design , 835 grade 1 children , aged 6–7 years , participated . A total of 482 children were treated through the ART and 353 children through the MTA approach .  Eight dentists produced a total of 1,891 single- and multiple-surface restorations . After 3 years , 22.1 % of the restorations were lost for evaluation . There was a statistically significant difference in the combined survival of all single- and multiple-surface restorations between the two approaches in favour of the ART approach ( p = 0.04 ) . The study revealed a 3-year cumulative survival percentage of single-surface ART and MTA restorations of 86.1 and 79.6 % , respectively . The difference was statistically significant ( p = 0.03 ) . The main reasons for both single-surface ART and MTA restorations to fail was ‘ restoration missing ’ followed by ‘ gross marginal defect ’ . The 3-year cumulative survival percentages of multiple-surface ART and MTA restorations were 48.7 and 42.9 % , respectively . The difference was not statistically significant ( p > 0.05 ) . The 3-year survival percentages of single- and multiple- surface ART and MTA restorations varied widely amongst the 8 operators with an operator effect ( p = 0.001 ) for multiple-surface MTA restorations . It can be concluded that the ART approach using glass-ionomer yielded better results in treating dentinal lesions in deciduous teeth than did the traditional approach using amalgam after 3 years . It is recommended to select the ART approach to complement the other activities of the school oral health programme OBJECTIVES The aims of this study are to assess the feasibility of the  Atraumatic Restorative Treatment ( ART ) approach in primary teeth and to compare the ART approach with traditional amalgam restorations in primary molars . METHODS This study was conducted in a paediatric dentistry clinic in Kuwait between April 1999 and December 2001 . The ART and amalgam restorations were placed r and omly on comparable pairs of primary molars , if available . In addition , the ART approach was used for other primary teeth that had no pulpal involvement and no perceived pain before treatment . The restorations were assessed by both the ART evaluation criteria and USPHS criteria in August-September 2000 and in August-December 2001 . The mean follow-up period for the restorations was 8.3 months in the first assessment ( 2000 ) and 22 months in the second assessment ( 2001 ) . The assessment was possible for 35 children ( mean age = 5.7 years ) , 18 of whom had comparable pairs ( n = 35 pairs ) of restorations in their primary molars . In addition , 48 other ART restorations  were assessed in 2000 and 42 in 2001 . RESULTS In a 2-year follow-up , 89.6 % of all ART restorations were considered successful . The failure rate of the comparable pairs of ART and amalgam restorations was 5.7 % . There was no significant difference in success rate between ART and amalgam techniques . CONCLUSIONS Based on a 2-year follow-up evaluation , the class I ART restorations seemed to have a high success rate , indicating the appropriateness of the ART approach in primary teeth The present study was aim ed at comparing the effectiveness of three minimally invasive restorative treatment approaches for dentinal lesions in occlusal surfaces . The approaches tested comprised a conventional and a modified – conventional treatment and a modified Atraumatic Restorative Treatment ( ART ) . The conventional approach was performed in a university dental clinic whilst the modified – conventional , employing portable equipment , and the modified ART , using h and instruments and a caries removal solution ( Caridex ® ) , were carried out in the field . Using the split – mouth design , 430 matched contralateral pairs of occlusal cavities were restored with amalgam or glass – ionomers in permanent molars of 152 school children by one dental therapist . The restorations were assessed using a modified USPHS – Ryge criteria . After 2 years , the cumulative survival percentages for occlusal amalgam and glass – ionomer restorations were 92 and 96 % , respectively . The survival of all restorations in the conventional , modified – conventional and the modified ART group was 96 , 96 and 91 % , respectively . The survival of occlusal amalgam and glass – ionomer restorations per treatment group was as follows : 94 and 99 % , respectively ( conventional group ) ; 95 and 97 % , respectively ( modified – conventional group ) , and 89 and 93 % , respectively ( modified ART group ) . The differences in survival percentage between restorations with amalgam and glass – ionomer , and between the three restorative treatment approaches were not statistically significant . In countries facing scarcity in re sources for dental care , ART seems a promising restorative approach to occlusal caries in posterior teeth . However , a longer clinical observation period is required to substantiate this initial conclusion OBJECTIVE This study compares the quality of class I restorations  made with the atraumatic restorative treatment ( ART ) technique and conventional class I amalgam restorations . METHODS The study was carried out among secondary school students in Mzuzu , Malawi . First-year students in 1987 who needed at least two class I restorations were selected . Based on a split-mouth design , each participant received both ART and conventional restorations . The 89 pairs of class I cavities were divided r and omly into two groups , since two different cermet ionomer cement ( CIC ) filling material s were used . Impressions of the restorations and subsequent models were made shortly after restoration , after six months , one year , two years , and three years . The quality of the restorations was determined on the models following the US Public Health Service criteria . Bulk fracture , contour , marginal integrity , and surface texture of the restorations were recorded and evaluated separately . Survival rates were determined by the result ant score of all criteria . RESULTS Though conventional amalgam restorations performed better on all criteria , this difference was significant only for the contour criterion . The survival rates of ART restorations after three years ( 81.0 % ) were lower than those of amalgam restorations ( 90.4 % ) ( P=.067 ) . CONCLUSIONS The quality of ART class I restorations is competitive with that of conventional amalgam restorations OBJECTIVE The purpose of this study was to compare the success rates of  glass-ionomer cement restorations placed with the atraumatic restorative treatment approach and conventional cavity preparation methods . METHOD AND MATERIAL S Two encapsulated , high-strength , esthetic conventional glass-ionomer cements were placed in 82 Class I and 53 Class II atraumatic restorative treatment and conventional cavity preparations  , and an encapsulated amalgam alloy was placed in 32 Class I conventional preparations , in vital primary molars of 60 Chinese children aged 7 to 9 years . RESULTS The atraumatic restorative treatment preparations , made with h and instruments only , took approximately 50 % longer to complete than did the preparations completed with conventional rotary instrumentation . After 1 year , there were no amalgam failures . For the glass-ionomer cement restorations , when the atraumatic restorative treatment method was used , significantly better survival rates were found for Class I ( 92.9 % ) than for Class II ( 64.7 % ) cavity preparations . There was also a strong trend for relatively better survival rates for the conventional cavity preparation method ( 86.7 % ) than for the atraumatic restorative treatment ( 64.7 % ) method for Class II cavity preparations . However , both the atraumatic restorative treatment and conventional methods appeared equally effective for Class I preparations . CONCLUSION In a clinic setting , the use of atraumatic restorative treatment h and instruments for cavity preparation is more time consuming , and the method may also provide less mechanical retention and /or bulk of glass-ionomer cement for some Class II preparations in primary molars than does the use of conventional rotary instruments The atraumatic restorative treatment technique ( ART ) is based on removing infected tooth material using only h and instruments and filling the subsequently cleaned cavity with adhesive material such as glass ionomer . As its name suggests , the ART technique should be atraumatic during treatment , as well as for the tooth itself as for the patient . It was primarily developed for treating people living in underserved areas of the world where re sources and facilities such as electricity and trained manpower are limited . Many studies have evaluated the ART technique and the results have supported its application . However , a very limited number of studies have compared ART with more conventional techniques . For that reason , a study was conducted in Pakistan , to compare the ART technique with another more conventional treatment technique . The results of this study show that the preparations with h and instruments result ed in smaller sized cavities and therefore may be less traumatic to the tooth . It was also associated with less pain reactions compared to the more conventional technique . Although preparations with h and instruments required more time , this did not seem to affect the survival of restorations . The survival of glass ionomer cement restorations  made with h and instruments was comparable with single surface amalgam restorations made with a more conventional technique . Recurrent caries was not associated with any glass ionomer cement restorations made with h and instruments . The retention rate of glass ionomer sealants was low , however one dentist had a sealant retention rate of 81.5 percent that suggests that this procedure can be performed satisfactorily in conjunction with a glass ionomer cement restoration . Operator variances did seem to affect the restorations . Survival of glass ionomer restorations  made with both h and and rotary instruments varied for different operators . Similarly , the retention of fissure sealant also varied amongst operators . Operator differences also influenced the extent of tooth substance lost due to cavity preparation . The ART technique is a feasible approach towards the treatment of dental caries especially of one-surface lesions for underserved population OBJECTIVE To evaluate the remineralization of carious dentine following the restoration of an extensive lesion in a permanent molar with a high strength glass-ionomer cement ( GIC ) .  MATERIAL S AND METHODS Thirteen first permanent molars , which were scheduled for extraction because of the presence of extensive caries lesions , were selected for this study . They were first restored , according to the ART technique , using encapsulated Fuji IX(GP ) , which contains a strontium glass rather than the traditional calcium glass . The cavities were prepared with a clean enamel margin and minimal removal of the carious dentine around the walls . After a period of 1 - 3 months they were harvested and subsequently sectioned and examined using an electron probe micro analysis ( EPMA ) and scanning electron microscopy ( SEM ) . RESULTS EPMA demonstrated that both fluorine and strontium ions had penetrated deep into the underlying demineralized dentine . The only possible source of these ions was the GIC restoration . CONCLUSION The pattern of penetration of the fluorine and strontium ions into the dentine was consistent with a remineralization process OBJECTIVES The Atraumatic Restorative Treatment ( ART ) approach was compared with the traditional amalgam ( TA ) approach in order to test their appropriateness to complement a preventive and educational school oral health programme in Syria . METHODS Using a parallel group design , 370 and 311 grade 2 children were r and omly assigned to the ART and the TA group respectively . Eight dentists placed 1117  single- and multiple-surface restorations .  A modified actuarial method was used to estimate survival curves . The jackknife method was applied to calculate the st and ard error in the cumulative survival percentages . RESULTS A statistically significant difference in cumulative survival percentages between single-surface non-occlusal ART and comparable amalgam restorations was observed after 4.3 , 5.3 and 6.3 years . The survival of single-surface non-occlusal  ART  posterior restorations ( 80.2 + /- 4.9 % ) was statistically significantly higher than that of occlusal posterior ART restorations ( 64.8 + /- 3.9 % ) at evaluation year 6.3 . There was no statistically significant difference observed between survival percentages of large ( 55.8 + /- 10 % ) and that of small ( 69.2 + /- 4.6 % ) single-surface posterior ART restorations after 6.3 years . There was an operator effect observed for single-surface ART and comparable amalgam restorations . Secondary caries was observed in 2.3 % of single-surface ART restorations and in 3.7 % of single-surface amalgam restorations during the 6.3 year observation period . CONCLUSIONS The ART approach provided higher survival percentages for single-surface restorations than the TA approach over 6.3 years and is therefore appropriate for use in school oral health programmes . Secondary caries was only a minor reason for ART restorations to fail . An operator effect was observed for both treatment approaches The null hypothesis tested was that there is no difference in the survival percentages of all restorations placed through the Atraumatic Restorative Treatment ( ART ) approach , with high-viscosity glass ionomer , and those produced through the traditional approach , with amalgam ( TA ) , in the permanent dentitions of children after 6.3 years . Using a parallel group design , we r and omly assigned a total of 370 children , aged 6 to 9 years , to the ART group and 311 children , also aged 6 to 9 years , to the TA group . Eight dentists placed a total of 1117 single- and multiple-surface restorations . The cumulative survival percentages  for ART glass-ionomer restorations were statistically significantly higher than those of amalgam restorations at all time intervals except the first ( p ≤ 0.044 ) . After 6.3 years , the cumulative survival percentages of ART and amalgam restorations were 66.1 % ( SE = 3.1 % ) and 57.0 % ( SE = 3.3 % ) , respectively . We concluded that the restorations produced with the ART approach , with high-viscosity glass ionomer , survived longer than those produced with the traditional approach , with amalgam , in the permanent teeth of young children
target: Studies investigating restorations placed in the primary dentition showed no significant differences between the groups after 12 and 24 months .
  In the permanent dentition , the longevity of ART restorations is equal to or greater than that of equivalent amalgam restorations for up to 6.3 years and is site-dependent .
  No difference was observed in primary teeth .
background: The aim was to report on the longevity of  restorations placed using the atraumatic restorative treatment ( ART ) approach  compared with that of  equivalent placed amalgam restorations .