Evaluation of the effectiveness of atraumatic restorative treatment in caries removal in school-age children
Keywords:
CARIES DENTAL; ODONTOLOGÍA PEDIÁTRICA; TRATAMIENTO RESTAURATIVO ATRAUMÁTICO DENTAL.; DENTAL CARIES; PEDIATRIC DENTISTRY; DENTAL ATRAUMATIC RESTORATIVE TREATMENT.; CÁRIE DENTÁRIA; ODONTOPEDIATRIA; TRATAMENTO DENTÁRIO RESTAURADOR SEM TRAUMA.Abstract
Introduction: dental caries is highly prevalent in childhood, and conventional treatment may generate anxiety, which motivates the use of minimally invasive techniques such as atraumatic restorative treatment.
Objective: to evaluate the effectiveness of atraumatic restorative treatment in the survival of restorations in primary and permanent dentition in children.
Methods: a systematic review of the scientific literature was conducted across different databases, using an algorithm to identify relevant sources. The selected studies, after applying rigorous inclusion and exclusion criteria, were critically evaluated and coherently integrated into the final synthesis of the review.
Development: atraumatic restorative treatment uses manual instruments to remove carious tissue and restore with glass ionomer. Studies report success rates between forty-seven and ninety percent, depending on factors such as operator skill, type of material, and cavity size. Compared with conventional techniques, atraumatic restorative treatment shows slightly lower results, though with advantages in reducing anxiety, shorter application time, and better acceptance by children and parents. The combination with silver diamine fluoride or the hall technique increases restoration survival.
Conclusions: atraumatic restorative treatment is an effective and minimally invasive technique for managing caries in pediatric populations. Although it presents lower survival than conventional methods, its simplicity, low cost, and clinical acceptance make it a valuable alternative, especially in primary care contexts and vulnerable populations.
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1. Aguilar A, Caro T, Saavedra J, França C, Fernandes K, Mesquita R, et al. La práctica restaurativa atraumática: Una alternativa dental bien recibida por los niños. Rev Panam Salud Publica/Pan Am J Public Heal [Internet]. 2012 [Citado 20/06/2025]; 31(2):148–52. Available from: https://www.scielosp.org/pdf/rpsp/2012.v31n2/148-152
2. Muñoz C, Gambetta K, Santamaría R, Splieth C, Paris S, Schwendicke F, et al. ¿Cómo Intervenir el Proceso de Caries en Niños? Adaptación del Consenso de ORCA/EFCD/DGZ. Int J Interdiscip Dent [Internet]. 2022 [Citado 20/06/2025]; 15(1): 48–53. Available from: https://www.scielo.cl/pdf/ijoid/v15n1/2452-5588-ijoid-15-01-48.pdf
3. Catalá M, Cortés O. La caries dental: una enfermedad que se puede prevenir. An Pediatr Contin [Internet]. 2014 [Citado 20/06/2025]; 12(3): 147–51. Available from: https://www.elsevier.es/es-revista-anales-pediatria-continuada-51-articulo-la-caries-dental-una-enfermedad-S1696281814701842
4. Santos N, Moreno A, Lara N. Caries y salud bucal, percepciones acerca de la enfermedad. Rev Odontopediatría Latinoam [Internet]. 2021 [Citado 20/06/2025]; 11(2): 1–19. Available from: https://www.revistaodontopediatria.org/index.php/alop/article/view/255
5. Santos A, Lorido I, González A, Ferrer MÁ, Zapata MD, Ambel J. Prevalence of dental caries in children enrolled in preschool education from a low socioeconomic status area. Pediatr Aten Primaria [Internet]. 2019 [Citado 20/06/2025]; 21: 47–59. Available from: https://scielo.isciii.es/pdf/pap/v21n82/1139-7632-pap-21-82-e47.pdf
6. Morales L, Gómez Gonzáles W. Caries dental y sus consecuencias clínicas relacionadas al impacto en la calidad de vida de preescolares de una escuela estatal. Rev Estomatol Hered [Internet]. 2019 [Internet]. 2019 [Citado 20/06/2025]; 29(1): 17–29. Available from: http://www.scielo.org.pe/pdf/reh/v29n1/a03v29n1.pdf
7. Cárdenas S, Pérez C, Angel M. Caries dental en niños de la primera infancia de la ciudad de Cartagena. Dental caries in children of early childhood in the city of Cartagena. Cienc y Salud [Internet]. 2018 [Citado 20/06/2025]; 10(2): 50–61. Available from: https://revistas.uninunez.edu.co/index.php/cienciaysalud/article/view/1167
8. Jiang M, Fan Y, Li KY, Lo ECM, Chu CH, Wong MCM. Factors affecting success rate of atraumatic restorative treatment (ART) restorations in children: A systematic review and meta-analysis. J Dent [Internet]. 2021 [Citado 20/06/2025]; 104: 103526. Available from: https://pubmed.ncbi.nlm.nih.gov/33188846/
9. Fronza L, Schmitz M, Porn JL, Garcia EJ, Bussadori SK, Hilgenberg SP. RemociÃtextthreesuperiorn quimica-mecÃ!`nica del tejido cariado en dientes permanentes: reporte de caso clÃ-nico. Rev EstomatolÃtextthreesuperiorgica Hered [Internet]. 2017 [Citado 20/06/2025]; 27(2):111–5. Available from: http://www.scielo.org.pe/scielo.php?script=sci_arttext&pid=S1019-43552017000200007
10. Simbaña N, Ribadeneira L, Ramos R, Ortega M. Técnicas minimamente invasivas en odontopediatria para el tratamiento de lesiones cariosas en tiempos de COVID-19. Reporte de caso. Odontol (Habana) [Internet]. 2022 [Citado 20/06/2025]; 24(1):1–11. Available from: https://doi.org/10.29166/odontologia.vol24.n1.2022-e3596
11. Torres E. Tratamiento Restaurador Atraumático (TRA): Una alternativa libre de aerosoles tras la pandemia por COVID-19 [Internet]. 3M Oral Care; 2020 [Citado 20/06/2025]. Disponible en: https://www.researchgate.net/profile/Eraldo-Pesaressi/publication/344387704_Tratamiento_Restaurador_Atraumatico_TRA_Una_alternativa_libre_de_aerosoles_tras_la_pandemia_por_COVID-19/
12. Dau R, Astudillo P, Zambrano M, Armijos F. Un enfoque sistemático para las técnicas de eliminación de caries profunda. Recimundo [Internet]. 2023 [Citado 20/06/2025]; 7(2): 98–106. Available from: https://dialnet.unirioja.es/servlet/articulo?codigo=9006265
13. Garbim J, Laux C, Tedesco T, Braga M, Raggio D. Atraumatic restorative treatment restorations performed in different settings: systematic review and meta-analysis. Aust Dent J [Internet]. 2021 [Citado 20/06/2025]; 66(4): 430–43. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/adj.12871
14. Lin G, Cher C, Cheah K, Koh S, Chia C, Lim R, et al. Acceptability of atraumatic restorative treatment and Hall Technique among children, parents, and general dental practitioners: a systematic review and meta- analysis. Quintessence Int [Internet]. 2022 Jan [Citado 20/06/2025]; 53(2): 156–69. Available from: https://pubmed.ncbi.nlm.nih.gov/34410073/
15. Vollú A, Rodrigues GF, Rougemount Teixeira RV, Cruz LR, Dos Santos Massa G, de Lima Moreira JP, et al. Efficacy of 30% silver diamine fluoride compared to atraumatic restorative treatment on dentine caries arrestment in primary molars of preschool children: A 12-months parallel randomized controlled clinical trial. J Dent [Internet]. 2019 Sep [Citado 20/06/2025]; 88: 103165. Available from: https://pubmed.ncbi.nlm.nih.gov/31279925/
16. Mohammed S, Awad S, Wahba A. Comparison of Clinical Outcomes of Silver- modified Atraumatic Restorative Technique vs Atraumatic Restorative Technique in Primary Teeth: A Randomized Controlled Trial. J Contemp Dent Pract [Internet]. 2022 Nov [Citado 20/06/2025]; 23(11): 1140–5. Available from: https://pubmed.ncbi.nlm.nih.gov/37073938/
17. Arrow P, Piggott S, Carter S, McPhee R, Atkinson D, Mackean T, et al. Atraumatic Restorative Treatments in Australian Aboriginal Communities: A Cluster-randomized Trial. JDR Clin Transl Res [Internet]. 2021 Oct [Citado 20/06/2025]; 6(4): 430–9. Available from: https://pubmed.ncbi.nlm.nih.gov/33016169/
18. Aly A, Aziz A, Elghazawy R, El Fadl R. Survival Analysis and Cost Effectiveness of Silver Modified Atraumatic Restorative Treatment (SMART) and ART Occlusal Restorations in Primary Molars: a randomized controlled trial. J Dent [Internet]. 2023 Jan [Citado 20/06/2025]; 128: 104379. Available from: https://pubmed.ncbi.nlm.nih.gov/36460236/
19. Faustino D, Figueiredo M. Atraumatic restorative treatment-ART in early childhood caries in babies: 4 years of randomized clinical trial. Clin Oral Investig [Internet]. 2019 Oct [Citado 20/06/2025]; 23(10): 3721–9. Available from: https://pubmed.ncbi.nlm.nih.gov/30666480/
20. Satyarup D, Mohanty S, Nagarajappa R, Mahapatra I, Dalai RP. Comparison of the effectiveness of 38% silver diamine fluoride and atraumatic restorative treatment for treating dental caries in a school setting: A randomized clinical trial. Dent Med Probl [Internet]. 2022 [Citado 20/06/2025]; 59(2): 217–23. Available from: https://pubmed.ncbi.nlm.nih.gov/35506381
21. Araujo M, Innes N, Bonifácio C, Hesse D, Olegário I, Mendes F, et al. Atraumatic restorative treatment compared to the Hall Technique for occluso-proximal carious lesions in primary molars; 36-month follow-up of a randomised control trial in a school setting. BMC Oral Health [Internet]. 2020 Nov [Citado 20/06/2025]; 20(1): 318. Available from: https://pubmed.ncbi.nlm.nih.gov/33176756/
22. Mobarak E, El-Deeb H, Daifalla LE, Ghaly M, Mustafa M, Sabry D, et al. Survival of multiple-surface ART restorations using a zinc-reinforced glass-ionomer restorative after 2 years: A randomized triple-blind clinical trial. Dent Mater [Internet]. 2019 Sep [Citado 20/06/2025]; 35(9): 185–92. Available from: https://pubmed.ncbi.nlm.nih.gov/31235189/
23. Pesaressi E, Zelada-Lopez D, Cosme T, Diaz J, Huanqui M, Fidela de Lima Navarro M, et al. Randomised clinical trial of Class II ART restoration in primary teeth with and without retentive grooves after 12 months. Eur J Paediatr Dent [Internet]. 2024 Mar [Citado 20/06/2025]; 25(1): 42–9. Available from: https://pubmed.ncbi.nlm.nih.gov/38078810/
24. Menezes R, Velasco S, Bastos R, Molina G, Honório H, Frencken J, et al. Randomized clinical trial of class II restoration in permanent teeth comparing ART with composite resin after 12 months. Clin Oral Investig [Internet]. 2019 Sep [Citado 20/06/2025]; 23(9): 3623–35. Available from: https://pubmed.ncbi.nlm.nih.gov/30612246/
25. Liu Z-H, Ma H-R, Miao F, Zhou S. [Analysis of the effect of improved ART with high-intensity glass ionomer cement in the treatment of primary caries in children]. Shanghai Kou Qiang Yi Xue [Internet]. 2021 Jun [Citado 20/06/2025]; 30(3): 278–82. Available from: https://pubmed.ncbi.nlm.nih.gov/34476445/
26. Jiang M, Wong MCM, Chu CH, Dai L, Lo ECM. A 24-month randomized controlled trial on the success rates of restoring untreated and SDF- treated dentine caries lesions in primary teeth with the ART approach. J Dent [Internet]. 2020 Sep [Citado 20/06/2025]; 100: 103435. Available from: https://pubmed.ncbi.nlm.nih.gov/32712307/
27. Menezes R, Velasco S, BRESCIANi E, Bastos R, Navarro MF. A prospective and randomized clinical trial evaluating the effectiveness of ART restorations with high- viscosity glass-ionomer cement versus conventional restorations with resin composite in Class II cavities of permanent teeth: two-year follow-up. J Appl Oral Sci [Internet]. 2021 [Citado 20/06/2025]; 29: e20200609. Disponible en: https://pubmed.ncbi.nlm.nih.gov/33656064/
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Copyright (c) 2025 Karen Stephanie Peñarreta Tutillo, Edison Xavier Flores-Portugal, Carmen Salinas-Goodier
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