The ART approach: clinical aspects reviewed

Abstract

The success of ART as a caries management approach is supported by more than 20 years of scientific evidence. ART follows the contemporary concepts of modern cariology and restorative dentistry. It challenges treatment concepts such as step-wise excavation and the need for complete removal of affected dentine. The ART approach so far has mainly used high-viscosity glass-ionomer as the sealant and restorative material. Cariostatic and remineralization properties have been ascribed to this material which requires further research to establish its clinical relevance. The adhesion of high-viscosity glass-ionomer to enamel in pits and fissures is apparently strong, as its remnants, blocking the pits and fissures, have been considered a possible reason for the low prevalence of carious lesion development after the glass-ionomer has clinically disappeared from it. Encapsulated high-viscosity glass-ionomers may lead to higher restoration survival results than those of the hand-mixed version and should, therefore, not be neglected when using ART. Similarly, the use of resin-modified glass-ionomer with ART should be researched. The effectiveness of ART when compared to conventional caries management approaches has been shown in numerous studies. Proper case selection is an important factor for long-lasting ART restoration survival. This is based on the caries risk situation of the individual, the size of the cavity opening, the strategic position of the cavitated tooth and the presence of adequate caries control measures. As the operator is one of the main causes for failure of ART restorations, attending a well-conducted ART training course is mandatory for successful implementation of ART.

FIGURE-1. A) High-viscosity glass-ionomer (Fuji IX) sealant in tooth 47 after 12 years. The distal fissure appears to be clinically free of glass-ionomer material. B1) On the scanning electron microscopy (SEM) image (12x), glass-ionomer material is clearly visible till end of distal fissure. C2) Good adhesion of high-viscosity glass-ionomer to enamel (SEM: 100x). D3) Glass-ionomer material present in the fissure connecting the central with the mesial pit (SEM: 100x). The glass-ionomer sealant was clinically not visible in the fissure (Copyright: J. Frencken)