The atraumatic restorative treatment (ART) approach has become an evidence-based treatment option for dental caries in less developed countries showing a mean annual failure rate of 5% in class I cavities (1). Little information is available for ART in class III and IV cavities (2), although epidemi- ological data indicate treatment needs in incisors, especially in the young population of some African countries (3). ART combines a less traumatic technique because of manual cavity preparation with the use of a glass-ionomer cement as an adhesive and fluoride releasing restoration mate- rial (4, 5). The clinical skills are simple, and therefore, ART can be performed by dental auxil- iaries (6). In areas without primary oral health care, however, carious teeth often remain untreated or are extracted in case of complications (7). Because of patients’ functional and aesthetic requirements, there seems to be a need to treat anterior teeth restoratively rather than surgically. Following emerging treatment strategies, including the con- cept of a shortened dental arch with missing molars, but with anterior teeth and premolars in function (8), a minimal intervention technique for incisors using the ART approach appears promising for areas with limited oral health care resources. The advantages of the restoration material used in ART are as follows: (i) dental auxiliaries performing ART are experienced in handling glass-ionomer cements and a manual cavity preparation, (ii) technical Community Dent Oral Epidemiol 2011; 39: 164–170 All rights reserved Ó 2010 John Wiley & Sons A/S Class III Atraumatic Restorative Treatment (ART) in adults living in West Africa – outcomes after 48 months Jordan RA, Hetzel P, Franke M, Markovic L, Gaengler P, Zimmer S. Class III Atraumatic Restorative Treatment (ART) in adults living in West Africa – outcomes after 48 months. Community Dent Oral Epidemiol 2011; 39: 164–170. Ó 2010 John Wiley & Sons A ⁄ S Abstract – Objectives: This observational study assessed the effectiveness of class III restorations using the atraumatic restorative treatment (ART) approach in permanent anterior teeth over a 48-month period. Methods: Dental auxiliaries placed a total of 117 class III ART restorations in 2004, using a cosmetically improved glass-ionomer (Ionofil Ò Plus; VOCO, Cuxhafen, Germany), in 67 patients with a mean age of 27.3 years in the rural Jahali Health Center, The Gambia. Independent examiners evaluated the restorations after 24 and 48 months using the clinical ART evaluation criteria. Results: Seventy-six of the restorations could be observed over 48 months in 51 patients. After 48 months, 53 of 76 restorations were classified as clinically acceptable (without or with minor intervention (repair) needed), and 23 restorations were classified as insufficient. There was no statistical difference in a clustered performance rating between restorations placed in central and lateral incisors (P = 1.0). Conclusions: The adoption of the ART approach to class III caries cavities made restorative dental care in anterior teeth available in a West African region. The long-term performance was comparable to other studies. Longitudinal clinical studies with greater populations are required to substantiate these results. Rainer A. Jordan, Philipp Hetzel, Markus Franke, Ljubisa Markovic, Peter Gaengler and Stefan Zimmer Department of Propaedeutic Dentistry, Faculty of Health - Dentistry, Witten/ Herdecke University, Germany Key words: dental atraumatic restorative treatment; dental caries; health services research; permanent dental restoration; treatment outcome Rainer A. Jordan, Department of Propaedeutic Dentistry, Faculty of Health - Dentistry, Witten ⁄ Herdecke University, Alfred-Herrhausen-Str. 50, D-58448 Witten, Germany Tel.: +49 (2302) 026 ext. 607 Fax: +49 (2392) 926 ext. 661 e-mail: andreas.jordan@uni-wh.de Submitted 29 May 2009; accepted 30 July 2010 164 doi: 10.1111/j.1600-0528.2010.00574.x