Two-year evaluation of the atraumatic restorative treatment approach in primary molars class I and II restorations CAROLINA DA FRANCA 1 , VIVIANE COLARES 1 & EVERT VAN AMERONGEN 2 1 Departament of Social Dentistry, Dental School, University of Pernambuco, Pernambuco, Brazil, and 2 Academic Centre for Dentistry in Amsterdam, Amsterdam, The Netherlands International Journal of Paediatric Dentistry 2011; 21: 249– 253 Background. Atraumatic restorative treatment (ART) has the advantages of reducing pain and fear and of being more cost-effective than the tra- ditional approach. Aim. The aim of this study was to investigate the survival of ART class I and II restorations in pri- mary molars at 2 years. Design. The sample consisted of 190 restorations and placed in 155 children 6–7 years old of both genders. The treatment was performed by two final-year dental students. All patients were trea- ted in a completely supine position on tables available in the schools. The restorations were evaluated at 1, 12, and 24 months. Results. The best results were found for class I in each period of follow-up. After 1 month, the success of class I restorations was 94.6% and class II restorations 70.1%. After 12 months, the success rate was 50.6% for class I and 15.2% for class II. The most frequent failure characteristics were totally or partially lost and gross marginal defect. Conclusions. The rate of success of restorations using the ART approach was significantly lower for class II. Introduction Atraumatic restorative treatment (ART) is an approach that involves a preventive and restorative caries management concept that has been developed in the last two decades 1 . This technique consists of removing deminer- alized dental tissue using only hand-held instruments and restoring the cavity with an adhesive filling material 2 . This is in accor- dance with the modern concept of minimal intervention because it conserves sound tooth tissue and it is also preventive because it pro- tects adjacent pits and fissures. Atraumatic restorative treatment is a simple technique with many advantages, such as it reduces pain and fear during dental treatment 3 ; it does not require electricity 2 ; and it is more cost-effective than the traditional approach using amalgam 4 . It is an alternative treatment available to a large part of the world’s popula- tion 2 . In addition, it is mostly indicated for use in children, as it is reportedly atraumatic because no rotary instruments are used and in most cases no local anaesthesia is needed 3,5 . According to a systematic review, ART res- torations with high-viscosity GIC are success- ful, and their survival rate may even exceed that of amalgam fillings, although these find- ings should be treated with caution owing to unclear randomized sequence allocation and ⁄ or allocation concealment 6 . In addition, the introduction of ART into the oral health care systems of low- and middle-income countries would reduce extractions and increase the proportion of teeth restored and sealed 1 . A reduction in tooth extractions is a goal of WHO for 2020 7 . In the literature, there are relatively few investigations on this treatment approach in the primary dentition. Table 1 shows the most recent studies in which the rate of success of ART restorations ranges from 43.4% to 96.7% for class I and from 12.2% to 83.3% for class II. The aim of this study was to investigate the survival of ART restorations in primary molar classes I and II restorations at 2 years. Materials and methods Study population This study was conducted at schools in Recife, Brazil, with children 6–7 years old of both genders. Correspondence to: Carolina da Franca, Rua Jacobina, 45/2102. Recife – PE – Brazil, 52011180. Tel.: +55 81 3242 9708/+55 81 9606 6850. E-mail: carolinafbandeira@yahoo.com.br Ó 2011 The Authors International Journal of Paediatric Dentistry Ó 2011 BSPD, IAPD and Blackwell Publishing Ltd 249 DOI: 10.1111/j.1365-263X.2011.01125.x