Failure rate of high-viscosity GIC based ART compared with that of conventional amalgam restorations--evidence from an update of a systematic review

SADJ. 2012 Aug;67(7):329-31.


Introduction: Atraumatic Restorative Treatment (ART) involves using only hand instruments for removing carious tooth tissue and then restoring the resulting cavity with an adhesive restorative material.

Objective: To answer the question as to whether, in patients with carious cavities of any class in primary and permanent teeth, ART restorations with high-viscosity glass-ionomer cement (GIC) have a higher failure rate than amalgam restorations placed after drilling, in tooth cavities of the same size, dentition and follow-up period.

Methods: Thirteen databases were searched for relevant trials up to January 2012. Hand-searching was performed for non indexed journals. References of included trials were checked. Prospective, clinical controlled trials with a followup period of at least one year were selected. The investi gated outcome was restoration failure. Meta-analysis was conducted and internal trial validity was assessed in-depth.

Results: Twenty trials were accepted for review. The majority of the results show no differences between the types of intervention. The current evidence indicates that the failure rate of high-viscosity GIG/ART restorations is not higher than, but is similar to that of conventional amalgam fillings after periods longer than six years. There is a risk that these results are affected by bias and confirmation by further trials is recommended.

Publication types

  • Comparative Study
  • Review
  • Systematic Review

MeSH terms

  • Bias
  • Dental Amalgam / chemistry*
  • Dental Atraumatic Restorative Treatment*
  • Dental Restoration Failure*
  • Dental Restoration, Permanent*
  • Glass Ionomer Cements / chemistry*
  • Humans
  • Viscosity


  • Glass Ionomer Cements
  • Dental Amalgam