Frencken J E, Makoni F, Sithole W D
Department of Preventive and Community Dentistry, University of Nijmegen, The Netherlands.
Community Dent Oral Epidemiol. 1998 Dec;26(6):372-81. doi: 10.1111/j.1600-0528.1998.tb01975.x.
Atraumatic restorative treatment (ART) consists of removing demineralised tooth tissues with hand instruments only, restoring the prepared cavity and sealing the adjacent pits and fissures with an adhesive filling material. This relatively painless, no-handpiece, minimal intervention approach to controlling dental caries is described. ART was applied in an oral health care programme in Zimbabwe that was carried out amongst secondary school students from 1994 to 1997. A new glass ionomer (Fuji IX) was used as the restorative and sealant material. Sealants were placed in high caries risk students using the 'press-finger' technique. A total of 297 one-surface ART restorations and 95 glass ionomer sealants were placed in 142 and 66 students, respectively. After 3 years, the lost-to-follow-up percentages for one-surface ART restorations and glass ionomer sealants were 30.6% and 30.5%, respectively. Actuarial (life table) analysis resulted in 3-year survival rates of one-surface ART restorations of 88.3% (95% CI: 92.4%-84.2%), ranging from 94.3% to 65.4% per operator. A total of 28 ART restorations placed in 25 students failed. Reasons for failure related to the material and the operator (11 restorations or 5.3% each), and to caries adjacent to the restoration (one restoration or 0.5%). Reasons for failure were not recorded for five restorations (2.3%). Sealants were placed on surfaces diagnosed as early enamel lesions. After 3 years, 71.4% (95% CI: 81.7%-61.1%) of the fully and partially retained sealants survived with a range of 100% to 55.6% per operator. Of the sealed surfaces 96.3% (95% CI: 100%-92.2%) survived 3 years without developing caries. Experienced operators placed better ART restorations than inexperienced operators. This study has demonstrated that ART with a glass ionomer restorative material and sealants provided high quality preventive and restorative dental care to this student population. ART has become one of the treatment modalities available to oral health workers in managing dental caries.
非创伤性修复治疗（ART）仅使用手动器械去除脱矿的牙体组织，预备窝洞后用黏结性充填材料修复窝洞并封闭相邻的窝沟。本文描述了这种相对无痛、无需牙钻、干预最小的控制龋齿的方法。1994年至1997年期间，在津巴布韦针对中学生开展的一项口腔保健项目中应用了ART。一种新型玻璃离子水门汀（富士IX）用作修复和封闭材料。采用“按压手指”技术为患龋风险高的学生放置窝沟封闭剂。分别为142名和66名学生放置了297个单面ART修复体和95个玻璃离子水门汀窝沟封闭剂。3年后，单面ART修复体和玻璃离子水门汀窝沟封闭剂的失访率分别为30.6%和30.5%。精算（寿命表）分析得出单面ART修复体的3年生存率为88.3%（95%可信区间：92.4% - 84.2%），每位操作者的生存率在94.3%至65.4%之间。25名学生中放置的28个ART修复体失败。失败原因与材料和操作者有关（各11个修复体或5.3%），以及与修复体相邻的龋齿有关（1个修复体或0.5%）。5个修复体（2.3%）未记录失败原因。窝沟封闭剂放置在诊断为早期釉质病变的牙面上。3年后，完全和部分保留的窝沟封闭剂的生存率为71.4%（95%可信区间：81.7% - 61.1%），每位操作者的生存率在100%至55.6%之间。在接受封闭的牙面中，96.3%（95%可信区间：100% - 92.2%）在3年内未发生龋齿。经验丰富的操作者比经验不足的操作者放置的ART修复体质量更好。本研究表明，使用玻璃离子水门汀修复材料和窝沟封闭剂的ART为该学生群体提供了高质量的预防性和修复性口腔保健。ART已成为口腔卫生工作者在治疗龋齿时可用的治疗方式之一。
