Use of the ART technique within the school setting can be a practical and effective method of treating caries among large populations of underserved children.

Subjects: The study sample was composed of 197 children, mean age 12.560.6 years at baseline, attending 4 schools in Deyang City, Sichuan Province, China. They had a mean decayed, missing, or filled teeth (DMFT) score of 0.6, with a mean decayed teeth (DT) score of 0.4. At the 6-year follow-up, 117 children (59% of original cohort) remained in the study.

Key Exposure/study Factor: The primary study factor was caries treatment using atraumatic restorative treatment (ART) restorative therapy. A total of 294 ART restorations were placed by 5 local assistant dentists, who had received a short training course in the procedure. Seventy-eight percent were single-surface restorations not involving more than half of the surface (so-called "small" restorations); the remaining 22% involved either more than half of a single surface or extended onto more than one surface (so-called "large" restorations), including 5% that were class II restorations.

Main Outcome Measure: The main outcome measure was failure of the ART restoration at 6 years. Failure included loss of the restoration (total or partial), replacement by another restoration, or the presence of either a gross defect or gross wear. Assessment using US Public Health Service criteria, including caries assessment, at 5 years was also reported.

Main Results: The principal findings were that 76% of small ART restorations and 59% of large restorations had not failed at 6 years. The large restorations were nearly 6 times more likely to fail as compared with the small (hazard ratio = 5.87, P <.05). Loss of the restoration was the principal reason for failure for both small and large restorations. Recurrent caries was specifically diagnosed at 5-year follow-up, and found to be present in around 6% of small restorations, with none of the larger restorations having been diagnosed as carious.

Conclusions: The authors concluded that the 6-year survival of ART restorations in this study sample was high, with the likelihood of success related to restoration size. They further concluded that application of this treatment technique at school could be used to help address the needs of large populations of underserved children.