Does ART have a place in preservative dentistry?

The ART technique consists of hand excavating carious tissue and placing a highly viscous glass ionomer cement as a restoration material and as a seal ant. Although the results of several studies are promising, the retention r ates of these restorations for primary teeth are not impressive. Materials and methods that yield greater success rates are needed to improve long-ter m caries management outcomes. Ln principle, ART should yield outcomes simil ar to those associated with preservative dentistry, including the potential for minimal surgical intervention, conservation of sound tooth structure, avoidance of pain and need for local anesthetic injections, reduced risk fo r subsequent endodontics and tooth extraction, and increased survival time of the affected teeth. The ideal direct-filling ART material would be bioco mpatible and tooth colored; "forgiving" in its handling properties; insensi tive to moisture or desiccation; hardenable without special equipment; able to form stable bonds to enamel and dentin; able to seal marginal gaps agai nst bacteria; capable of releasing fluoride or remineralization and antibac terial agents when demineralization is most likely; and resistant to chemic al attack. The highly viscous glass ionomer materials currently used for AR T meet several of this criteria, though they may be deficient in their abil ity to seal marginal gaps against bacteria and in their sensitivity to desi ccation. Furthermore, although they release fluoride over the lifetime of t he restoration, this fluoride release alone may not prevent caries progress ion in all cases. It is necessary for cases of high caries risk to use chlo rhexidine in conjunction with fluoride to achieve caries arrest and reminer alization of adjacent areas of the affected teeth. Thus, while the ART tech nique offers some benefits in restoring function and reducing the rate of c aries progression, it is unlikely that current materials will be able to ar rest caries progression completely in high-risk persons.