Atraumatic restorative treatment versus amalgam restoration longevity: a systematic review

The aim was to report on the longevity of restorations placed using the atraumatic restorative treatment (ART) approach compared with that of equivalent placed amalgam restorations. Five databases were systematically searched for articles up to 16 March 2009. Inclusion criteria: (1) titles/abstracts relevant to the topic; (2) published in English; (3) reporting on 2-arm longitudinal in vivo trials; (4) minimum follow-up period of 12 months. Exclusion criteria: (1) insufficient random or quasi-random allocation of study subjects; (2) not all entered subjects accounted for at trial conclusion; (3) subjects of both groups not followed up in the same way. Fourteen from the initial search of 164 articles complied with these criteria and were selected for review. From these, seven were rejected and seven articles reporting on 27 separate datasets, accepted. Only identified homogeneous datasets were combined for meta-analysis. From the 27 separate computable dichotomous datasets, four yielded a statistically significant improvement of longevity of ART versus amalgam restorations: posterior class V, 28% over 6.3 years; posterior class I, 6% after 2.3 years and 9% after 4.3 years; posterior class II, 61% after 2.3 years. Studies investigating restorations placed in the primary dentition showed no significant differences between the groups after 12 and 24 months. In the permanent dentition, the longevity of ART restorations is equal to or greater than that of equivalent amalgam restorations for up to 6.3 years and is site-dependent. No difference was observed in primary teeth. More trials are needed in order to confirm these results.