Factors affecting success rate of atraumatic restorative treatment (ART) restorations in children: A systematic review and meta-analysis

Objectives: Aim of this systematic review was to summarize the factors that affect the success rate of atraumatic restorative treatment (ART) restorations in children. Data/Sources: Two independent reviewers conducted a literature search in the databases PubMed, Medline and Web of Science until October 2019 with no initial time limit. Articles reporting on clinical outcomes of ART restorations placed in children were included. Study selection: A total of 67 articles were included in this review reporting on clinical outcomes of ART restorations placed in children in 47 studies. The overall estimated success rate and 95 % confidence interval (CI) of ART restorations were 0.71 (0.65-0.77) and 0.67 (0.56-0.78) at the 12-month and the 24-month follow-up, respectively. Operator was one of the significant factors associated with the success rate of ART restorations. ART restorations placed by dental students/therapists had a significantly lower success rate compared with those placed by dentists. Besides, type of restoration (single-surface vs. multiple-surface restoration) was also associated with the success rate of ART restorations. Other factors including dentition, restorative material, clinical setting, and moisture control method had no significant influence on the success rate of ART restorations in children. Conclusion: It is concluded that ART approach can be used to manage cavitated caries lesions in children. Operator and type of restoration are significant factors influencing the success rate of ART restorations. Clinical significance:: This study provides valuable information on the factors that affect success rate of ART restorations in children, which helps clinicians to make informed decisions on provision of ART restorations in children.