Clinical Oral Investigations

, Volume 22, Issue 8, pp 2703–2725 | Cite as

Survival percentages of atraumatic restorative treatment (ART) restorations and sealants in posterior teeth: an updated systematic review and meta-analysis

  • R. G. de Amorim
  • J. E. Frencken
  • D. P. Raggio
  • X. Chen
  • X. Hu
  • S. C. Leal



The aim of the present study is to update the results of two previous meta-analyses, published in 2006 and 2012, on the survival percentages of atraumatic restorative treatment (ART) restorations and ART sealants. The current meta-analysis includes Chinese publications not investigated before.

Materials and methods

Until February 2017, six databases were interrogated (two English, one Portuguese, one Spanish and two Chinese). Using six exclusion criteria, a group of six independent reviewers selected 43 publications from a total of 1958 potentially relevant studies retrieved. Confidence intervals and/or standard errors were calculated and the heterogeneity variance of the survival rates was estimated.


The survival percentages and standard errors of single-surface and multiple-surface ART restorations in primary posterior teeth over the first 2 years were 94.3% (± 1.5) and 65.4% (± 3.9), respectively; for single-surface ART restorations in permanent posterior teeth over the first 3 years, they were 87.1% (± 3.2); and for multiple-surface ART restorations in permanent posterior teeth over the first 5 years, they were 77% (± 9.0). The mean annual dentine-carious-lesion-failure percentages in previously sealed pits and fissures using ART sealants in permanent posterior teeth over the first 3 and 5 years were 0.9 and 1.9%, respectively.


ART single-surface restorations presented high survival percentages in both primary and permanent posterior teeth, whilst ART multiple-surface restorations presented lower survival percentages. ART sealants presented a high-caries-preventive effect.

Clinical relevance

ART is an effective evidence-based option for treating and preventing carious lesions in primary and permanent posterior teeth.


Sealant Restoration Atraumatic restorative treatment Survival Meta-analysis Systematic review 



We would like to thank all the authors of the studies that made up the database for the current meta-analysis. Special thanks go to Dr. Ewald Bronkhorst for skillful analysis of the data.


The work was partially supported by the National Council for Scientific and Technological Development from the Brazilian Government, under grants 309521/2015-7 and 306852/2016-0.

Compliance with ethical standards

Conflict of interest

RG de Amorim declares that he has no conflict of interest. JE Frencken is the originator of the ART approach and as such could be considered to have a conflict of interest. DP Raggio has received research grant from the National Council for Scientific and Technological Development from the Brazilian Government (grant number 309521/2015-7). X Chen declares that she has no conflict of interest. X Hu declares that she has no conflict of interest. SC Leal has received research grant from the National Council for Scientific and Technological Development from the Brazilian Government (grant number 306852/2016-0).

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study, formal consent is not required.

Supplementary material

784_2018_2625_MOESM1_ESM.doc (62 kb)
ESM 1 (DOC 61 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.BrasíliaBrazil
  2. 2.Department of Oral Function and Prosthetic DentistryRadboud University Medical CentreNijmegenThe Netherlands
  3. 3.Orthodontics and Pediatric Dentistry Department, School of DentistryUniversity of São PauloSão PauloBrazil
  4. 4.State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of StomatologyWuhan UniversityWuhanChina
  5. 5.Department of Dentistry, Faculty of Health SciencesUniversity of BrasíliaBrasíliaBrazil

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