Conclusions 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
Objective The aim of the present study is to up date 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 .
Is high-viscosity glass-ionomer-cement a successor to amalgam for treating primary molars?
OBJECTIVES To assess and compare the cumulative survival rate of amalgam and atraumatic restorative treatment ( ART ) restorations in primary molars over 3 years . METHODS 280 children aged 6 - 7 years old were enrolled in a cluster r and omized controlled clinical trial using a parallel group design covering two treatment groups : conventional restorative treatment with amalgam ( CRT ) and atraumatic restorative treatment ( ART ) using a high-viscosity glass-ionomer ( HVGIC ) Ketac Molar Easymix . Three pedodontists placed 750 restorations ( 364 amalgam and 386 ART in 126 and 154 children , respectively ) which were evaluated at 0.5 , 1 , 2 and 3 years . The proportional hazard rate regression model with frailty correction , ANOVA and Wald tests , and the Jackknife procedure were applied in analysing the data . RESULTS The cumulative survival rates over 3 years for all , single- and multiple-surface CRT/amalgam restorations ( 72.6 % , 93.4 % , 64.7 % , respectively ) were no different from those of comparable ART/HVGIC restorations ( 66.8 % ; 90.1 % and 56.4 % , respectively ) ( p=0.10 ) . Single-surface restorations had higher survival rates than multiple-surface restorations for the both treatment procedures ( p<0.0001 ) . A higher proportion of restorations failed because of mechanical reasons ( 94.8 % ) than of secondary caries ( 5.2 % ) . No difference in reasons for restoration failures between all types of amalgam and ART/HVGIC restorations were observed ( p=0.24 ) . SIGNIFICANCE The high-viscosity glass-ionomer used in this study in conjunction with the ART is a viable option for restoring carious dentin lesions in single surfaces in vital primary molars
Conclusions 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
Objective The aim of the present study is to up date 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 .