Dental caries is a highly prevalent disease that remains a worldwide public health problem affecting 2.4 billion people with permanent dentition and 621 million children with primary dentition.It affects 60% to 90% of school aged children and up to 100% of adults in most countries. Concurrently, the WHO considers dental caries as the fourth most expensive chronic disease to treat. Dental caries and its consequences are considered as the most important burden of oral health. The resultant pain and discomfort can negatively affect people’s quality of life. Furthermore, the management of this condition imposes huge financial burden on the individuals and ultimately the society. Conventional treatment methods (drill and fill)for Dental caries involves the use of rotary burs alone or in conjunction with hand instruments.Various dental restorative materials are used, ranging from metal based materials such as amalgam to tooth-coloured materials, such as resin composites.

Conventional restorative treatment requires reticulated water and electricity supply which is limited in the outreach programs. Therefore, Atraumatic Restorative Treatment (ART) was developed around 1985, mainly for treating caries in children living in under-served areas of the world where resources and facilities such as electricity and trained manpower are limited. It has been considered an innovative, painless and minimally invasive treatment for the management of caries and restored with an adhesive material (GIC). The advantages of ART include: a biologically friendly approach, low cost, reduced risk for subsequent endodontics and tooth extraction, and lower dental anxiety in children and adults (more patient-friendlier). In addition, people who are elderly, medically-compromised (e.g. HIV infected) or dental phobic can have problems accessing dental care and could benefit from the ART approach. 

The performance of ART restorations for longevity has been evaluated through numerous clinical trials with the results of studies showing that ART performs well for occlusal cavities in primary and permanent teeth. Meta-analysis study of two hundred four publications, and 66 reports on ART restorations on survival rate of atraumatic restorative treatment showed high survival rates for single-surface ART restorations using high-viscosity glass ionomers in primary and permanent teeth over 2 and 5 years, respectively. The survival rates of multiple-surface ART restorations using high-viscosity glass ionomers were low for the primary teeth at 2 years and the number of such studies for the permanent teeth was low. The mean annual failure rates of single-surface and multiple surface ART restorations in primary teeth over the first 2 years were 3.5% and 19%, respectively. The mean annual failure rates of single-surface ART restorations using high-viscosity glass ionomers in permanent teeth over the first 3 and 5 years were 5.0% and 4.0%, respectively. The mean annual failure rate of multiple-surface ART restorations using high-viscosity glass ionomers in permanent teeth was 14% over the first year.

Exploration of scientific literature revealed limited studies to date assessing the survival rate of the innovative tooth-coloured resin based self-curing, fluoride releasing, chemically bonded restorative material using ART approach for deciduous molars among underserved paediatric populations with limited water and power supply where conventional restorative treatment (Drill and Fill) is not feasible. Thus, the present study aims to evaluate the survival rate of a self-curing, fluoride releasing, resin based restorative material with conventional glass ionomer restoration for ART in school children in outreach programmes using split mouth design.