Conclusions from the symposium. Two decades of ART: success through research

ABSTRACT Two decades of ART research has served as the catalyst for a new way of thinking about oral health care. It is now necessary to build on the success of ART research by educating existing and future oral health professionals and health decision makers about the benefits of the ART approach. It is also important to build upon the sound research base that already exists on ART even though enough is known about ART to consider it is a reliable and quality approach to control caries. While oral health promotion through prevention remains the essential foundation of oral health, the ART approach is an important corner stone in the building of global oral health.


INTRODUCTION
While it might seem only yesterday for those who pioneered the development and research of the Atraumatic Restorative Treatment (ART) approach, two decades have already passed since the start of the first major study on ART in Khonkaen, Thailand 3 . The timing of this present symposium therefore serves not only as a temporal milestone for ART but also marks the principal outcome of two decades of ART research, namely its contribution to successfully improving oral health worldwide.
In organizing this important symposium, reviewing and building upon the two decades of ART research, it was only appropriate that it be held in Latin America, for although ART did not originate there, it is a Region where huge attention has been focused on the ART approach.
It is also a Region which has in many ways been at the forefront recently in many fields of ART,

EARLY RESEARCh
In the early 1990's, research into the ART approach was spearheaded by a few dedicated workers who saw the true potential for this approach. This research was neither easy nor straightforward since it was often conducted under difficult conditions in the field on shoestring budgets. Moreover, such research was often not appreciated or valued by our peers since ART challenged traditional concepts of restorative treatment and caries management.
Despite the early resistance by many to the ART approach, some of whom considered ART to be "third-world dentistry" or "dentistry out of Africa" or even "dirty dentistry", time has proven such pundits wrong. This was achieved through a combination of sound research to provide an excellent evidence base for the approach and

RESEARCh OUTCOMES
As is evidenced by the papers presented during this symposium, over the past twenty years ART has become one of the most researched approaches for the control of dental caries and certainly for minimal intervention (MI) approaches for caries 1,2 . In this respect ART could be considered in many ways to be the spearhead of MI. It certainly helped to build the momentum of the MI movement amongst a traditionally conservative dental profession who are often slow to grasp new approaches, even those that have a significant evidence base, and adopt them as part of their day-to-day practice armamentarium.
While the past two decades of ART can be heralded as a success story, it is necessary to build on this success. One part of this is to educate existing and future oral health professionals and health decision makers about the benefits of the ART approach. The other is to build upon the sound research base that already exists on ART.
While we know enough about ART to know it is a reliable and quality approach to control caries, there will always be a call for addition research to improve on success. In particular, in order to make the quantum leap forward to achieve a significant improvement in oral health in all countries of the world there will be a need for resources to be allocated to applied research on approaches such as ART and allied areas. Here

ACKNOWLEDgEMENTS
We are grateful to the organising committee of the IADR meeting, headed by Dr. Olga Zambrano and Dr. Ana Maria Acevedo. The ART symposium would not have been the success it was if it had not been for their hard work and commitment.
As chairpersons they ensured an excellent atmosphere for discussion and exchange of ideas in convivial surroundings. We would also like to thank 3MESPE for providing financial support for this ART symposium.