The purpose of this paper was to critically analyse the results obtained with the Atraumatic Restorative Treatment (ART) technique. The ART approach involves the excavation of cavitated carious lesions with hand instruments and restoration of the cavities and associated pits and fissures with a glass ionomer restorative material. The clinical trial outcomes involving ART include retention rates, cost effectiveness, operative sensitivity, and the effect of personnel with different educational backgrounds involved in this alternative operative treatment. Comparative studies involving permanent and deciduous teeth using amalgam and glass ionomer sealants have also been included in the same projects. Specially defined clinical criteria have been used to evaluate the results. ART offers an opportunity for restorative dental treatment under field conditions where no electricity is available. Three-year data have been published, but long term studies using relevant comparison alternatives are lacking. ART has so far been largely employed on populations with a low DMFT. The technique should also be applied to high risk patients with rampant caries before the maximal benefit of the treatment can be ascertained.