9. Atraumatic Restorative Treatment (2).ppt

ART
Atraumatic Restorative treatment
Dr. Prachi Sharma
MAHATMA GANDHI DENTAL COLLEGE & HOSPITAL
DEPARTMENT OF PUBLIC HEALTH DENTISTRY

CONTENTS
 Introduction .
 Development of an ART .
 Application of ART.
 Instruments used.
 Principal steps involved.
 Indication and contraindications.
 Advantages and limitations.
 Conclusion.
2

INTRODUCTION
 Although dental caries has substantially decreased in the
industrialized countries, it remains to be a widespread
problem all over the world.
 Most of the carious teeth in the developing countries tend to
go untreated to such an extent that the only treatment option
available is extraction.
3

 ART approach includes both prevention and treatment of
dental caries.
 Often abbreviated to the acronym ART.
 Based on Minimal intervention technique.
4

 ART(Atraumatic Restorative Treatment) is defined as a minimally
invasive care approach in preventing dental caries and stopping its further
progression ( Jo E. Frencken, 2012).
 AAPD (American Academy of Pediatric Dentistry) defines ART as a
“dental caries treatment procedure involving the removal of soft,
demineralized tooth tissue using hand instrument alone, followed by
restoration of the tooth with an adhesive restorative material, routinely
glass ionomer.”
5

PRINCIPLE OF ART
 This procedure is based on the principles -
 Removing caries using hand instruments only.
 Restoring the tooth with an adhesive filling
material - glass ionomer .
6

 The ART approach was pioneered in Tanzania in the mid
1980’s.
 Then it was followed by several community field trials
conducted in Thailand and Zimbabwe in 1991 and 1993
respectively.
 Results have shown that 71% and 85% of the ART restorations
remained in the teeth after 3 years.
8

 In April 1994, the World Health Organization introduced ART
as part of the world health day.
 ART has been placed on the agenda of the International
Dental Federation (FDI) to consider ART’s appropriateness,
effectiveness and potential training programmes.
 At least 25 countries around the world are carrying out
clinical or laboratory experiments on ART related questions.
9

INDICATIONS OF ART
 Introducing oral care to very young not previously exposed to dentistry.
 For patients with extreme fear/anxiety.
 For mentally and / or physically handicapped patients.
 For home – bound elderly and those living in nursing homes.
 In high – risk caries clinics as an intermediate treatment to stabilize
conditions.
 Only in small cavities (involving dentin)
 Public health programs
 Those cavities that are accessible to hand instruments.
10

CONTRA INDICATIONS OF ART
 There is presence of swelling/ abscess near the carious
tooth.
 The pulp of the tooth is exposed
 Teeth have been painful for a long time and there may
be chronic inflammation of pulp.
 There is an obvious carious cavity, but opening is
inaccessible to hand instruments.
 There is a clear signs of a cavity, e.g. proximal surface,
but it cannot be entered from the proximal or occlusal
direction.
11

INSTRUMENTS AND
MATERIALS USED IN ART

 Mouth mirrors
 Explorers
 Pair of tweezers
13

 Dental hatchets
 Small and medium sized
spoon excavators,
14

 Carvers
 Appliers
 Glass slab/ Mixing Pad
 Spatula
15

 The light source can be the sun(
natural) or artificial light.
 To improve visibility, a special
light source fixed to a pair of
spectacle frames that is
powered by a rechargeable
battery source is used.
Other- headlamp, light attached to
mouth mirror.
17

 The essential materials are
gloves.
 cotton wool rolls and pellets
(size 4).
 Glass ionomer Cement
 petroleum jelly (Vaseline)
wedges, plastic strips and
clean water.
18

 Reasons for using hand instruments rather than electric
rotating hand pieces are-
- Use of a biological approach, which requires minimal cavity
preparation that conserves sound tooth tissues and causes less
trauma to the teeth.
- Low cost of hand instruments compared to electrically driven dental
equipment.
- Reduces psychological trauma to patients
- Simplified infection control
- Hand instruments can easily be cleaned and sterilized after every
patient.
19

 The reasons for using Glass- Ionomer are-
- As the glass-ionomer sticks chemically to both enamel and
dentin.
- fluoride is released from the restoration which will prevent
and arrest caries.
- It is rather similar to hard oral tissues and does not inflame the
pulp or gingiva.
20

Operating Positions 21
• The distance between operators eye to the patient’s tooth is usually between
30 to 35 cm.
• Operator should be positioned behind the head of the patient.
• Patient’s mouth is considered as the center of clock face. Range of positions
of operator lies on an arc from 10 to 1 on the clock.
• The direct rear position i.e. at 12 o clock and Right rear position- 10 o clock
are most commonly used position.

 Isolate the tooth with
cotton wool rolls
Rationale: It is easier to
work in a dry environment
than in wet one.
Cotton wool rolls are
available in all parts of the
world.
23

Clean the tooth surface to be
treated with a wet cotton
wool pellet
Rationale: The wet cotton
wool pellet remove debris
and plaque from the surface,
thus improving visibility of
the extent of the lesion.
24

 Widen the entrance of the lesion
Rationale: The hatches replaces the bur, by rotating the
instruments tip, unsupported enamel will break off,
making an opening large enough for the small excavator
to enter.
25

 Remove caries: Depending
on the size of the cavity, use
either the small / the
medium sized excavator.
26

 Rationale: All soft caries should be removed.
To prevent caries progression and to obtain a good seal
of the coronal part of the restoration.
27

 Clean the occlusal surface: All
pits and fissures should be clear
of plaque and debris as much as
possible.
Rationale: The remaining pits
and fissures will be sealed with
the same material used for
filling the cavity.
28

 Provide pulpal protection if necessary
Rationale: Calcium hydroxide stimulates repair of
dentin and glass ionomers are biocompatible.
29

 Conditioning the prepared cavity –
- Rationale: in order to improve the chemical bonding of glass
ionomer to the tooth structures, the cavity walls must be clean.
- it is done using a chemical solvent- a dentin conditioner or the liquid
supplied with glass ionomer cement.
- Usually a 10% solution of polyacrylic acid.
30

 Mix glass ionomer
according to
manufacturer’s
instructions:
31

 Insert mixed glass
ionomer into the
cavity and overfill
slightly
32

 Press coated gloved
finger on top of the entire
occlusal surface and
apply slight pressure,this
is called press fingure
technique.
Rationale: The finger
pressure should push the
Glass Ionomer into the
deeper parts of the pits
and fissures. 33

 Remove excess material
with the carvers
34

 Cover filling / sealant with petroleum jelly (Vaseline) /
apply varnish.
 Instructs the patient not to eat for at least one hour
 For restoring proximal cavities, a plastic strip and wedges
are used to produce a correct contour to the filling.
35

LIMITATIONS OF ART
 Survival rate - the largest study reported so far is of 3
years duration.
 The techniques acceptance by oral health care personnel
is not yet assured.
 limited to small and medium sized, one surface lesions
36

 The possibility exists for hand fatigue from the use of
hand instruments over long periods.
 Hand mixing might produce a relatively unstandardized
mix of glass ionomers
37

CONCLUSION
 ART is NOT a compromise but a perfect alternative treatment
approach for developing countries and special groups in the
industrialized world.
 There is great potentials for its use among children, fearful adults,
physically and mentally handicapped and the elderly.
 It makes restorative care more accessible for all population groups.
38

 http://www.dhin.nl/literature.htm
 http://www.whocollab.od.mah.se/expl/artintrod.html
 Ho T.F., Smales R.J. and Fang D.T. : A 2 year clinical study of two glass
ionomer cements use in the atraumatic restorative treatment (ART)
technique. Community Dent Oral Epidemiol. 1999 Jun; 27 (3) : 195-
201.
 Frencken Jo E., Pilot T., Songpaisan Y., Phantumvanit P. Atraumatic
restorative treatment (ART) : rationale, technique and development. J
Pub Health Dent 1996 ; 56 : 135-140.
 Anusavice K.J. : Does ART have a place in preservative dentistry?
Comm Dent Oral Epidemiol. 1999 ; 27 : 442-448. 39
References :

9. Atraumatic Restorative Treatment (2).ppt

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