ATRAUMATIC RESTORATIVE TREATMENT
(ART)
CONTENTS
-
1) History of ART
2) What is ART
3) Principles of ART
4) Indications
5) Contraindications
6) Advantages
7) Disadvantages
8) Instruments used
9) Glass ionomer cement
10) Steps of ART
11) Reasons for ART failure
12) Sterilization protocols
13) References
HISTORY OF ART
-First evaluated in Tanzania in the mid 1980s.
-ART was later introduced in South Africa by its Dutch inventor, Prof. Jo Frencken
in 1996, and still widely unknown amongst the general public who dreads dental
visits.
-This procedure has been specially developed for people in less industrialized
countries.
Also, for special groups like institutionalized adults, physically and mentally
handicapped people, refugees, people in deprived communities etc who cannot
seek restorative care.
-ART has been promoted by the WHO as a means of delivering care in
underdeveloped countries that do not have electricity or access to
sophisticated dental equipment.
-In 2001 the American Academy of Pediatric Dentistry (AAPD) adopted a
policy on ART, referring to it as “alternative restorative treatment.” The
AAPD policy acknowledged that “not all dental disease can be treated by
‘traditional’ restorative techniques” and recognized ART as “a useful and
beneficial technique in the treatment and management of dental caries
where traditional cavity preparation and placement of traditional dental
restorations are not possible.”
-In 2008 the AAPD further refined their policy and included the
technique in a broader discussion of “Interim Therapeutic Restorations”
(ITR)
WHAT IS ART ?
-Atraumatic restorative treatment (ART) is a
minimally invasive treatment technique used
for restoring teeth by means of hand
instrumentation for decay removal and
fluoride-releasing adhesive materials (glass
ionomer) for filling.
-Instruments used for removal of carious
lesions include spoon excavators, along with
caries softening gel; which when removed is
restored with high viscosity GIC.
PRINCIPLES OF ART
There are 2 principles of ART treatment:
1) It is based on modern knowledge about minimal intervention, minimal invasion
and minimal cavity preparation for carious lesions.
2) It is a procedure based on removing carious tooth tissues using hand
instruments alone and restoring the cavity with adhesive restorative material.
INDICATIONS
-Areas without electricity and sophisticated dental aids
-Children from poor families
-In homes for mentally and physically disabled, and the elderly patients
-Small to pit and fissure caries
CONTRAINDICATIONS
-Presence of abscess, sinus or fistula near the carious tooth
-Pulp exposure
-Teeth having pain for a long time-chronic pulpitis
-Obvious caries inaccessible to hand instrument
ADVANTAGES
-Does not require complicated mechanical instrumentation
-Employs use of already present hand instruments
-Minimal discomfort to patient
-Cause less pain
-No need for injecting local anaesthesia
-Low cost of treatment
-Safe and minimum intervention procedure
-Advantages of GIC in form of adhesion, biocompatibility and anticariogenicity
-Does not require any suction or water
-There’s no noise
-Can be used for uncorporative patients
-There’s conservation of tooth strucuture
DISADVANTAGES
-Poor access and visibility in posterior region might interfere with proper
removal of carious lesion
-Hand fatigue during instrumentation
-Can’t be used in cases where mouth opening is restricted
-If proper sterilization protocols not followed, might lead to cross
contamination
INSTRUMENTS REQUIRED
- MOUTH MIRROR
>Reflects light
>Indirect vision
>Retraction of cheek & tongue
-EXPLORER
>To identify soft carious dentin
-TWEEZERS
>For carrying cotton rolls, cotton pellets,
wedges and articulation paper
-SPOON EXCAVATOR
>For removing soft carious dentin
>For removal of excess of GIC
-HATCHETS
>For widening the entrance to the cavity
>Slicing away thin unsupported and
carious enamel
-CARVER
>For inserting mixed GIC into cleaned
cavity
>To remove excess restorative material
>To shape GIC
-MIXING PAD AND AGATES SPATULA
>For mixing GIC Mixing
-COTTON ROLLS AND PELLETS
>To absorb saliva
>For cleaning cavities
-PETROLEUM JELLY
>To keep moisture away from GIC
>To prevent gloves from sticking to GIC
-WEDGES
>To hold plastic strip close to the shape of the
proximal surface of the tooth
-GLASS IONOMER CEMENT
>POWDER : Si oxide, Al oxide, Ca flouride
>LIQUID : Polyacrylic acid or Demineralized
water
>Type: GIC is used for restoring the cavities.(type
VII)
>P/L ratio -3:1
GLASS IONOMER CEMENT
-ADVANTAGES OF USING GIC:
>International research shows that ART restorations are as durable and
successful as conventional restorations and are considered as permanent
fillings.
>This procedure helps to reduce bacteria causing caries, as GIC chemically
bonds the filling material to cavity walls, thus preventing any further nutrient
supply to remaining bacteria.
>As result bacteria ‘starve’ and become inactive.
>Also continued fluoride release by GIC also acts toxic against bacteria and
assist in the remineralisation and rebuild of weakened tooth tissues.
-PRECAUTIONS FOR GIC
MATERIAL
>Dispense P/L only when cavity is
properly dried. Recap the bottles
immediately after use. This prevents
uptake of moisture from the air or
evaporation of water component
from the liquid.
>If more than 30 seconds are used
for mixing and the mixture looks dry ,
discard it because there will be poor
adhesion to the tooth structure.
>It is a sensitive technique
-CLASSIFICATION OF GIC BASED ON INTENDED USE:
>Type I= Luting
>Type II= Restorative
>Type III= Liner/ base
>Type IV= Pit and fissure sealant
>Type V= Luting for orthodontic purpose
>Type VI= Core build up material
>Type VII= Fluoride releasing
>Type VIII= Atraumatic restorative treatment
>Type IX= Deciduous teeth
STEPS OF ART
Tooth is isolated with cotton rolls(fig 1)
Tooth surface to be treated is cleaned with
wet cotton pellet
Entrance of lesion is slightly widened using
hand instrumentation to remove overhanging
unsupported enamel rods (fig 2)
Fig 3
Fig 1
Dentinal caries is removed using small/
medium sized spoon excavator (fig 2-3)
Fig 2
If necessary protective base (calcium hydroxide) is applied
(fig 4)
Cavity surface and occlusal margins are smoothened and
cleaned
Cavity is acid etched and GIC is mixed as per instructions
within 35 secs
Fig 4
Mixed GIC is placed in the cavity and slightly overfilled
Using a gloved finger smeared with petroleum jelly, slight
pressure is applied onto the cavity surface and it is gently
pressed into cavity occlusally (fig 5)
Fig 5
Bite is checked and excess/ high points in the cavity are
removed using a carver, and occlusal surface is gently
prepared (fig 6)
Bite is rechecked
Petroleum jelly is again smeared over the GIC surface
Patient is asked not to bite with the given tooth side for
atleast ½ hr to 1 hr and all other relevant instruction are
given to patient
Fig 6
REASONS FOR ART FAILURE AND MANAGEMENT
STERILIZATION PROTOCOL
REFERENCES
-
Grossman’s endodontic practice
Soben Peter - Public health dentistry
Shobha Tandon – Textbook of Pedodontics
Mahuli, amit. (2015). Atraumatic restorative treatment for the
management of dental caries: A systematic review.
International journal of oral health and medical research. Julyaugust 2015 | vol 2 |. page 80-84.
THANK YOU
PRESENTED BY
PRIYA PURI
FINAL YEAR, BDS