INTRODUCTION

PRINCIPLES

INDICATIONS

CONTRA INDICATIONS

ADVANTAGES

PROCEDURE

FAILED/DEFECTIVE RESTORATION

CONCLUSION

Atraumatic Restorative Treatment is a procedure based on removing carious tooth tissues using hand instruments alone and restoring the cavity with an adhesive restorative material.

The Atraumatic Restorative treatment (ART) is based on :Modern knowledgeMinimal interventionMinimal invasionMinimal cavity preparation

To achieve the goal TEETH FOR LIFE

Pioneers of ART JOE FRANKEN and CHRISTOPHER HOLMGREN

Removing carious tooth tissues using hand instruments only

2. Restoring the cavity with a restorative material that sticks to the tooth

Reasons for using Hand Instruments rather than electric rotating hand pieces:

Biological approach

Low cost

Psychological trauma

Simplified infection control

Reasons for using Glass Ionomer

Chemical bonding

Fluoride release

Aesthetic

4. Pulpal Irritation

ART is carried out

Only in small cavities

Accessible cavities

Public health programs

One surface cavitiesPit and Fissures on the occlusal surfacePit on lingual surfaces of upper molarsBuccal groove of molars

Cervical third of buccal surfaceProximal surfaces of the anterior teeth

Multi-surface cavities :Occlusal and proximal surfaces of premolar and molarsOcclusal and lingual surfaces of molarProximal and buccal surfaces of anterior

ART should not be used when there is :

Swelling / Abscess / Fistula near the carious tooth

Pulp exposed

Chronic Inflammation

Inaccessible

Proximal caries

Biological approach

Remineralization

Painless

No psychological trauma

No electrically driven instruments

Simple technique and Easy Repair

Cost effective

Class I cavities of comparable size, ART restorations with high strength GIC reach the same survival rates as Amalgam.

Restorative care accessible to all population care

It is a wonderful way of introducing a nervous patient to dental care thereby laying the foundation for a lifetime of good oral health care.

Average life of restoration 2years

May not be accepted by all Oral Health Workers

Hand fatigue

ARRANGE A GOOD WORKING ENVIRONMENT

OUTSIDE THE MOUTH

The operators work posture and position

Assistance

Working alone

Patient position

Patients head position

Operating Light

B. INSIDE THE MOUTH

VOROSCOPE

Patient Head Position

2. HYGIENE AND CONTROL OF CROSS INFECTION

Universal infection control procedures followed:

Place all the instrument in water immediately

Remove all debris from the instruments by scrubbing with brush in a soapy water. If an autoclave is not available; Prepare fire using the fuel availablePut the clean instrument in a pressure cooker for sterilization.

3. RESTORING THE CAVITY

IsolationCaries removal

Widen the entrance of the cavity use enamel hatchet Remove carious dentine with spoon excavators Overhanginng enamel must be removed Well supported dental hatchet Excavation is easy when tooth is dry Care is to be taken when caries is removed at :The enamel dentin junction the floors in the deep cavitiesMulti-surfaced caries - Mylar strip correction of tooth contourPlacing of a wedge

Isolation in upper and lower archCotton rollsCotton pellets

Circular scoopingmovements of theexcavatorFracturing offunsupported enamelwith a hatchetCaries Restoration for single surface

Conditioning the prepared cavity :

Dentin Conditioner 10% solution of polyacrylic acid

The liquid supplied with the GIC itself

Mixing

Application of dentin conditioner

Precautions for Glass ionomer Cement :

Restoring the Cavity: The restorative processof a one-surface cavityin various stagesa. The cavity andadjacent pits andfissures are overfilled

b. Press the restorativematerial with glovedfinger. Excess materialis visible

c. Removal of excessmaterial by the carverblade of theapplier/carverPress-finger technique

Caries Restoration for Multi surfaceUsing the spoonexcavator to removecarious dentine in amultiple-surface cavityThe position of thedental hatchet forsmoothing the proximaloutline

Plastic strip and wedge inpositionRestorative material pushedinto place under unsupportedenamelSlightly overfilled sealedrestorationFor Posterior teeth

Finished sealed restoration

Positioning of the stripbetween the teethInsertion of a wedgeThe strip is pulled around the tooth while the mixture is settingA straight instrument is pressed against the strip to shape the restorationFor Anterior Teeth

A restoration may not be acceptable or unsatisfactory if :

Restoration is completely missing Some reasons for the failure could be:Contamination with saliva or blood during procedureMix too wet or dry ( Ideal Chewing Gum )Not all soft caries removedUndermined enamel is left behind

2. Part of restoration has broken away :

It is probable that The restoration was too high Air bubbles trapped in the restoration during placement

3. The Restoration has fractured :

This most commonly happens when the restoration is too high 4. The Restoration has worn away:

Possible reasons: the patient eats very hard food frequently the paitent clenches his/her teeth frequently improper mix

5. Caries has developed in the adjacent fissures or surface :

LIST OF ESSENTIAL INSTRUMENTS AND MATERIALSInstruments Mouth mirrorExplorerPair of tweezersDental hatchetSpoon excavator, smallSpoon excavator, mediumSpoon excavator, largeApplier/carverGlass slab or paper mixing padSpatulaMaterialsCotton wool rollCotton wool pelletClean waterGlass-ionomer restorative materialliquid, powder and measuring spoonDentine conditionerPetroleum jellyWedgePlastic stripArticulation paperOtherExamination glovesMouth maskOperating lightOperation bed / headrest extensionStoolMethylated alcoholPressure cookerInstrument forcepsSoap and towelSheet of textileSharpening stone and oil

ART is a breakthrough that has broken many barriers and allowed delivery of restorative treatments possible despite unavailability of electricity or communities that cannot afford dental treatment.

ART is a combined preventive and curative oral care procedure which must be administered along with health promoting messages about : Prudent life Good oral hygiene Use of fluoride tooth paste Sealant application.