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Atraumatic Restorative Treatment ART

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Atraumatic Restorative Treatment ART

  1. 1. A.R.T Fourth year
  2. 2. OUTLINE • Definition • Concepts of ART • Indications • Instruments & Materials used • Technique • Advantage • Disadvantage • Causes of failure and treatments
  3. 3. • A new method for treating dental caries that involves neither water nor electricity was presented. The procedure called as ATRAUMATIC RESTORATIVE TREATMENT. It Consists of manual excavators until maximum amount of decayed tissue is removed with hand instruments. A highly density glass ionomer cement (GIC) seals the cavity and a follow up is performed every year. In this procedure oral health care workers need only a few instruments that can be carried easily with them
  4. 4. • ART was developed following the mentioned principles and it is on line with the philosophy of MID. • What started as an alternative resource for out- reach situations, it became one of the most flexible methods for caries removal and restoration of the cavity in many private dental offices worldwide.
  5. 5. Traditional concepts of cavity design ‘The application of a mechanical design on a biological process' 1 2 3 1 2 3 4
  6. 6. Traditional concepts of cavity design Mechanical retention – Flat floors – Vertical walls – Triangular retention niches – Undercut areas 1 2 3 1 2 3 4
  7. 7. Biological principals of cavity preparation 1 2
  8. 8. ART vs. Conventional
  9. 9. Biological Prep Don’t remove hard (often discolored) dentin 1 2 3 4 5
  10. 10. ART INDICATIONS: • Great technique for root caries • Good alternative in out reach situations • Excellent for fearful children • Good alternative in medically compromised patients • Good alternative in mentally compromised patients
  11. 11. Advantages It is popular among millions of peoples because: • it is non threatening • non painful • low cost • it is also simple to practice • the instruments can be carried out in a bag • it is more effectively reached to the community. • and can prevent extraction in most cases. • Biological approach with minimal cavity preparation. • Gain all the advantage of the GIC as a restorative material. • ART was pioneered in the mid 1980s in the Tanzania and the careful application of ART decreases 85% of chances of caries for 3 years
  12. 12. INSTRUMENTS & MATERIAL USED • The success of any treatment depends on the operator knowing the function of the various instruments and using them correctly. • (1)Mouth mirror:-to reflect light onto the field of operation, to view the cavity indirectly and to retract the cheek or tongue. • (2)Explorer:-to identify where soft caries dentin is present. Do not poke the point into very small caries lesion. This may destroy the tooth surface and the caries arrestment process. Also do not probe into deep cavities where you might damage or exposure the pulp. • (3)Pair of tweezers:-to carry cotton wool rolls, wedges.
  13. 13. • (4)Small and medium sized spoon excavators:-this instrument is used to remove soft carious dentine. small excavator have a diameter of 1 mm. this instrument is for use in small cavities and for cleaning the enamel/dentin junction. the diameter of this medium spoon is 1.5 mm. it is used for removing soft caries from large cavities rounded surface is used to push the material into small cavities. (5) Dental hatchets:-this instruments is used for widening the entrance to the cavity, for slicing away the unsupported and carious enamel left.
  14. 14. (6)Applier and carver:- this double ended instrument has two functions. blunt end is used for inserting GIC into the cavity and sharp end is used to remove the excess material and shape the restoration. (7)Mixing pad and Spatula:-the mixing pad that is supplied with the cement and the spatula may be metal or plastic. (8)Light source that is powered by a rechargeable battery source is used.
  15. 15. The essential materials • (1)Gloves:-for hygiene purpose. • (2)Cotton wool rolls:-to absorb the saliva. • (3)Pellets:-for cleaning the cavity. • (4)Petroleum jelly:-prevents GIC sticking to the gloves and for final insulation. • (5)Wedges:-these are used to hold the plastic strips close to the shape of proximal surface of a tooth so that restorative material is forced between the tooth and gums. • (6)Plastic strips:-used for contouring the proximal surface in multiple surface restorations. • (7)GIC material
  16. 16. • Known attributes of Glass Ionomer materials – Adhesive properties – Degree of wear resistance – Biocompatibility – Fluoride release – Remineralization capabilities • Unknown effect on salivary mutans strep levels
  17. 17. Fuji IX Hand Mix Package
  18. 18. WHAT TO DO BEFORE APPLYING ART? • Before you actually start the atraumatic restorative treatment of a carious lesion in a tooth you should know how to • (1)Arrange a good working environment. • (2)Select and use the correct instruments. • (3)Control cross infections. • (4)Use the GIC material.
  19. 19. Arrangements of good working environment • The correct positioning of both the operator and patient is essential to achieve good quality care. At the same time both patient and operator should be comfortable. • The distance from the operators eye to patients mouth is usually between 30-35 cm. the operator should be positioned behind the head of the patient the exact position will depend on the area of the patient mouth to be treated. The most common position are 12 and 10 o’ clock.
  20. 20. • A dry operating area, A very important aspect for the success of ART is control of saliva around the tooth being treated. Cotton wool rolls are quite effective at absorbing saliva and can provide short term protection from moisture /saliva. • HYGENE AND CONTROL OF CROSS INFECTIONS Always wear gloves. Cleaning and sterilization is necessary to prevent infection. Cleaning of the surface can be done by cotton and methyl spirit. In the clinic the instruments can be sterilized by autoclave or a pressure cooker. All these preventive measures prevent the spread of HIV and HBV.
  21. 21. The procedure for caries removal for one surface cavities step by step • (1)Place cotton wool rolls alongside the tooth to be treated. • (2)Remove plaque from tooth surface with wet cotton wool pellets. • (3)Dry the tooth surface with dry cotton wool pellets • (4)If necessary make the entrance of the cavity wider with enamel hatchet. • (5)Remove the carious dentin with excavators . • (6)Remove unsupported thin enamel with the hatchet. Make sure the enamel does not contain any carious lesion. • (7)Clean the cavity with wet and then dry cotton wool pellets.
  22. 22. • Remove the caries near the pulp carefully, and provide pulp protection if necessary. • (9)Clean the cavity again with wet cotton wool pellets. (8)insert the mixed GIC into the cavity and overfill slightly. Press petroleum jelly with coated gloves fingers from the top of the occlusal plane surface and apply slight pressure. This is called Press finger technique. • (10)ask the patient to bite to check the bite relations. • (11)Remove the excess material with carver. • (12)Recheck the bite and adjust the height of the restoration until comfortable. • (13)Cover the filling or sealants with petroleum jelly once again or apply varnish. • (14)Instruct the patient to not eat at least for one hour.
  23. 23. • In order to enhance the adhesiveness between the tooth and GIC, cavity walls must be clean. Other chemicals for this purpose are dentin conditioners 10% solutions of poly acrylic acid apply one drop to the cavity wall for 10-15 seconds • Note:-In case of multiple surface restoration plastic strips and wedges were used.
  24. 24. Failed or defective restoration:- • A restoration may not be acceptable or unsatisfactory anymore for several reasons. It is completely missing, a large part of it has broken, fractured restoration, the restoration has worn away or caries has developed at the restoration margin or elsewhere on the tooth surface
  25. 25. Restoration is completely missing due to : • Restoration is completely missing Contamination with saliva or blood during the restorative procedure . Mix of material was too wet or too dry. Not all the soft caries had been removed. Thin undermined enamel had been left behind and this later broke off.
  26. 26. 2. Part of the restoration has broken • it is probable that the restoration was too high or air bubbles were trapped in the material during the placement of the restoration. whatever the reason clean the tooth surface and/or remaining restorative material with an explorer or small excavator and wet cotton wool pellets first, before conditioning the entire surface and material, fill the gap with a new mixture of GIC and ensure that the restoration is not too high
  27. 27. 3. The restoration has fractured • This most commonly happens in a multiple surface restoration which was too high. the way to repair it depends on the location of the fracture line and the mobility of the fractured part. If the fractured part is loose and can be removed, repair the gap as describe as above. however if the fractured part can not be removed repair through ART is not possible and traditional treatment using a drill is needed.
  28. 28. 4. The restoration has worn away • Possible reasons, the patient eats very hard food frequently, the patients clenches his/her teeth frequently or the mixture had been too wet or too dry. The restoration should be rebuilt, ensure that all the surface of the tooth and the remaining restoration are clean and free from soft tissues.
  29. 29. • Apply dentin conditioner over the glass ionomer and the cavity walls . Place a new layer of GIC on top of the old one, finish the restoration as described earlier.
  30. 30. 5. Caries has developed • May be in the adjacent fissure or pit. Remove all the soft decay . Clean and restore the new cavity adjacent to the restoration according to the standard procedure.
  31. 31. Performance of ART Restorations • ART needs to be considered as a caries treatment modality that benefits people • ART should be taken seriously by the dental profession and dental schools • Organized educational courses need to be taken prior to applying the approach in the field and clinic
  32. 32. References • Art and Science • Frenken J,Holmgren C The Atraumatic Restorative Treatment approach. In tissue preservation in caries treatment. Quintessence Publications,2001 chapter 7. • Gustavo F,Gaston P Diverse fields for ART
  33. 33. Any questions?