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Simplified and modified atraumatic restorative treatment

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Simplified and modified atraumatic restorative treatment

  1. 1. Simplified and Modified Atraumatic Restorative Treatment (SMART) Prepared by :Gholami hamed
  2. 2. Introduction: • SMART: a Simplified and Modified Atraumatic Restorative Treatment is a method to remove caries and minimal cavity preparation using only hand instruments and fill it with glass ionomer cement, can be applied to restorative treatment of primary teeth. • the method is showed to obtain sufficient effect comparable to composite resin fillings and amalgam fillings , without inducing fear of children.
  3. 3. • SMART. is a slow and gentle technique that is well tolerated by the most fearful of patients. It is more comfortable than standard techniques. No injections or powered drills are needed. Young children do very well with it
  4. 4. Applications: • Good alternative in field conditions • Excellent for fearful children • Good alternative in medically compromised patients • Good alternative in mentally compromised childs
  5. 5. Principles of SMART A. removing carious tooth tissues using hand instruments only B.restoring the cavity with a restorative material that sticks to the tooth.
  6. 6. cavities suitable for SMART: 1.involving dentin 2. accessible to hand instruments 3.one surface more than multiple surface cavities
  7. 7. contraindications: a.pulp disease at sequellae chronic or irriversible pulpitis pulpul exposure abscess or fistula b.inaccessible to hand instruments
  8. 8. instruments: Mouth mirror Explorer Pair of tweezers Dental hatchet Spoon excavator, small Spoon excavator, medium Spoon excavator, large Applier/carver Glass slab or paper mixing pad Spatula
  9. 9. Materials: Cotton wool roll Cotton wool pellet Clean water Glass-ionomer restorative material liquid, powder and measuring spoon Dentine conditioner Petroleum jelly Wedge Plastic strip Articulation paper
  10. 10. Outhers: Examination gloves Mouth mask Operating light Operation bed / headrest extension Stool Methylated alcohol Pressure cooker Instrument forceps Soap and towel Sheet of textile Sharpening stone and oil
  11. 11. basic techniques: a.good working invirinment b.patient positioning c.operator positioning d.correct instruments e.infection control f.GIC material
  12. 12. Why glass ionomer? bonds to enamel and dentin fluoride release Ease to use
  13. 13. instruments: A small enamel hatchet used to open access to underlying softened dentine
  14. 14. Two spoon-shaped excavators, one small with a spoon approximately 1 mm across, another slightly larger are used to excavate soft dentine
  15. 15. A small flat plastic instrument is used for applying the GIC and for shaping the restoration.
  16. 16. An Enamel Access Cutter (EAC) can be used to access the cavity when the enamel hatchet is too large
  17. 17. The instruments are laid out in the sequence that they are going to be used
  18. 18. operative procedures: • PREPARING THE CAVITY a. Place a cotton roll and dry the working tooth. b .Use the dental hatchet to gain access and excavators to remove soft caries and unsupported enamel. It is very important that: 1. All soft caries is removed at enamel-dentinejunction. 2. To avoid exposure of pulp in deep cavities, leave asmall portion of affected dentine near pulp region
  19. 19. The smallest excavator is used to remove soft dentine from the enamel dentine junction by making circular scooping movements under the enamel
  20. 20. Where more access is required, some of the enamel can be gently fractured off with the blade of the hatchet along the line of the enamel prisms
  21. 21. • CLEANING THE PREPARED CAVITY The purpose of cleaning the cavity walls is to improve chemical bonding of GIC to toothstructure. Cavity could be cleaned by: 1. Dentine conditioner (10% Polyacrylic acid) 2. The liquid supplied by GIC itself. With dentine conditioner clean the cavity walls for10-15 seconds and dry with cotton wool pellets. Repeat the procedure if contaminated by blood or saliva
  22. 22. The GIC is inserted into the cavity in small increments using the rounded end of the applier/carver instrument.
  23. 23. Slightly overfill the cavity and then place additional GIC in any pits and fissures adjoining the cavity
  24. 24. • RESTORING THE CAVITY After cavity is washed and dried, start mixing GIC powder and liquid. Insert in small amounts using applier/carver to avoid air bubbles and build the restoration slightly high on occlusal surface. Insert material into corners and unsupported enamel first. With petroleum jelly on the gloved index fingerpress the soft material into the cavity, this iscalled “the press-finger technique”. Do not disturb the restoration during hardening phase.
  25. 25. The tip of the index finger is then placed onto the central part of the restorations to enable the GIC to be pressed firmly into the cavity, pit and fissures
  26. 26. After 1-2 minutes check the occlusion. If the restoration too high, remove the stained portion of restoration with a carver blade.
  27. 27. The finished restoration is then covered with petroleum jelly or varnish and the patient advised not to eat for at least one hour
  28. 28. A completed restoration sealant
  29. 29. Glass-Ionomer Used as a Sealant It is not always easy to see early dental caries. Its progression can be rapid, particularly in young people who have already untreated cavities and/or restorations. If nothing is done, early dental caries can develop to a cavity in less than 1 year.
  30. 30. Sealing pits and fissures with glass-ionomer can control dental caries and prevent it from occurring. The presence and viability of microorganisms under pit and fissure sealants has bee investigated. It has been shown that when the sealant remain intact, the number of viable microorganisms left beneath the sealant decreases with time.
  31. 31. The destructive activity of the remaining bacteria is reduced, leaving the bacteria incapable of causing tooth destruction. This is logical since remaining bacteria are now cut off from their source of nutrients. There is convincing evidence that pit and fissure sealants are capable of arresting the carious process.
  32. 32. Even when glass-ionomer sealants have been partly or completely lost, there is usually a benefit to the patient because the fluoride released from the material will have made the enamel harder.
  33. 33. Indications: As glass-ionomer sticks chemically to enamel, it is useful as a sealant. It also releases fluoride into the enamel and this may stop development of caries. Experience has shown that sealants of glass- ionomer remain in the deeper pit and fissures that are most at risk for decay. In contrast, sealants may be lost rather quickly in shallow pits and fissures
  34. 34. Procedures: notice: Place the sealant only in the pit and fissures. Take care not to cover the cusps of the tooth
  35. 35. 1. Isolate the tooth with cotton wool rolls. Keep the treatment area dry. 2. Clean the surface from debris with a cotton wool pellet dipped in water. 3. Gently remove debris from deepest parts of pit and fissures with an explorer 4. Apply dentine conditioner or diluted glass-ionomer liquid into the pits and fissures for 10-15 seconds
  36. 36. 5. Immediately wash the pits and fissures, using wet cotton wool pellets to clean off the conditioner. Wash 2-3 times. 6. Dry the pits and fissures with cotton wool pellets. 7. Mix the glass-ionomer and apply it in all pits and fissures with the blunt blade of the applier/carver. Overfill slightly.
  37. 37. 8. Rub some petroleum jelly on the gloved index finger. 9. Put the index finger on the mixture, press and remove finger sideways after a few seconds. 10. Remove visible excess of mixture with a large excavator
  38. 38. 11. Wait 1-2 minutes till the material feels hard, while keeping the tooth dry. 12. Check the bite using the articulation paper and adjust the amount of sealant with the carver if needed. 13. Apply a new layer of petroleum jelly. 14. Remove cotton wool rolls. 15. Ask the patient not to eat for at least one hour