ATRAUMATIC

RESTORATIVE TREATMENT
◼ PRESENTED BY : Dr swati Agrawal
 LESSON PLAN

Name Of The Presenter : Dr Swati Agrawal

Subject : Public Health Dentistry
Topic : ART
Date :
Duration :1 Hour
Target Audience : BDS Year
Teaching Learning Method: Lecture
Teaching Learning Media: Audiovisual Aid, Lcd Projector, White Board
CONTENTS:
◼ 1. Introduction
◼ 2.Principles
◼ 3.Indications
◼ 4.Contraindications
◼ 5.Advantages
◼ 6.Procedure
◼ 7.Failed/Defective Restoration
 INTRODUCTION
❑ It is a procedure based on removing carious
tooth tissue using hand instruments alone and
restoring the cavity with an adhesive
restorative material
DEFINITION
◼ Atraumatic restorative treatment is
defined as a minimally invasive care
approach in preventing dental caries and
stopping its further progression (jo e.
franken , 2012)
PRINCIPLES
◼ The two main principles of art are:
1)removing carious tooth tissues using hand
instruments only
2)restoring the cavity with a restorative
material that sticks to the mouth
THE RESONS FOR USING HAND INSTRUMENTS RATHER
THAN ELECTRIC ROTATING HANDPIECES ARE:

◼ 1.The use a biological approach, which requires

minimal cavity preparation that conserves
surrounding tooth tissues and causes less trauma to
the teeth

▪ 3)The low cost of hand instruments compared to

electrically driven dental equipment
◼ 4)The limitation of pain that reduces the need for local
anaesthesia to a minimum and reduces psychological
trauma to patients

◼ 5)Simplified infection control, hand instruments can

easily be cleaned and sterilized after every patient.
NOWDAYS GLASS IONOMER CEMENT IS USED
AS RESTORATIVE MATERIAL IN ART

❖ 1.GIC sticks chemically to enamel and dentine

❖ 2. Flouride is released from the restoration

which will prevent and arrest caries

❖ 3.It does not inflame pulp and gingiva

❖ 4.Good marginal seal

❖ 6.low oral solubility

❖7.minimal cavity
preparation

❖8.good esthetics
 INDICATIONS

Art is carried out

1)only in small cavities (involving dentin)

2)in those cavities that are accessible to hand

instruments.

3)public health programs

 CONTRAINDICATIONS

❑ART SHOULD NOT BE USED WHEN: 1

1)presence of swelling (abscess) or fistula near
the carious tooth

2)pulp of the tooth is exposed

3)teeth have been painful for long time and there

may be chronic inflammation of the pulp
4)there is an obvious carious cavity, but the
opening is inaccessible to hand instruments

5)there are clear signs of cavity, for ex. In

proximal surface, but the cavity can’t be
entered from the proximal or occlusal direction
the OPENING IS INACCESSIBLE TO HAND
INSTRUMENTS
ADVANTAGES:
▪ 1)it requires minimal cavity preparation that
conserves surrounding tooth tissues and
causes less trauma to teeth.

▪ 2)it is painless andneed for local anesthetics

are reduced and so is the
psychological trauma to patients.
◼ 3)simplifies infection control as hand instruments
can easily be cleaned and sterilized.

◼ 4)no electrically driven and expensive dental

equipment needed which enables art to be
practiced in remote areas and in the field.

◼ 5)this technique is simple enough to train non-

dental personal or primary health care workers.
◼ 6)art approach is very cost effective

◼ 7)it is a friendly procedure, there are great

potentials for its use among children, fearful
adults, physically and mentally handicapped
and the elderly.

◼ 8)it makes restorative care more accessible

for all population groups.
PROCEDURE 1.ARRANGE A
GOOD WORKING ENVIRONMENT

A.OUTSIDE THE MOUTH B.INSIDE THE MOUTH

1)the operator’s work posture ▪ success of art is
and position
control of saliva
2)assistance around the tooth
being treatment.
3)working alone cotton wool rolls are
effective at absorbing
4)patient position
saliva and can
5)patient’s head position provide short-term
protection from
moisture/saliva
6)operating light
2.HYGIENE AND CONTROL OF
CROSS INFECTION
◼ 1)place all instrument in water after use.

◼ 2)remove all debris from instruments by scrubbing

with brush in soapy water.
◼ 3)prepare fire using fuel like wood, gas , charcoal,
solar energy.
◼ 4)put clean instruments in pressure cooker and
add clean water to depth of 2-3cm from bottom.
◼ 5)Place cooker on stove and boil for 15
minutes. Ensure that steam continues to be
released. Add water and repeat the cycle.

◼ 6)Remove the pressure cooker from stove

after 15 min. And leave it to cool.

◼ 7)take instruments out of it with forceps and

dry them with clean towel and store in
3.RESTORING THE CAVITY
✓ 1)keep the tooth dry.

✓ 2)remove plaque from the tooth surface

✓ 3)removal of caries
CONDITIONING THE PREPARED
CAVITY
❑ To improve bonding of GIC to tooth structure,
cavity walls must be clean by using a chemical
solvent. There are 2 possibilities:

1)a dentine conditioner or tooth cleaner,

especially developed for this purpose

2)liquid supplied with GIC itself.

The dentine conditioner is usually a 10%
MIXING OF GIC
➢ 1)place a spoonful of powder on glass slab or
mixing pad.

➢ 2)divide 2 equal portions of powder by

spatula.
➢ 3)dispense 2 drops of liquid.

➢ 4)spread liquid with spatula over surface of

about 1.5-2cm.
➢ 5)roll powder into liquid using spatula.

➢ 6)as soon as all powder particles are wetted,

2nd portion is folded into the mix.now mix
firmly while keeping mass together
mixing should be
completed within 20-30sec . final mixture
should look smooth like chewing gum.
RESTORING THE CAVITY
o 1)cavity is conditioned , washed and dried,
GIC can be mixed.

o 2)mixture is inserted into cavity in small

amounts .

o 3)press restorative material firmly into cavity

and fissure. This is called ‘the press-finger
technique’.
o 4)excess GIC will displaced by press finger
technique. Carefully remove any excess material
with a medium or large excavator.

o 5)leave restoration till it get harder and keep tooth

moisture free.

o 6)place a piece of articulation paper on restored

tooth. Check high points and do correction. Ask
patient not to eat for one hour.
FAILED OR DEFECTIVE
RESTORATIONS
✓ 1)restoration is completely missing.
✓ 2)part of restoration has broken away .

✓ 3)restoration has fractured .

✓ 4)restoration has worn away.

✓ 5)caries has developed in the adjacent fissures

or surface.
REFERENCES

1)Soben Peter
2)www.google.com
3)www.wikipedia.org
THANK YOU