Atraumatic restorative treatment

By – Rahul kolte
Final yr
 Contents
 Definition
 Principles
 Indications
 Contraindications
 Instruments
 Procedure
 Advantages
 Disadvantages
 Definition
 The Atraumatic Restorative Treatment (ART) is a
procedure based on removing carious tooth tissues using
hand instruments alone and restoring the cavity with an
adhesive restorative material.

 A.k.a Alternative Restorative Treatment (ART)

 It was first evaluated in Tanzania in the mid 1980s

 Principles of ART
 The two main principles of ART are:

 removing carious tooth tissues using hand

instruments only, and

 restoring the cavity with a restorative material

that sticks to the tooth.
 Indications

 Cavity involving the dentine

 Cavity is accessible to hand instruments.
 Pediatric & Geriatric care.
 High caries risk management.
 Extreme dental fear/anxiety management.
 Contraindications

 Swelling or fistula near the carious tooth.

 Pulp of the tooth is exposed.
 Teeth - Painful for a long time.
 Opening is inaccessible to hand
instruments.
Essential instrument requirements for
ART
 Mouth mirror
 Explorer

 Tweezers

 Spoon shape excavators (small, medium,

large)
 Dental hatchet

 Applier / Carver

 Mixing spatula and pad

Spoon shape excavators

 small excavator
 medium size
 large size
Dental hatchet/ Enamel Access Cutter

 Applier / Carver
 Mixing spatula and pad

 Matrix band
Essential Materials required for
ART
 Cotton wool rolls
 Cotton wool pellets
 Petroleum jelly
 Plastic strip
 Wooden wedges
 Procedure
Arrange a good working environment

Outside the mouth

the distance from the operator’s eye to the
patient’s tooth is usually between 30-35cm

the assistant’s head should be 10-15cm

higher than the operator.
 Inside the mouth
 Why Isolation for saliva control is needed?
it can be done with :
 Cotton wool rolls
Hygiene and control of the cross
infection
 Wash the instruments with brush in soapy
water
 Put the clean instruments in an autoclave
 Alternatively we can use a pressure cooker
 Take instruments out with forceps and dry
them with a clean towel
 Store in a covered metal box
 Examining the cavitated tooth
Extent of caries
- Removal debris & plaque

Clean with cotton wool

pellet
Gaining access to the carious lesion

Hatchet placement & rotation

Make an entrance enough for
excavator to penetrate
Caries removal
Removal of soft, completely demineralized dentine use a
spoon excavator
 Scooping movements
 Removal of thin, overhanging
enamel
 Hatchet is used
 Blade
 Place at the edge

Improves access and visibility

Conditioning the cavity

 Improves the chemical bonding

 10% solution of polyacrylic acid

 Mixing the glass-ionomer
 Spatulate powder and liquid
 Mixing time advised by manufacturer
 Faster setting in high temperature
 Restoring the cavity and filling the
pits and fissures
Use applier/carver
 “The press-finger technique“
 Use the gloved index finger (with small
amount of petroleum jelly)
 press firmly

 Move index finger sideways

 “The press-finger technique“ results in

displacing the excess glass-ionomer
 Remove excess quickly (use carver or
excavator)
 Don’t dislodge ART restoration
 Adjusting the bite
 Check the bite
 Use articulating paper

 the patient is advised not to eat

for at least an hour.
 Advantages
 Use of easily available and relatively inexpensive hand instruments.

 Biologically friendly approach

 Limitation of pain, thereby minimizing the need for local anesthesia.

 Simple infection control practice.

 Chemical adhesion of glass ionomers.

 Leaching of fluoride from glass ionomers.

 Preventive and curative treatment.

 Ease of repairing defects.

 Low cost.
 Limitations

 Long-term survival rates for glass-ionomer ART

restorations and sealants are not available

 Hand fatigue from the use of hand instruments over long

periods.
 Conclusion

 ART procedure has been focused to develop

on such group of people who are unable to
obtain restorative dental care
 It is combined preventive & curative oral care
procedure
 It is not compromised but a perfect alternative
method for developing countries & special
groups in industrialized area
Thank you