ART

ATRAUMATIC/
ALTERNATIVE
RESTORATIVE TREATMENT

Caries has been defined in many

ways but it can be considered to be
A process that result in gradual
loss of the mineral that make up
the tooth structures
This applies to both enamel and
dentin caries

INTERACTION OF
AETIOLOGICAL FACTORS IN
THE ORAL CAVITY

BACTERIAL PLAQUE
+
REFINED
CARBOHYDRATE

DEMINERALISATION

SALIVA+HYGIENE+
FLOURIDE
+
NATURAL
PROTECTIVE FACTOR

REMINALISATION

INTRODUCTION
PREVENTION AND TREATMENT OF DENTAL
CARIES
BASED ON EXCAVATING AND REMOVING
CARIES USING HAND INSTRUMENT ONLY
OR ROTARY INSTRUMENT (LOW SPEED)
RESTORING TOOTH WITH ADHESIVE
FILLING MATERIAL (GLASS IONOMER)
SIMPLE , INEXPENSIVE, NON-THREATNING,
NOT-PAINFUL

ALTERNATIVE RESTORATIVE
TREATMENT
RESTORATIVE

CARE FOR INFANT, CHILDREN,

ADOLESCENT AND PERSON WITH SPECIAL
HEALTH CARE NEEDS IN CLINICAL
CIRCUMTANCES ARE UNIQUE
WHEN THIS CLINICAL CIRCUMTANCES DO
NOT PERMIT TRADITIONAL CAVITY
PREPARATION AND PLACEMENT OF
TRADITIONAL DENTAL RESTORATION, USE
OF ART MAY BE BENEFICIAL

DEFINITION
DENTAL CARIES TREATMENT PROCEDURE
INVOLVING THE REMOVAL OF SOFT
DEMINERALIZED TOOTH TISSUE USING
HAND INSTRUMENT ONLY, FOLLOWED BY
RESTORATION OF THE TOOTH WITH AN
ADHESIVE MATERIAL, ROUNTINELY GLASS
IONOMER
Yip HK, Smales RJ, Ngo HC, Tay FR 2001

INDICATION AND
CONTRAINDICATION

Small cavity involving

dentine
The cavity is
accessible to hand
instrument

There is of presence of
swelling or fistula
The pulp of the tooth is
exposed
Teeth had been painful
for a long time and
there may be chronic
inflammation of the
pulp
Cavity in accessible to
hand instrument

BIOLOGICAL PRINCIPLES OF
CAVITY PREPARATION
This should be restricted to cavity cleaning
It only involves :
- obtaining access and
- removal of dead, non- remineralizeable
dentine and enamel
Thus the shape of the cavity is determined by
the
anatomy of the carious lesion as is presents at
the time of cavity preparation
Therefore there cannot be some preconceived
mechanical cavity design (Black principles)

ADHESIVE MATERIAL FOR

MINIMAL CAVITY PREPARATION
GLASS IONOMER
A DENTAL GLASS IONOMER IS
SUPPLIED AS : - POWDER AND LIQUID
IN SEPARATE BOTTLES (HAND-MIX
VERSION)
- IN AN ENCAPSULATED FORM
COMPOSITE
COMPOMER

INSTRUMENT AND MATERIAL

MOUTH MIRRORS
EXPLORERS
TWEEZERS
SPOON EXCAVATOR
HATCHETS/HOE
CARVER

GLASS-IONOMER
CEMENT
COTTON
ROOL/PELLETS
SPATULA
PETROLEUM
JELY/VASELINE
WEDGES

CLINICAL CHARATERISTIC

Glass-ionomer bond chemically to enamel

and dentine and provide good cavity seal
Slow release of fluoride after it has set
Pulpal friendly, during setting the material
may cause the pulp to feel tender. After
24 hours, when completely set, adverse
reaction do not occur anymore

TECHNIQUE

THE AREA AROUND THE CARIOUS TOOTH TO BE TREATED IS KEPT

DRY BY PLACING COTTON ROLLS
THEN THE CAVITY ENTRANCE IS WIDENED BY USING HATCHET/ HOE
WITH SPOON EXCAVATOR CARIES IS REMOVED
WHEN ALL CARIES HAS BEEN REMOVED AND THE CAVITY CLEANED
AND DRIED A DENTINE CONDITIONER IS APPLIED ON THE CAVITY
TO IMPROVE THE BONDING MATERIAL TO THE TOOTH
MIXING THE GLASS-IONOMER IN 20 32 SECONDS
THE MIXTURE IS INSERTED WITH FLAT END OF THE CARVER. THE
CAVITY IS OVERFILLED TO INCLUDE REMAINING PIT AN FISSURES
RUB SOME VASELINE ON THE GLOVE INDEX FINGER AND THE
FILLING MATERIAL PRESSED FIRMLY WITH THE FINGER ON THE
TOOTH
REMOVED THE EXCESS MATERIAL USING CARVER
INSTRUCT THE PASIEN NOT TO EAT AT LEAST 1 HOUR

MIXING

Powder and liquid ratio

Place a spoonful of powder on a glass slab/ mixing pad.
Use spatula to divide the powder into two equal portions
then dispense a drop of liquid next to the powder
First spread the liquid with the spatula over a surface
1,5 cm2, start mixing by adding one half of the powder
into the liquid using spatula. Roll the powder into liquid
gently wetting the particle without spreading them
around the slab.
As soon as all powder particle are wetted, the second
portion is folded into the mix. Now mix firmly while
keeping the mass together.
The mixing should be completed within 20 30 second
The final mixture should look smooth like chewing gum

What is the function of surface conditioner ?

A surface conditioner is an organic acid, usually a weak
polyacrylic acid
The removal of outer carious dentine either with hand
instrument or a drill result in the production of a smear
layer
This smear layer prevents adequate bonding of the glassionomer to the tooth tissue and should therefore be
removed
In order to achieve this, a surface conditioner is used
A Chemical solvent is used for conditioning
1. Dentin conditioner : 10% solution of polyacrylic acid
2. Liquid supplied with glassionomer itself

Conditioning is how to clean the prepared cavity

1. Dentine conditioner
- Apply one drop of the conditioner on a pad or the slab
- Dip a cotton pellet in the drop of the conditioner and clean the
entire cavity and adjacent fissures for 10 15
- Wash the cavity and fissures at least twice with cotton pellet
dipped in clean water
2. The glassionomer liquid
- The liquid is too strong and needs to be diluted
- Placing one drop of liquid on a pad or slab
- Moisten a cotton pellet by dipping it in water
- Remove the excess water by touching the pellet against a dry
cotton roll
- Dip the moist pellet in the glassionomer liquid and use it as a
dentine conditioner in the way described above

.............

caries

preparation

Glass-ionomer filling