GOOD MORNING…

Atraumatic Restorative
Treatment

By Dr. Anagha Agrawal

 CONTENTS
 Introduction
 Purpose of doing ART
 Principles
 Indications
 Contra-indications
 Procedure
 Arrange a good working environment
 Hygiene and control of cross infection
 Essential instruments for ART
 Restoring the cavity
 Failed or defective Atraumatic restorations
 Advantages
 Limitations
 Conclusion
 INTRODUCTION

• ART is defined as “a dental caries treatment procedure involving

the removal of soft, demineralized tooth tissue using hand
instrument alone, followed by restoration of the tooth with an
adhesive restorative material, routinely glass ionomer”.

• ART is based on modern knowledge about

Minimal intervention
Minimal invasion
Minimal cavity preparation
 INTRODUCTION

• Pioneered in Tanzania in the mid 1980s as part of the

community based primary oral health program by the
University of Dar-e-Salaam.
• The originator - Dr. Jo Frencken.

• He described it as an answer to a problem of dental care

delivery in rural Africa.
 INTRODUCTION

• WHO presented ART on World Health Day, on 7 April

1994, on occasion that marked the beginning of the year
of oral health, 1994-1995.

• It has been endorsed by the WHO and International

Association for Dental Research as a means of restoring
and preventing caries with the goals of preserving tooth
structure, reducing infection and avoiding discomfort.
 PURPOSE OF INTRODUCTION OF ART

• It enables treatment in the areas with absence of electricity

or
where community cannot afford expensive dental equipment

• For patients with extreme fear/anxiety

• For introducing children to dental care and help to them

overcome fears of traditional dental treatment.

• For treatment of Special groups – physically and mentally

disabled

• Home bound elderly and those living in nursing homes

• In school dental health programmes

 PRINCIPLES OF ART

The two main principles of ART are :

• Removal of caries with the help of hand instruments only

• Restoring the cavity with an adhesive restorative material

 INDICATIONS

• In small cavities

• In those cavities that are accessible to hand instruments

• In public health programs

 CONTRAINDICATIONS
• Presence of swelling or fistula near the carious tooth

• Presence of pulpal exposure

• Painful teeth with chronic inflammation of pulp

• Cavity opening is inaccessible to hand instruments

 PROCEDURE

Essential Instruments for ART-

• Mouth mirror
• Explorer
• Pair of Tweezers
• Spoon excavator - small – 1mm
- medium –1.5mm
- large –2mm
• Dental hatchet
• Applier / carver
• Mixing pad and spatula
 PROCEDURE

Essential Materials for ART-

• Cotton wool rolls and pellets

• Clean water
• Petroleum jelly
• Plastic strips
• Wedges
• Dentine conditioner
• Glass ionomer cement
• Articulation paper
 PROCEDURE

Others-

• Examination gloves
• Mouth mask
• Operating light
• Operating bed / head rest extension
• Stool
• Methylated alcohol
• Pressure cooker
• Instrument forceps
• Soap and towel
• Sharpening stone
 PROCEDURE

1. Arrange a good working environment –

A. Outside the mouth-

- The operator’s work posture and position
The operator sits firmly on stool, with straight back, thighs parallel to
the floor and both feet flat on the floor. The head and the neck should
be still, the line between the eyes horizontal and the head bent
slightly forward to look at the patients mouth. The distance from the
operators eye to the patient’s tooth is usually between 30 and 35 cms.

- Assistance
The assistant works at the left side of the right handed
operator and should sit as close to the patient as possible, facing
the patients mouth.
- Working alone
 PROCEDURE

- Patient’s position
Patient should lie on the back on the flat surface.
- Patient’s head position
The patient can assist the operator by tilting,
turning the head and opening the mouth wide enough to
provide access to the area of operation.
- Operating light
the light source can be sun (natural) or artificial.

B. Inside the mouth

 PROCEDURE

2. Hygiene and control of cross infection

3. Restoring the cavity-

- Caries removal

- Conditioning the prepared cavity

- Mixing

- Restoring the cavity

 FAILED OR DEFECTIVE ATRAUMATIC
RESTORATIONS

A restoration may not be acceptable or unsatisfactory if,

1. Restoration is completely missing

2. Part of the restoration has broken away
3. The restoration has fractured
4. The restoration has worn away
5. Caries has developed in the adjacent fissures or surface
 ADVANTAGES OF ART
• Makes it possible to reach people who otherwise never would
have received any oral care

• The limitation of pain, thereby reduces psychological trauma

to the patient.

• Simplified infection control

• The use of easily available and relatively inexpensive hand

instruments rather than expensive electrically driven dental
equipment
 ADVANTAGES OF ART

• The leaching of fluoride from glass ionomers,

which prevents secondary caries development and
probably remineralizes carious dentin.

• The combination of a preventive and curative

treatment in one procedure.

• Technique is simple enough to train non-dental

personnel or primary healthcare workers.
 LIMITATIONS OF ART

• Long-term survival rates for glass ionomers ART restoration

and sealants are not yet available; the longest study reported
so far is of 3 years duration.
• At the moment its use is limited to small and medium sized,
one surface lesions because of the low wear resistance and
strength of existing glass ionomer materials.
• The technique’s acceptance by oral health care personnel is
not yet assured.
• The possibility exists for hand fatigue from the use of hand
instruments over long periods.
• A misconception by the public that the glass ionomer “white
fillings” are only temporary dressings.
 CONCLUSION
• ART is a combined preventive and curative oral care
procedure, which must be administered along with health
promoting messages about a prudent diet, good oral hygiene,
use of fluoride toothpaste and sealant application.

• ART is not a compromise but a perfect alternative treatment

approach for developing and underdeveloped countries and
special groups in the industrialised world.

• It is a breakthrough towards achieving the goal of “Teeth for

life”.
THANK YOU