GOOD EVENING…

Atraumatic Restorative
Treatment
By Dr. Anagha Agrawal
 CONTENTS
 Introduction
 Principles
 Indications
 Contra-indications
 Advantages
 Procedure
 Arrange a good working environment
 Hygiene and control of cross infection
 Essential instruments for ART
 Restoring the cavity
 Failed or defective restorations
 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”.
- A textbook of PHD (CM Marya)

• ART is based on modern knowledge about minimal

intervention, minimal invasion and minimal cavity preparation
for carious lesions.
 INTRODUCTION
 The ART approach was pioneered in Tanzania in the mid 1980s as part of
the community based primary oral health program by the University Dar-
e-Salaam.

 The originator of the ART approach is Dr. Jo Frencken.

 He described it as an answer to a problem of dental care delivery in rural

Africa.

 It was then followed by several community field trials conducted in

Thailand and Zimbabwe in 1991 and 1993 respectively and the results
showed 71% and 85% of the ART restorations remained in the teeth after 3
years.
 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 -

• Enable treatment in the areas with absence of electricity or

where community cannot afford expensive dental
equipment.
• For patients with extreme fear/anxiety.
• Introducing children to dental care and help to overcome any
fears of traditional dental treatment.
• For treatment of Special groups – physically and mentally
disabled
• Home bound elderly and those living in nursing homes
• School dental health programmes
• Treatment camps
 Principles of ART -

The two main principles of ART are :

 Removal of carious tooth tissues with the help of hand

instruments only

 Restoring the cavity with an adhesive restorative

material
 Why hand instruments ?

Biological approach
Low cost
Reduces psychological trauma to the patient
Simplified infection control
 Why Glass Ionomer Cement ?

Chemical bonding with the

tooth structure

Fluoride releasing property

Non irritant
 Indications –

 In small cavities

 In those cavities that are accessible to hand instruments

 Public health programs

Contraindications –

 Presence of swelling or fistula near the carious tooth

 Exposure of pulp

 Painful teeth with chronic inflammation of pulp

 Cavity opening is inaccessible to hand instruments

 Armamentarium –

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
 Essential Materials for ART-

 Cotton wool rolls and pellets

 Clean water
 Petroleum jelly
 Plastic strips
 Wedges
 Dentine conditioner
 Glass ionomer cement
 Articulation paper
 Others-

 Examination gloves
 Mouth mask
 Operating light
 Operating bed / head rest extension
 Stool
 Methylated alcohol
 Pressure cooker
 Instrument forceps
 Soap and towel
 Sharpening stone
 Procedural steps –
1. Arrange a good working environment –

A. Outside the mouth-

- The operator’s work posture and position
- Assistance
- Working alone
- Patient’s position
- Patient’s head position
- Operating light

B. Inside the mouth

2. Hygiene and control of cross infection

3. Restoring the cavity-

- Caries removal
- Conditioning the prepared cavity
- Mixing
- Restoring the cavity
Failed or defective 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
 Biological approach
 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
 A straightforward and simple infection control practice
without the need to use sequentially electroclaved hand
pieces
 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
 The ease of repairing defects in the restoration
 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 ionomers 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

 The misapprehension that ART can be performed easily – this

is not the case and each step must be carried out to perfection

 A misconception by the public that the glass ionomer “white

fillings” are only temporary dressings.
ART – Important Guidelines

 Treating dental caries using ART approach without emphasis

on preventive measures is a job only half done.

 It is important to explain to people and motivate them about

how they can prevent dental caries from affecting other teeth.
 In general, prevention of dental caries can be taken up and
managed based on the following elements :

1. Removal of plaque
2. Counselling on proper diet
3. Application of flourides
4. Application of antimicrobial agents
5. Application of sealants
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