Atraumatic Restorative

Treatment
Lesson plan
 Title : Atraumatic restorative treatment.

 Method used : Power point presentation.

 Time allotted: 30 minutes.

 Audience : Final year.

 Evaluation : Multiple choice question.

Introduction
• Atraumatic Restorative Treatment is defined as a minimally
invasive care approach in preventing dental caries and stopping its
further progression.
Jo E. Frencken, 2012
• The American Academy of Paediatric Dentistry (AAPD) defines ART
as “A dental caries treatment procedure involving the removal of
soft, demineralized tooth tissue using hand instruments alone,
followed by restoration of tooth with an adhesive restorative
material, routinely glass ionomer cement.
 Principles

1. Removing carious tooth tissue using hand

instrument only.
2. Restoring the cavity with a restorative
material that sticks to the tooth
 Indication
 ART is carried out

1. Only in small cavities ( involving dentin).

2. In those cavity that are accessible to hand
instruments.
3. Public health program.
 Contraindication
Ifthere is presence of swelling , abscess or fistula near
carious tooth.
The pulp of tooth is exposed.
Teeth have been painful for a long time and there may be
a chronic inflammation of pulp.
There is an obvious carious cavity but opening is
inaccessible to hand instrument.
There are clear signs of a cavity, for example in a
proximal surface, but the cavity cannot be entered from
the proximal or occlusal surface.
 Advantages
ART is a biological approach that requires minimal cavity
preparation that conserves sound tooth tissues and causes less
trauma to tooth.
As ART is painless the for local anaesthetics are reduced and so
is the psychological trauma to patient .
Simplifiesinfection control as hand instruments can easily be
cleaned and sterilized.
No electrically driven and expensive dental equipment needed
which enables ART to be practiced in remote areas.
This technique is simple enough to train non dental
personnel or primary health care workers.
ART approach is very cost effective.
Since it is friendly procedure , there are great potentials
for its use among children, fearful adults , physically
handicapped , and elderly.
Itmakes restorative care more accessible for all
populations.
Essential instrument for ART
 Mouth mirror

 Explorer

 Pair of tweezer

 Spoon excavator

 Dental hatchet

 Carver

 Mixing pad and spatula

 Materials used for ART
 Glass ionomer cement.

 Dentine conditioner.

 Cotton wool rolls.

 Cotton wool pellets.

 Petroleum jelly.

 Plastic strips.

 Wedges.
Procedure

Arrange a good Hygiene and

Restoring the
working control of cross
cavity
environment infection
1. Arrange a good working environment

A. Outside the mouth

1. The operator work posture and

position.

The work and posture of operator

should provide the best view of the
inside of patient mouth. The distance
from operators eye to patient tooth is
usually between 30 to 35cm. The
position of operator will depend on
area of patient mouth to be treated.
Assistance
• When treating the children using
ART, it is a great advantage if
another person mix glass ionomer
cement.

• The assistant head should be 10-

15 cm higher than the operator so
that the assistant can also see the
operator field and can pass the
correct instruments when needed.
 Patient position
• The patient lying on the back on a flat surface
will provide safe and secure body support and a
comfortable and a stable position for lengthy
periods of time.

• Patient 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.
B. Inside the mouth
• A very important aspect for success of ART is control of saliva around he
tooth being treated, cotton wool rolls are quite effective at absorbing saliva
and can provide short term protection from moisture
2. Hygiene and Control of Cross Infection
• Place all instruments in water immediately after use.

• Remove all debris from instruments by scrubbing with brush in

soapy water.

• Put the clean instruments in an autoclave.

• Alternatively we can use a pressure cooker.

• Take instruments out of pressure cooker with instrument forceps

and dry them with a clean towel.

• Store them in a covered metal box

Procedure
The tooth is isolated with cotton rolls.

Remove plaque from the tooth surface with a wet cotton pellet and then dry the surface with dry pellet.

If cavity opening in the enamel is small, widen the entrance. Do this by placing the blade of dental hatchet into the cavity and
turning the instrument backward and forward spoon.

Carious dentin can now be removed with the spoon excavation soft caries is removed by making circular scooping movements around
the long axes of instrument.

The overhanging of enamel can break very easily and must be removed. This is done with blade od dental hatchet.

If necessary provide pulpal protection with calcium hydroxide paste.

Conditioning of prepared cavity with a dentin conditioner or liquid of glass ionomer cement.
Procedure
According to manufacturer’s instructions the glass ionomer cement is mixed. The mixed glass ionomer is inserted into the cavity
and slightly overfilled.

A gloved finger, which is smeared with petroleum jelly, is pressed on top of the entire occlusal surface and slight pressure is
applied.

The bite is checked.

Excess material is removed with a sharp cover.

The bite is rechecked and all high points are removed.

The filling is covered with a petroleum jelly once again or the varnish may be applied.

The patient is the instructed not to bite with the tooth for at least half an hour.
Failed or defective restoration
1. Restoration is completely missing.

2. Part of restoration has broken away.

3. The restoration has fractured.

4. The restoration has worn away