‘ART’-An art of caries control

ATRAUMATIC RESTORATIVE TREATMENT

• ART  is defined as a minimally invasive care approach in preventing dental caries and stopping its further progression.( Jo E  Frencken,2012)
• AAPD defines it 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 “.

PRINCIPLES

   The two main principles of ART are:

1.  Removing carious tooth tissues using hand instruments only.
2.  Restoring cavity with a restorative material that sticks to the tooth.

INDICATIONS

   ART is carried out :

•  Only in small cavities(involving dentin)
•  In those cavities that are accessible to hand insturuments.
•  Public health programs

CONTRAINDICATIONS

• There is presence of swelling / fistula near the carious tooth.
• The pulp of the tooth is exposed.
• Teeth have been painful for a long time.
• If the opening of lesion  is inaccessible to hand instrument.

ADVANTAGES

• ART is a biological approach.
• Reduce psychological trauma to patients.
• Can be practiced in remote areas.
• Simplifies infection control.
• Simple procedure
• ART  approach is cost effective.
• Friendly procedure

INSTRUMENTS

• Mouth mirror
• Explorer
• Tweezer
• Spoon excavator
• Dental hatchet
• Carver
• Mixing pad & spatula

PROCEDURE

A)ARRANGE  A GOOD WORKING ENVIRONMENT

B)HYGIENE & CONTROL OF CROSS INFECTION

C)RESTORING THE CAVITY

1. Caries removal

      – Widen the entrance if the cavity opening is small.

      – Carious dentin is removed with excavator.

      – It is important to remove all the soft caries from the enamel-     dentin junction from the pulp.

      – Overhanging of enamel must be removed.

      – Excavation is easier done when the tooth is dry.

  – Particular care must be given when removing carious dentin from two places :

      a. The enamel-dentin junction

      b. The floor in deep cavities

 2. Conditioning the prepared cavity

           It is done to improve the chemical bonding of glass-ionomer to the tooth structures. For this the cavity walls must be very clean. It is done using a chemical solvent

    like : dentin conditioner or tooth cleaner

              the liquid supplied with GIC

    3. Mixing

  – Place a spoonful of powder on glass slab .

  – Divide into two proportions.

  – Dispense 2 drops of liquid next to powder.

    Spread it using spatula.

  – Start mixing by adding one half of powder into the liquid.

  – As soon as all powder particles are wetted, the second portion is folded into the mix.

    The mixing should be completed within 20-30s.

    Final mixture should look smooth like chewing gum.

Precautions for glass ionomer material

  – Dispense both liquid & powder onto slab only when cavity is dried properly.

  – Replace the lid immediately after use.

  – If the mixing exceeds more than 30s ,do not use it.

  – Follow instructions carefully because each type of gic has its own specific needs.

    4. Restoring the cavity

   – After the cavity is conditioned,washed & dried ,the GIC can be mixed.

  – The mixture is inserted into cavity using blunt end of applier instrument.

  – Rub a small amount of petroleum jelly.

REFERENCES

1)PETER S. ATRAUMATIC RESTORATIVE TREATMENT;TEXTBOOK OF PREVENTIVE AND COMMUNITY DENTISTRY;5TH EDITION

2)HIREMATH SS;ATRAUMATIC RESTORATIVE TREATMENT;TEXTBOOK OF PREVENTIVE AND COMMUNITY DENTISTRY;2ND EDITION