Atraumatic Restorative Treatment (ART) in Dentistry

Atraumatic Restorative Treatment (ART)

• A dental caries treatment procedure involving the removal of soft, demineralized tooth tissue using hand instruments alone, followed by restoration of the tooth with an adhesive restorative material, routinely glass ionomer.
• Principles:
  • Removing carious tooth tissues using hand instruments only.
  • Restoring the cavity with a restorative material that sticks to the tooth.
• Reasons for using hand instruments:
  • Makes restorative care accessible for all population groups.
  • Conserves sound tooth tissues and causes less trauma to the teeth.
  • Low cost.
  • Limits pain and reduces the need for local anesthesia.
  • Simplifies infection control.

Indications and Contraindications for ART

• Indications:
  • Cavities involving dentine.
  • Accessible to hand instruments.
• Contraindications:
  • The pulp is exposed.
  • Presence of abscess associated with the carious tooth.
  • If the teeth are painful for a long time and there may be chronic inflammation of the pulp.
  • Inaccessible to hand instruments.

Materials and Instruments Used in ART

• Material:
  • Glass ionomer cement.
• Instruments:
  • Dental Mirror.
  • Explorer.
  • Tweezer.
  • Dental Hatchet.
  • Spoon Excavator.
  • Carver.
  • Glass Slap and Spatula.
• Other materials:
  • Cotton Wool Roll.
  • Cotton Wool Pellet.
  • Dentine Conditioner.
  • Petroleum Jelly.
  • Articulating Paper.
  • Plastic Strip.
  • Wedge.

Steps of ART Procedure

• Isolate the tooth with cotton wool rolls.
• Clean the tooth surface to be treated with a wet cotton wool pellet.
• Widen the entrance of the cavity (if necessary).
• Remove caries using excavator.
• If the cavity is deep, apply pulpal protection (calcium hydroxide paste).
• Condition the cavity and occlusal surface using dentine conditioner.
• Mix glass ionomer according to the manufacturer's instructions.
• Insert the mixed glass ionomer into the cavity and overfill slightly.
• Place petroleum jelly into the gloved finger and press on the top of the entire occlusal surface.
• Check the bite and remove excess material with the carver.
• Recheck the bite and adjust the height of the restoration if needed.
• Cover filling with petroleum jelly and instruct the patient not to eat or drink for at least 1 hour.

Pits and Fissures Sealants

• Definition: An organic polymer (resin) that flows into the pits and fissures and bonds to the enamel surface mainly by mechanical retention.
• Purpose:
  • Provide a smooth occlusal surface.
  • Provide a physical barrier to seal off the pits and fissures.
  • Prevent bacteria and their nutrients from collecting within the pits or fissures.
• Criteria for ideal sealant:
  • Viscosity allowing penetration into deep pits and fissures.
  • Adequate working time.
  • Rapid curing.
  • Good and prolonged adhesion to enamel.
  • Low solubility.
  • Resistance to wear.
  • Compatibility with oral tissues.
  • Cariostatic action.

Indications and Contraindications for Pits and Fissures Sealant

• Indications:
  • Moderate and high-risk caries.
  • Incipient caries limited to the enamel pits and fissures.
  • Deep or irregular pits and fissures, especially if it catches the tip of the explorer.
  • When the opposing tooth is carious or restored.
  • Presence of isolating fossa from another with a restoration present.
• Contraindications:
  • Patient behavior affects isolation.
  • Open occlusal carious lesion.
  • Large occlusal restoration.
  • Self-cleansing pits and fissures.
  • Patient allergic to methacrylate.

Sealant Retention Failure

• Reasons for failure:
  • Moisture contamination.
  • Inadequate etching.
  • Incorporation of air bubbles into the sealant material.
  • Incomplete removal of debris from the pits and fissures.
  • Too slow application of the material.

Procedure of Pit and Fissure Sealant Application

• Prepare the tooth by cleaning pits and fissures surface and removing plaque and debris.
• Isolate the teeth.
• Dry the surfaces with air for 20-30 seconds.
• Etch the surface for 30-60 seconds.
• Rinse the etchant for 60 seconds.
• Dry the surface with air for 20-30 seconds.
• Apply sealant material on the pits and fissures.
• Evaluate the sealant for complete coverage and absence of voids or bubbles.
• Occlusal evaluation using articulating paper.
• Re-evaluation after six months.

Incipient Fissure Caries and Sealants

• Advantages of using invasive technique:
  • Ability to diagnose the extent of carious lesion.
  • High retention rate for sealant.
  • Reduce the microleakage rates.

Preventive Resin Restoration (PRR)

• Indicated where caries within a fissure has just reached the dentine.
• Procedure involves:
  • Removing carious tissue.
  • Bonding resin material into the cavity.
  • Covering all restorative material and the remaining fissures with sealant.