Atraumatic Restorative Treatment (ART) & Pits and Fissure Sealants PDF

ATRAUMATIC RESTORATIVE TREATMENT DENA MOHAMED CPHQ, MPH, MFDRCSI, BDS Definition of ART 01 Principles of ART 02 Reasons for using hand instruments 03 Indication and contraindication of ART 04 Material and instruments 05 OB...

ATRAUMATIC RESTORATIVE TREATMENT DENA MOHAMED CPHQ, MPH, MFDRCSI, BDS Definition of ART 01 Principles of ART 02 Reasons for using hand instruments 03 Indication and contraindication of ART 04 Material and instruments 05 OBJECTIVES Steps of application of ART 06 Atraumatic restorative treatment (ART) definition 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 of ART Principle #1 Removing carious tooth tissues using hand instruments only Principle #2 Restoring the cavity with a restorative material that sticks to the tooth Reasons for using hand instruments for ART 1. It makes restorative 2. It conserves sound tooth care accessible for all tissues and causes less 3. Low cost population groups trauma to the teeth 4. Limitation of pain that 5. Simplified infection reduces the need for local control. Hand instruments anesthesia to a minimum can easily be cleaned and and reduces psychological sterilized after every trauma to patients. patient. Indications for ART Indication #1 Cavities involving dentine Indication #2 Accessible to hand instruments Contraindications for ART contraindication #1 The pulp is exposed contraindication #2 Presence of abscess associated with the carious tooth Contraindications for ART contraindication #3 If the teeth painful for a long time and there may be chronic inflammation of the pulp contraindication #4 Inaccessible to hand instrument Material used in ART Glass ionomer cement is the material of choice for ART because of: 1.It bonds to enamel and dentine chemically 2.Continuous slow fluoride release 3.Ease of use Instruments used in ART Dental Mirror Reflect light Indirect vision Retraction of cheek and tongue Explorer Identify soft caries Remove debris Instruments used in ART Tweezer Carry out cotton wool pellet, wedges, and articulating paper Dental Hatchet Widening the entrance of the cavity Removing thin unsupported enamel and carious enamel Instruments used in ART Spoon Excavator Removing caries Removing excess GIC Carver Inserting GIC filling Remove excess restoration Instruments used in ART Glass Slap and Spatula Mixing the filling material Materials used in ART Cotton Wool Roll Isolation Cotton Wool Pellet Cleaning the cavity Materials used in ART Glass Ionomer Cement Filling material Dentine Conditioner Clean the cavity Materials used in ART Petroleum Jelly Prevent moisture contamination prevent adhesion of GIC into gloves and outer surface of tooth Articulating Paper Check the occlusion Materials used in ART Plastic Strip Controlling proximal restoration Wedge Hold plastic strips Recommended position The operator sits firmly on the stool behind the patient, with straight back, thighs parallel to the floor, and feet flat on the floor The patient should be placed on a flat surface The assistant should work on the left side of a right-handed operator close to the patient ART procedure 1. Isolate the tooth with cotton wool rolls 2. Clean the tooth surface to be treated with a wet cotton wool pellet 3. Widen the entrance of the cavity (if the entrance is small) 4. Remove caries using excavator ART procedure 5. If the cavity is deep, apply pulpal protection (calcium hydroxide paste) 6. Condition the cavity and occlusal surface, using dentine conditioner on a cotton wool pellet and rub the cavity and the occlusal surface for 10 – 15 seconds, then wash it by wet cotton wool pellet ART procedure 7. Mix glass ionomer according to the manufacture’s instruction for 20 – 30 seconds 8. Insert the mixed glass ionomer into the cavity and overfill slightly to include the remaining pits and fissures ART procedure 9. Place the petroleum jelly into the gloved finger and press on the top of the entire occlusal surface 10. Check the bite 11. Remove excess material with the carver ART procedure 12. Recheck the bite and adjust the height of the restoration if needed 13. Cover filling with petroleum jelly 14. Instruct the patient not to eat or drink for at least 1 hour ART procedure https://www.youtube.com/watch?v=8VlMyXhlIIw PITS AND FISSURE SEALANTS Definition of pits and fissures sealant 01 Purpose of sealant 02 Criteria for ideal sealant 03 Rational for using pits and fissures 04 sealant Indications and contraindications 05 Procedures of pits and fissures sealant 06 application OBJECTIVES Sealant retention failure 07 Incipient fissure caries and sealant 08 Preventive resin restoration PRR 09 A pit and fissure sealant definition Is an organic polymer (resin) that flows into the pits and fissures and bonds to the enamel surface mainly by mechanical retention Majority of sealants are made of Bis-GMA (Bisphenol A-glycidyl methylacrylate). Purpose of sealant Provide smooth occlusal surface Provide physical barrier to seal off the pits and fissures Prevent bacteria and their nutrients from collecting within the pits or fissures Criteria for the ideal sealant 1. Viscosity allowing penetration into deep pits 2. Adequate working time 3. Rapid curing and fissures 4. Good and prolonged 5. Low solubility 6. Resistance to wear adhesion to enamel 7. Compatible with oral 8. Cariostatic action tissues Indications for pits and fissure sealant Indication #1 Moderate and high risk caries Indication #2 Incipient caries limited to the enamel pits and fissures Indication #3 Deep or irregular pits and fissures especially if it catches the tip of the explorer Indications for pits and fissure sealant Indication #4 When the opposing tooth is carious or restored Indication #5 Presence of isolating fossa from another with a restoration present Contraindications for pits and fissure sealant contraindication #1 Patient behavior affect isolation contraindication #2 Open occlusal carious lesion contraindication #3 Large occlusal restoration Contraindications for pits and fissure sealant contraindication #4 Self-cleansing pits and fissures contraindication #5 Patient allergic to methacrylate Sealant retention failure 1 Moisture contamination 2 Inadequate etching Incorporation of air Incomplete removal of 3 bubbles into the sealant 4 debris from the pits and material fissures Too slow application of the 5 material Procedure of pit and fissure sealant application 1. Prepare the tooth by cleaning pits and fissures surface and removing plaque and debris 2. Isolate the teeth 3. Dry the surfaces with air for 20 – 30 seconds 4. Etch the surface for 30 – 60 seconds 5. Rinsing the etchant for 60 seconds Procedure of pit and fissure sealant application 6. Dry the surface with air for 20 – 30 seconds 7. Application of sealant material on the pits and fissures 8. Evaluate the sealant for complete coverage and absence of voids or bubbles 9. Occlusal evaluation using articulating paper 10.Re-evaluation after six months Procedure of pit and fissure sealant application https://www.youtube.com/watch?v=HFgUtQhEy2c Incipient fissure caries and sealants Advantage #1 Use an invasive technique, Ability to diagnose the extent of carious where the fissures are lesion widened with a small bur Advantage #2 before placement of sealants High retention rate for sealant It is used in cases of deep Advantage #3 and narrow fissures that are discolored and suspected of Reduce the microleakage rates being carious Preventive resin restoration (PRR) Indicated where caries within a fissure has just reached the dentine The procedure involves removal carious tissue followed by bonding resin material into the cavity, and finally covering all restorative material and the remaining fissures with sealant  THANK YOU ! QUESTIONS