Atraumatic restoration technique and preservative restoration technique

It explains about the ART And PRR techniques in pediatric dentiy

1. KAMINENI INSTITUTE OF DENTAL SCIENCES DEPARTMENT OF PEDODONTICS 1)ATRAUMATIC RESTORATIVE TREATMENT 2) PREVENTIVE RESIN RESTORATION Kathi. Tejaswini IV –BDS ROLL.NO-04

2. CONTENTS ATRAUMATIC RESTORATIVE TREATMENT ESSENTIAL INSTRUMENTS AND MATERIALS IN ART PRINCIPLES REASONS FOR USING GLASS IONOMER CEMENT PROCEDURE INDICATIONS &CONTRAINDICATIONS ADVANTGES &DISADVANTAGES PREVENTIVE RESIN RESTORATION TYPES ADVANTAGES PRECAUTIONS CONCLUSION REFERENCES

3. ATRAUMATIC RESTORATIVE TREATMENT It is defined as a minimally invasive care approach in preventing dental caries and stopping its further progression. [Jo E.Frencken ] ART is also known as A lternate R estorative T reatment

4. ESSENTIAL INSTRUMENTS AND materials for art Mouth mirror Explorer Tweezers Spoon excavator Dental hatchet Carver Mixing pad and Spatula Cotton rolls Petroleum jelly Plastic mylar strip wedges

5. principles: 1.Removing carious tooth tissues using hand instruments only 2.Restroring the cavity with a restorative material that sticks to the tooth REASONS FOR USING HAND INSTRUMENTS – 1.Use of biological approach which requires minimal cavity preparation that conserves sound tooth. 2.Limitation of pain that reduces the need for LA . 3.Infection control 4.Cost effective

6. REASONS FOR USING GLASS-IONOMER CEMENT : Bonds chemically to enamel and dentin. Release of fluoride- Anticariogenic. Compared to dental restorative materials ,GIC have high surface wear and lower strength. Similar to hard tissue and non irritating to oral soft tissue.

7. Procedure: The tooth is isolated with cotton rolls The tooth surface to be treated is cleaned with a wet cotton pellet The entrance of the lesion is slightly widened by hand instrument to remove gross overhanging unsupported enamel rods with enamel hatchet The dental caries is removed by using either small or medium size spoon shaped excavator

8. Is necessary provide pulp protection by calcium hydroxide paste The cavity surface along with occlusal margins are cleaned A cavity is conditioned According to manufactures instructions GIC is mixed The mixed glass ionomer is inserted into the cavity and slightly overfilled

9. A gloved finger which is smeared with petroleum jelly is pressed on the top of the entire occlusal surface and slight pressure is applied The bite is checked Excess material is removed with the sharp carver The bite is rechecked and all high points are removed The filling covered with petroleum jelly once again or the varnish may be applied The patient is instructed not to bite with the tooth for at least half an hour

10. INDICATIONS Only in small cavities (involving dentin). In those cavities that are accessible to hand instruments. In uncooperative /fearful patients or patients with special health care needs, people living in nursing homes and the home bound elderly. In public health programs.

11. CONTRA INDICATIONS There is presence of swelling (abscess) or fistula (opening from abscess to the oral cavity) near the carious tooth. The pulp of the tooth is exposed. Teeth have been painful for a longtime and there may be chronic inflammation of the pulp. There is an obvious carious cavity or clear signs of a cavity, but the opening is inaccessible to hand instruments.

12. ADVANTAGES Easily available, inexpensive hand instruments used Involves the removal of only decalcified tooth tissues Less time consuming Combined preventive and curative treatment can be done in 1 appointment The leaching of fluoride from glass ionomer prevents development of secondary caries

13. DISADVANTAGES ART restorations are not long lasting; the average life is 2years. Because of low wear resistance a low strength of existing glass ionomer material their use is limited to small and medium sized 1 surface cavity only. The continuous use of hand instruments over long period of time may result in hand fatigue. A relatively unstandardized mix of glass ionomer may be produced due to hand mixing.

14. LIMITATIONS Hand fatigue from the use of hand instruments over long periods Misconception by the public that "white fillings" are only temporary dressings

15. PREVENTIVE RESIN RESTORATION Preventive resin restoration utilizes the invasive and non invasive treatment of borderline or questionable caries. The resin placed in the carious areas and adjacent caries susceptible areas, seals them from the oral environment and provides a valuable treatment alternative to conventional restorations like amalgam.

16. If Caries is present in one area or . Part of the pits and fissures Then that particular caries is restored . And remaining pits and fissures are Protected with sealants Preventive resin restoration

17. Simonsen has classified them as Type A – suspicious pits and fissures where caries removal is limited to enamel. Type B – incipient lesion in dentin that is small and confined. Type C – characterized by need for greater exploratory preparation in dentin.

18. TYPE –A: Clean the surface Isolation Remove decalcified pits and fissure Place acid etchant gel for 20 to 60 sec wash and Dry Apply the sealant polymerize with visible light for 20 sec.

19. TYPE –B Removal of caries Application of acid etchant gel Bonding agent application Injection of filled composite resin Condensation and smoothing Filled sealant application Polymerization

20. TYPE -C Repeat all the steps of type B Type C is larger and deeper addition polymerization time ( 30 sec) In most cases LA is required.

21. ADVANTAGES Initial cavity preparation is required thus preventing unnecessary removal of healthy tooth structure for retention. Seals caries thereby halting destruction of tooth . Ex – teeth with pit &fissure and dens evaginatu s Loss of the restoration and subsequent replacement proves to be less invasive than that for conventional restoration like amalgam .

22. PRECAUTION- It is important to maintain excellent isolation from moisture contamination for the long term success of PRR.

23. CONCLUSION ART is minimally invasive approach to prevent dental caries and to stop further progression The purpose is to bring health care to rural areas where urban trained doctors would not settle This increases the chance for better oral health in communities in both developed and developing countries. PRR is the removal of minimal tooth structure compared with a conventional preparation, leaving a much stronger tooth.

24. REFERENCES Textbook of Pediatric Dentistry– Nikhil Marwah 4th edition Textbook of Pedodontics – Shobha Tandon 2nd edition