Atraumatic Restorative Treatment Dr. Amrutha.pptx

Atraumatic Restorative Treatment -Dr. Amrutha Joy

1. Atraumatic restorative treatment Dr. amrutha joy Reader Dept.of pediatric dentistry Royal dental college

2. CONTENTS Introduction History Principles Indications and contraindications Armamentarium Technique Applications of ART Advantages and limitations of ART Conclusion

3. INTRODUCTION Dental Caries is a Major Public health problem . Communities with few dental facilities and providers, alternative measures for treating caries are being developed . One alternative operative approach to manage carious lesions was tested in Africa in the mid 1980s, which known as the Atraumatic Restorative Treatment.

4. The modified technique termed “Alternative Restorative Technique” by the American Academy of Pediatric Dentistry. ART is based on knowledge about minimal intervention, minimal invasion and minimal cavity preparation for carious lesion.

5. “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 ”. - American Academy of Pediatric Dentistry

6. What does Atraumatic mean? Atraumatic means treatment causes no or minimal trauma: To patient in terms of pain. To decayed tooth in terms of conservation of sound tooth tissue and with respect to pulp. Any trauma experienced is less than in other invasive techniques.

7. HISTORY Pioneered in Tanzania as part of a community-based primary oral health program by the University of Dar es Salaam – 1980. Official adoption of ART by WHO on Oral Health Day - 1994 ART adopted by FDI at the annual meeting in Vienna - 2002

8. PRINCIPLES OF ART Removing carious tooth tissues using hand instruments only. Restoring the cavity with a restorative material that sticks to the tooth. Currently, ART is performed using Glass- I onomer as restorative material.

9. Reasons for using hand instruments Restorative care accessible for all population groups. Conserves sound tooth tissues. Low cost of hand instruments. Limitation of pain. Simplified infection control.

10. Reasons for using Glass- I onomer are Bonds chemically to both enamel and dentine. Fluoride is released from the restoration. D oes not inflame the pulp or gingiva.

11. INDICATIONS Caries involving the dentine Cavity is accessible to hand instruments. Limited access to traditional care . Pediatric & Geriatric care . High caries risk management . Extreme dental fear/anxiety management.

12. CONTRAINDICATIONS Swelling or fistula near the carious tooth. Pulp of the tooth is exposed. Teeth - Painful for a long time. Mouth opening is inaccessible to hand instruments.

13. ARMAMENTARIUM Instruments Mouth mirror Tweezer Explorer Small spoon excavator Medium spoon excavator Dental hatchet

14. Instruments Mixing pad Spatula Carver Applicator Light Source

15. Materials Petroleum jelly Wedges Plastic matrix Clean Water Gloves Cotton rolls/pellets High-viscosity, auto-cure glass ionomer .

16. TECHNIQUE A . Operating positions and lighting Operator's work posture and positions Sits firmly on a stool, with straight back, thighs parallel to the floor and both feet flat on the floor . Most commonly used positions: Direct rear position (12 o'clock) Right rear position (10 o'clock

17. Seating Position of Assistant Assistant works at the left side of a right-handed operator.

18. Patient Position Patient is made to lie on the back on a flat surface. e.g . a bamboo or wooden bed, a table. Headrest made of firm foam or a rubber ring with a cover.

19. Operating Light The light source can be natural or artificial. Artificial light - more reliable, constant and can also be focused on a particular spot. In a field setting a portable light source recommended e.g. headlamp, glasses with a light source attached or a light attached to the mouth mirror.

20. B. Isolation Important aspect for the success of ART - control of saliva. Cotton wool rolls quite effective at absorbing saliva.

21. C. Preparing the Cavity Remove plaque from the tooth surface with a wet cotton wool pellet, and then dry the surface with a dry pellet. Widen the entrance by placing the blade of the dental hatchet into the cavity and turning the instrument forward and backward like turning a key in a lock. If the cavity is very small, place a corner of the blade of the dental hatchet in the cavity first and then turn.

22. Carious dentine removed with excavator by making circular scooping movements around the long axes of the instrument. Important to remove all the soft caries from the enamel-dentine junction before removing caries near the pulp.

23. Overhanging enamel must be removed with the blade of dental hatchet. .

24. D. Cleaning the Prepared Cavity In order to improve the chemical bonding of glass- ionomer to the tooth structures, the cavity walls must be very clean. Dentine conditioner Liquid supplied with the glass- ionomer itself.

25. E. Restoration of prepared cavity Insert the mixture into the cavity in small amounts using the blunt end of the applier/carver instrument. Rub a small amount of petroleum jelly on the gloved index finger and press the soft restorative material firmly into the cavity and fissures.

26. Check Occlusion

27. Excess material is removed with a carver. After 1 to 2 minutes check the bite. Cover the ART restoration with a new layer of petroleum jelly. Not to eat for at least 1 hour .

28. APPLICATIONS OF ART Originally introduced for economically less developed populations . Introducing oral care to very young children, not previously exposed to dentistry . Patients with extreme fear/anxiety . Mentally and/or physically handicapped patients . Home-bound elderly and those living in nursing homes.

29. Advantages Use of easily available and relatively inexpensive hand instruments. Biologically friendly approach - results in relatively small cavities and conserves sound tooth tissue . Limitation of pain, thereby minimizing the need for local anesthesia.

30. Simple infection control practice . Chemical adhesion of Glass I onomers . Leaching of fluoride from Glass Ionomer . Ease of repairing defects . Low cost.

31. Limitations Long-term survival rates for Glass- Ionomer ART restorations are not available. Technique’s acceptance by oral health care personnel is not yet assured. Hand fatigue from the use of hand instruments over long periods. Use limited to small- and medium-sized, one-surface lesions.

32. CONCLUSION Greater part of world population has no access to restorative dental care . ART has potential to make oral health care available to larger part of worlds population than before . Treating dental caries using the ART approach without emphasis on preventive measures is a job only half done.

33. Thank you