ATRAUMATIC

RESTORATIVE TREATMENT
What is Atraumatic Restorative Treatment
(ART)….?
It is defined as a minimally invasive care approach in
preventing dental caries and stopping its further
progression. (Jo E. Frencken, 2012)

It has two
components

restoring
sealing caries cavitated dentin
prone pits and lesions with
fissures sealant
restorations
It is based on about minimal intervention, minimal
invasion and minimal cavity preparation.

It is a procedure based on removing carious tooth

tissues using hand instruments alone and restoring
cavity with an adhesive restorative material.

It is used to restore and prevent caries in young

patients, uncooperative patients, or patients with
special health care needs or when traditional cavity
preparations and restorations are not feasible.
Principles of ART…
2 main principles
of ART are:

Restoring cavity
Removing carious
with restorative
tooth tissues using
material that sticks
hand instruments
to tooth
Why we use hand instruments…?
Because :
It requires minimal cavity preparations that conserves
sound tooth and causes less trauma.
Limitation of pain that reduces need for local
anesthesia.
Simplified sterilization and infection control.
Low cost.
Glass Ionomer Cement(GIC) is used for
ART… Why…?
Reasons are :
GIC sticks chemically to enamel and dentin and need
to prepare cavity is reduced.
Fluoride released from restoration will prevent and
arrest caries.
It does not inflame pulp or gingiva.

Other materials used are: resin composite, compomer,

resin modified GIC, auto cured high viscosity GIC.
Advantages ….
It requires minimal cavity preparation.
It is painless.
Simplified sterilization and infection control.
Low cost instruments.
Simple technique and easy to train others.
Easy to use among children, fearful adults, physiclly
and mentally handicapped and elderly.
Indications….
It is carried out only in:-
 Small cavities(involving
dentin).
 In those cavities that are
accessible to hand
instruments.
 Public health programs.
Contraindications……
 If there is presence of
swelling/ fistula near carious
tooth.
 Pulp of tooth is exposed.
 Teeth have been painful for
long time.
 Chronic inflammation of pulp.
 Cavity but opening is
inaccessible to hand
instruments.
Procedures...

Arrange a good Restoring the cavity

working • Caries removal
environment Hygiene and • Conditioning of
• OUTSIDE THE control of cross prepared cavity
• Mixing
MOUTH infection
• INSIDE THE MOUTH • Restoring the cavity
Procedure….
1. Arrange a good working environment:
A) OUTSIDE THE MOUTH
Operator’s work posture and position: provide best inside
view of patient’s mouth with comfort of both.
Assistance: works on other side to help the operator.

Patient position: it should be stable, safe and secure

body support for the patient.
Patient’s head position: patient can assist operator by
tilting, turning and opening the mouth wide enough
to provide access to area of operation.
Operating light: source can be natural (sun) or
artificial. Artificial light is more reliable and
constant than natural light.
Natural light (sun) Artificial light
B) INSIDE THE MOUTH
Control of saliva around tooth to be treated.
Cotton wool rolls are quite effective at absorbing saliva.
2. Hygiene and control of cross infection:
Universal infection control procedure should be followed.
Place all instruments in water immediately after use.
Remove all debris from the instruments.
Put the clean instruments in a pressure cooker and add clean
water to a depth of 2-3 cm from bottom of cooker.
After 15 minutes, remove pressure cooker and leave it to cool.
Take out instruments by instrument forcep and dry and
clean them and store them in covered steel box.
Essential instruments for ART…
Mouth mirror
Explorer
Tweezers
Spoon excavator
Dental hatchet
Applicator/carver
Mixing pad and Spatula
Essential materials for ART….
Cotton wool rolls
Cotton wool pallets
Petroleum jelly
Plastic strip
Wedges
Glass Ionomer Cement
3. Restoring the cavity:
Clear and dry tooth so that extent of caries can now be
judged better.
Caries removal:
Remove all caries, soft dentin with spoon excavator.
Be careful while removing carious dentin near pulp, so
as not to injure the pulp.
Conditioning prepared cavity: cavity walls must be
very clean to improve the chemical bonding of GI to
tooth structure.
Dentin conditioner is usually a 10% solution
polyacrylic acid.
Mixing: take a spoonful of powder on glass slab/mixing
pad. Divide powder into 2 equal portions, then dispense
2 drops of liquid.
Roll powder into liquid.
Mixing should be completed within 20-30 seconds.
Final mixture should look smooth like chewing gum.
Restoring the cavity: after cavity is conditioned, wash and dry it,
GIC is mixed.
Mixture is inserted into the cavity using blunt end of applier/
carver instrument and pushed in the cavity.
Rub a small amount of petroleum jelly on the gloved index finger
and pres soft restorative material firmly into cavity and fissures.
Quickly and carefully remove any excess material with
a medium or large excavator.

Allow GIC to set.

Check for high points using articulating papers and if
any, reduce it.
Finish the cavity.
Advice patient not to eat for one hour.
Conclusion…..
Atraumatic Restorative Treatment is:
Developed to focus on such group of people who are
unable to obtain restorative dental care.
ART is combined preventive and curative oral care
procedure.
It is a breakthrough towards achieving goal of -“teeth for
life”.
Refrences…..
 Textbook of Essentials of Public Health Dentistry, 6th
Edition… Soben Peter….
Wikipedia
https://apps.who.int
Google images
Thank you….