art art(atromatic restorative tretment)

7/29/2019 Art Art(atromatic restorative tretment)

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ATRAUMATIC

RESTORATIVE

TREATMENT

BY HEMANT CHAURAHA


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CONTENTS

Introduction

History

Principles

Indications/contraindications

Material required

Steps

Advantages and limitations

Cost-effectiveness

Conclusion


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ART is a minimal invasive procedure

involves remaining markedly soften cenamel and dentine using only ha

instruments and then restoring the r

cavity with an adhesive materiaBy Jo Frencken 19

Introduction


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A NEW METHOD FOR TREATING DENTAL CARIESINVOLVES NEITHER DRILL WATER NOR ELECTRIWAS PRESENTED AT THE HEADQUARTER OF THGENEVA ON WORLD HEALTH DAY ON 7APRIL 199OCCASION THAT ALSO MARKED THE BEGINNINGTHE YEAR OF ORAL HEALTH, THE PROCEDURE CAS ATRAUMATIC RESTORATIVE TREATMENT.

HISTORY OF ARTART was pioneered in the mid 1980s in the tanjania by Jo Frencken.

It was found that the careful application of ART decreases 85% of chanc

caries for 3 years.


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Principles of ARTRemoving carious tooth

tissues using handinstruments only AND Restoring the cavit

restorative materisticks to the to

Currently, ART is performed using glass-ionomer as the res

material.


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Indications and Contra-Indications f In general ART is carried out only in

small cavities (involving dentine) andthat are accessible to hand instrume

ART is not used when:

1.There is an abscess (swelling) near tcarious tooth.

2.The pulp of the tooth is exposed.

3.Carious cavity not reachable with ha

instruments.


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Advantages of ART Easily available and relatively inexpens

instruments are used rather than e

electrically driven dental equipment.

A biologically friendly approach involving theof only decalcified tooth tissues, which r

relatively small cavities and conserve sou

tissue.

The limitation of pain, thereby minimizing the

local anesthesia.

The chemical adhesion of Glass Ionomer thathe need to cut sound tissues for retentirestorative materials.


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The leaching of fluoride from glass io

which prevents secondary caries deveand probably remineralizes carious de

The combination of a preventive and

treatment in one procedure.

The low cost. A straightforward and simple infection

practice without the need to use seq

electroclaved hand pieces.


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Limitations of ART Survival rate - the largest

reported so far is of 3 years dur

The techniques acceptance b

health care personnel is no

assured.

limited to small and medium

one surface lesions


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The possibility exists for hand fatfrom the use of hand instruments long periods.


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The reasons for using hand instruments rather thanrotating handpieces are:It makes restorative care accessible f

population- The cavity preparation conserves soutissues causes less trauma to the teeth- Low cost- Limitation of pain that reduces the nelocal anaesthesia and reduces psychotrauma to the patients.-Hand instruments can easily be cleanesterilized


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Restorative material for ARTGIC [Fuzi IX, Ketac molar]

The reasons for using glass-ionomer areas the glass-ionomer sticks chemically to bo

and dentine, the need to cut sound tooth tisprepair cavity is reduced,

-fluoride is released from the restoration to

and arrest caries and it is rather similar to h

tissues and does not inflame the pulp or gin

Material required


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Glass-Ionomer as a RestoratiMaterial

aluminum-oxide

calcium fluoride.Composition

powder silicon-oxide

liquid polyacrylic acid


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Mixing

Situation before

Mixing starts

Mixi

ion

First spread the liquid with the spatula over a surfabout 1.5 cm 2cm. Start mixing by adding one hapowder into the liquid using the spatula. Roll the pinto the liquid,gently wetting the particles withoutthem around the slab. As soon as all powder partiwetted, the second portion is folded into the mix. firmly while keeping the mass together. The mixinbe completed within 20-30 seconds,


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Restoring the Cavity Insertion of the mixture into the prep

cavity and over the remaining fissure

begin

immediately. Use the applier/carver t

small amounts of the mixture into th

This

technique will avoid air being trappebetween the floor of the cavity and t

ionomer

The entire application procedure mu

completed within 30-40 seconds.


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Applicationof ART


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Patient Position A patient lying on the backon a flat surface will providesafe and secure bodysupport and A headrest made of firm

foam or a rubber ring with acover, both stabilizes thepatient's head in the desiredposition and improves thecomfort of the patient.

Patient'sPositions

Backward tilt lifting thechin for access to upperteeth


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- Assuming that a table is present in most

communities, a very acceptable patient positi

created by attaching a head support to the entable.

- The patient is now positioned so that the sa

collects in the back of the oral cavity.

O ti P iti


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Position for Upper Anterior Toot

Position for Lower left Posterior Tooth Surfaces.

Position for Lower Right Posterior Tooth Surfaces

Position for Upper LeftPosterior Tooth Surfaces.

Position for Upper Right

Posterior Tooth Surfaces.

Operating Positions


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Operating LightGood vision is essential for working in

the oral cavity. The light source can be

the sun (natural) or artificial.Artificial light is more reliable and

constant than natural light and can also

be focused on a particular spot.

Therefore, in a field setting a portable

light source is recommended e.g. a

headlamp, glasses with a light source

attached or a light attached to the

mouth mirror.


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Arrangement in the mouth

A dry operating area, A very imp

aspect for the success of ART is cof saliva around the tooth being

Cotton wool rolls are quite effect

absorbing saliva and can provid

term protection from moisture /sa

HYGENE AND CONTROL OF CROSS INFECTIO


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HYGENE AND CONTROL OF CROSS INFECTIO

Always wear gloves.

Cleaning and sterilization is necessary tinfection.

Cleaning of the surface can be done by

and methyl spirit.

In the clinic the instruments can be steriautoclave or a pressure. cooker

All these preventive measures prevent t

of HIV and HBV.


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Preparing the Cavity The procedure for caries removal forone-surface cavities step-by-step1. Place cotton wool rolls along side

the tooth to be treated.

2. Remove plaque from tooth surfacwith wet cotton wool pellets.

3. Dry the tooth surface with drycotton wool pellets.


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4. If necessary, make the entrance ofthe cavity wider with a dental hatchet.5. Remove the carious dentine with

excavators starting at the enamel-dentine junction.6.Fracture off unsupported thin enamel

with the hatchet. Make sure the enameldoes not contain any carious spots.7. Clean the cavity with wet and thendry cotton wool pellets


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8. Remove the caries near the pulcarefully. 9. Clean the cavity again with wetwool pellets. 10. Check the relation of the tooth

restored with the opposing teeth basking the patient to bite. 11. Complete the procedure by drcavity with dry cotton wool pellet


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Clean the occlusal surface:All pits and fissures should

be clear of plaque anddebris as much as possible.

Rationale:The remaining pits andfissures will be sealed withthe same material used forfilling the cavity.

The Procedure for Restoring one


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The Procedure for Restoring one-

surface Cavities step-by-step

1.Check that all instruments and materia

are available and ready for use.2. Ensure that the tooth is kept dry durin

the restoration phase.

3. Mix restorative material according to

earlier description (20-30 seconds).4. Insert the mixture in small amounts in

the cavity and into the adjacent fissure

using the blunt blade of the carver.


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7. Remove visible excess of glass-i

with a medium or large excavator.

8. Wait 1-2 minutes till the materia

hard, whilst keeping the tooth dry.

9. Check the bite using articulation

and adjust the height of the restora

with the applier/carver if needed.


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10. Apply a new layer of petrol

jelly.

11. Remove cotton wool rolls.

12. Ask the patient not to eat f

least one hour.


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ART: What not to Forget

1. Removal of plaque,2. Counselling on proper diet,3. Application of fluorides,4. Application of antimicrobial age5. Application of sealants.


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Study in South Africa

1 surface amalgam 1 surf composite 1 surfa

Capital cost per

restoration

3.11 ZAR 3.09 ZAR 1.58 ZA

Multiple surface 21.05 ZAR 33.79 ZAR 19.60 Z

COST EFFECTIVENESS


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Conclusion:-It is not compromise but a peralternative treatment approacdeveloping countries.


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References

art art(atromatic restorative tretment)

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