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PRINCIPLES
INDICATIONS
CONTRA INDICATIONS
ADVANTAGES
PROCEDURE
FAILED/DEFECTIVE RESTORATION
CONCLUSION
Atraumatic Restorative Treatment is a procedure based on removing carious tooth tissues using hand instruments alone and restoring the cavity with an adhesive restorative material. The Atraumatic Restorative treatment (ART) is based on : 1. Modern knowledge 2. Minimal intervention 3. Minimal invasion 4. Minimal cavity preparation To achieve the goal TEETH FOR LIFE Pioneers of ART JOE FRANKEN and CHRISTOPHER HOLMGREN
2. Restoring the cavity with a restorative material that sticks to the tooth
Reasons for using Hand Instruments rather than electric rotating hand pieces: 1. Biological approach
2. Low cost
3. Psychological trauma
1. Chemical bonding
2. Fluoride release
4. Pulpal Irritation
3. Aesthetic
ART is carried out Only in small cavities Accessible cavities Public health programs
One
surface cavities
Multi-surface cavities :
Chronic Inflammation
Inaccessible
Proximal caries
Biological approach
Remineralization
Painless
No psychological trauma
No electrically driven instruments
Class I cavities of comparable size, ART restorations with high strength GIC reach the same survival rates as Amalgam. Restorative care accessible to all population care It is a wonderful way of introducing a nervous patient to dental care thereby laying the foundation for a lifetime of good oral health care.
1.
Assistance
Working alone
Patient position
Patients head position Operating Light
VOROSCOPE
Mouth opening
2. HYGIENE AND CONTROL OF CROSS INFECTION Universal infection control procedures followed: I. Place all the instrument in water immediately
II. Remove all debris from the instruments by scrubbing with brush in a soapy water. If an autoclave is not available; Prepare fire using the fuel available Put the clean instrument in a pressure cooker for sterilization.
3. RESTORING THE CAVITY Isolation Caries removal Widen the entrance of the cavity use enamel hatchet Remove carious dentine with spoon excavators Overhanginng enamel must be removed Well supported dental hatchet Excavation is easy when tooth is dry Care is to be taken when caries is removed at : 1. The enamel dentin junction 2. the floors in the deep cavities Multi-surfaced caries - Mylar strip correction of tooth contour Placing of a wedge
Cotton rolls
Cotton pellets
Conditioning
Press-finger technique
The position of the dental hatchet for smoothing the proximal outline
Insertion of a wedge
The strip is pulled around the tooth while the mixture is setting
A restoration may not be acceptable or unsatisfactory if : 1. Restoration is completely missing Some reasons for the failure could be: Contamination with saliva or blood during procedure Mix too wet or dry ( Ideal Chewing Gum ) Not all soft caries removed Undermined enamel is left behind
Possible reasons: the patient eats very hard food frequently the paitent clenches his/her teeth frequently improper mix
Materials
Cotton wool roll Cotton wool pellet Clean water Glass-ionomer restorative material liquid, powder and measuring spoon Dentine conditioner Petroleum jelly Wedge Plastic strip Articulation paper
Other
Examination gloves Mouth mask Operating light Operation bed / headrest extension Stool Methylated alcohol Pressure cooker Instrument forceps Soap and towel Sheet of textile Sharpening stone and oil
ART is a breakthrough that has broken many barriers and allowed delivery of restorative treatments possible despite unavailability of electricity or communities that cannot afford dental treatment.
ART is a combined preventive and curative oral care procedure which must be administered along with health promoting messages about : Prudent life Good oral hygiene Use of fluoride tooth paste Sealant application.