Atraumatic Restorative Treatment (ART) Dr Hidayathulla Shaikh

Introduction ART is based on modern knowledge about minimal intervention & minimal cavity preparation for carious lesions. It is procedure based on removing carious tooth tissue using only hand instruments & restoring cavity with adhesive restorative materials. ART was started in mid 1980s -- as part of Primary Oral Health Care at Dar-El-Salaam, Tanzania-- Jo E. Frencken. First Clinical Trial conducted at Thailand (1991), Large scale Clinical Trial and Testing was done at Zimbabwe (1993). Later it was tried at Pakistan (1995), subsequently tried in USA & Europe.

This procedure has been specially developed for people in less industrialized countries. Also for special groups like institutionalized adults, physically and mentally handicapped people, refugees, people in deprived communities etc who cannot seek restorative care. As it is a tooth friendly procedure, there are great potential for its use in children. The two main principles of ART are – Removing carious tooth tissues using hand instruments only. Restoring a cavity with a restorative material that sticks to the tooth.

Reasons for using hand instruments rather than electric rotating headpieces are – 1) conserves sound tooth and causes less trauma. 2) low cost of hand instruments 3) Limitation of psychological trauma 4) Simplified infection control Indications Only in small cavities involving dentine Cavities accessible to hand instruments In public health programs

Contraindications Presence of abscess, sinus or fistula near the carious tooth Pulp exposure Teeth having pain from a long time-chronic pulpitis Obvious caries inaccessible to hand instrument Advantages Instruments are Easily available and less expensive Conservation of tooth structure No noise No water and suction required Minimal pain Low cost of the whole procedure Minimal operator training is required

PROCEDURE Position A. patient-supine on a simple table with head support B. Operator near the head of table/patient

Instruments Mouth mirror Explorer Tweezer Spoon excavator Hatchet Applier Carver Mixing pad and spatula

Steps in ART 1.Isolate the tooth with cotton 2.Clean the tooth surface to be treated with wet cotton

3.Widen the entrance of lesion with hatchet and remove the unsupported enamel.

4.Remove caries with excavator-circular scooping movements 5.Pupl protection-if necessary 6.Clean the occlusal surface

7.Condition the cavity and occlusal surface with 10% polyacrylic acid 8.Mix GIC-mixing 20-30 sec.final mixture should be smooth like chewing gum.

9. Insert GIC into cavity and slightly overfill. 10.Press with coated gloved finger on entire occlusal surface and apply slight pressure

Check the bite Remove excess material with carver Cover filling with petroleum jelly and then apply varnish

Limitations Long term survival rate is questionable, so far-3years. Can be done only in areas accessible to hand instruments. Possibility of hand fatigue over a period of time. Hand mixing of GIC-can result in improper mix and can cause weak strength of restoration Questionable acceptance by dental profession. People misunderstand it for a temporary filling.