1. Matt Fisher, DMD, MS Albuquerque IHS Dental Clinic June 5, 2013

2.  Caries stabilization utilizing similar techniques to ART (Atraumatic Restorative Technique)  Unlike ART, ITRs are considered to be provisional restorations  Recognized by the AAPD as a beneficial provisional technique  Coded as a provisional restoration (2940)

3.  Used to restore or prevent further decalcification and caries in young patients, uncooperative patients, or patients with special health care needs.  Used when circumstances do no permit traditional cavity preparation and/or placement of traditional dental restorations, or when caries control is necessary prior to the placement of traditional restorations

4.  Very young patients with small or large single-surface or two-surface preparations that may lack traditional retentive properties  Teeth should have no clinical or radiographic signs of infection  Uncooperative children that can’t or won’t tolerate injections or lengthy restorative procedures

5.  Uncooperative older children that have caries in primary molars that will be exfoliating in the near future  Temporary restoration of hypocalcified permanent molars that will require full coverage in the future

6.  Cotton rolls and pellets  Microbrush applicators  Floss  Vaseline or other lubricant  Mirror, explorer, probe, cotton forceps, spoon excavator  Slow-speed handpiece  Assortment of round burs and finishing burs

7.  Glass Ionomer Restorative Material  Traditional GI better than RMGI  High fluoride release better  Fuji IX GP Extra a good choice  Glass Ionomer capsule activator and applier  Glass Ionomer Cavity Conditioner  Glass Ionomer Sealer  Fuji Coat LC  Amalgamator  Curing Light

8.  A true Glass Ionomer Cement  Fast-setting  Can finish restoration in 2.5 minutes  Contains additional glass filler for improved translucency and esthetics  6x more fluoride release than traditional GIs  Increased durability, wear resistance, and compressive strength  Shade A1 or B1 in children

9.  Remove caries with a slow-speed handpiece with a carbide round bur or hand instruments, with caution not to expose the pulp  Maximum caries removal at the periphery of the prep to minimize leakage  Some caries can be left in the apical part of the prep to avoid pulp exposures

10.  After prep is completed, rinse and dry the tooth with cotton roll isolation.  Apply cavity conditioner for 10 seconds to remove the smear layer. Rinse with water  Dry tooth with cotton pellet or gentle blowing being careful not to dessicate the tooth. Surfaces should still appear moist

11.  Tap GI capsule on counter to loosen powder and activate  Place in mixer (amalgamator) and mix for 10 seconds  Load capsule in capsule applier  Syringe GI into cavity prep and slightly overfill  Lubricate finger with Vaseline and wipe across the GI in the prep forcing the GI into the prep and surrounding grooves

12.  Use a probe, explorer or spoon excavator to wipe off additional GI, paying particular attention to the interproximal areas  Place cotton roll on the contra-lateral side and have the patient bite on it for 2-2.5 minutes to allow the GI to set  Contour filling and remove any additional GI with a large round bur or finishing bur

13.  Floss interproximal areas to verify there is no GI in this area  Isolate with cotton rolls, dry tooth, and apply GI Sealer. Light cure sealer for 10 seconds.  Rinse mouth

14.  Always use Tell-Show-Do  Show patient brown spot on their tooth and tell them you are going to brush it off and make it clean again  Show them slow-speed on their fingernail letting them know it’s a toothbrush that spins and brushes  Air syringe and suction  Show patient finished result

15.  Start with a non-binding bur if possible  Use intermittant, light strokes with the handpiece to prevent heat buildup  Clean periphery of prep before going deep  Leave decay at bottom of prep to avoid pulp exposure  Work fast… Try to keep appointment under 15-20 minutes for young children

16.  Easy and fast first appointment if possible. This appointment sets the tone for the remaining appointments  Make difficult appointments or those requiring local anesthetic last if patient is asymptomatic  Use the small high-speed surgical suction or the saliva ejector