Atraumatic restorative treatment (art) for tooth Atraumatic Restorative Treatment (ART), is based on removing decalcified tooth tissue using only hand instruments and restoring the cavity with an adhesive filling material. A minimally invasive approach to both prevent dental carious lesions and stop its further progression

2.  Atraumatic Restorative Treatment (ART), is based on removing
decalcified tooth tissue using only hand instruments and
restoring the cavity with an adhesive filling material.
 A minimally invasive approach to both prevent dental carious
lesions and stop its further progression.

3.  Initiated in the mid-eighties in Tanzania in response to
an inappropriately functioning community oral health
programme that was based on western health care
models and western technology.
 It consists of two components:
 sealing of carious-prone pits and fissures (ART
sealants)
 restoration of cavitated dentin lesions with
restorations (ART restorations)

4.  Adoption of ART by the World Health Organization on
World Health Day, in 1994 as an effective and efficient
method of caries control.
 This technique has achieved considerable interest
worldwide both in,
developing countries where skilled human and other
resources are not readily available
underserved communities in the industrialized world
who are unable to afford for care for dental caries by
more conventional means.

5.  Carried out in the absence of electricity, pipe water
and anesthesia.
 Performed not only by dentists but also by other
operating dental personnel, such as dental therapists.
 This increases the chance for better oral health in
underserved communities in both developed and
developing countries.
 Minimize oral health related inequalities.

6.  Introduced in to clinical setting in 1990’s
 Acceptable method to treat anxious patients with
minimal discomfort and pain.

8.  Where conventional restorative procedures are
impossible
 Anxious children and adults
 Patients who are physically/medically/mentally
handicapped
 Cavitated tooth
 Cavity could be reached with hand instruments

9.  Presence of swelling or fistula in relation to the teeth.
 Tooth with pulp exposure
 Painful tooth for a long time which probably involves the
pulp
 There is an obvious carious cavity, but the opening is
inaccessible to hand instruments
 There are clear signs of a cavity, eg: in a proximal surface,
but the cavity cannot be entered from the proximal or the
occlusal direction

10. Instruments
MOUTH MIRROR
EXPLORER/PROBE
PAIR OF TWEEZERS
EXCAVATOR
DENTAL HATCHET
APPLIER/CARVER
MIXING-PAD and SPATULA

11. Materials
 GLASS-IONOMER CEMENT
 DENTINE CONDITIONER
 COTTON WOOL ROLLS
 COTTON WOOL PELLETS
 PETROLEUM JELLY
 PLASTIC STRIP
 WEDGES

12. 1. Arrange a good working environment
Outside the mouth
 Operators – posture and position
 Assistance
 Patient position
 Operating light
Inside the mouth
 Control of Saliva

13. 2. Hygiene and Control of Cross Infection
 Always wear gloves and mask.
 Cleaning and disinfection of the working place and
sterilization of instruments.
 Place all instruments in water immediately after use.
 Remove all debris from the instruments by scrubbing
with brush in soapy water.
 If an autoclave is available, follow the manufacturer's
instructions carefully
 If a pressure cooker is available, prepare fire using the
fuel available - wood, gas, charcoal, solar energy.
 Put the clean instruments in a pressure cooker and add
clean water to a depth of 2- 3cm from the bottom and
boil.

14. 3. Caries removal
• Remove soft superficial carious tissues with the
spoon excavator.
• Not necessary to prepare a cavity.
• If the opening of the hole is narrow, widen the
entrance of the cavity by placing the blade of the
dental hatchet
• If TF is in place remove it completely
• After all the caries is removed from the cavity,
it is cleaned with wet cotton wool/water syringe.

15. 4. Conditioning the cavity
• In order to improve binding of the
material to the tooth surface, smear
layer on the dentine is removed .
• The surface is therefore cleaned with
dentine conditioner- 10% Polyacrylic
acid/GIC liquid
• Apply one drop of conditioner on a
mixing pad or slab.

16. 5. Mixing the material
• Follow the instruction according to the
manufacturer.
• Place a scoop of the powder on a mixing pad
• Use the spatula to divide the powder into two equal
portions, and then put a drop of liquid next to the
powder.
• Spread liquid on the mixing pad with the spatula and
start mixing by adding one half portion of the
powder into the liquid.
• As soon as the powder particles are wetted the
second portion of the powder is included into the
mixture. Mixing should be completed within 20-30
sec.
• Final mixture should look smooth, glossy and putty
type.

17. 6. Placing the filling material
 Insert the material into the cavity with a filling instrument and
plug with slight pressure. Slightly overfill. (ART restoration)
 Spread additional material on the occlusal surface to cover pits
and fissures (ART sealant).
 Rub some petroleum jelly on the gloved index finger and place
the index finger on the restorative material, press and remove
finger sideways after a few seconds.
 Remove visible excess of glass-ionomer with a carver and free the
occlusion.
 Cover the entire surface with a cavity varnish. Avoid eating or
drinking for one hour.

19.  After 12 months, Class II/multisurface and Class III/IV
ART restorations have generally shown success rates of
approximately 55-75% and 35-55% respectively.
 Failures were usually from restoration losses and
fractures.
 Class I & V/single-surface ART restorations have had
much better short-term success rates of approximately
80-90%.

20. ART is a biological approach that requires
minimal cavity preparation and
conserves sound tooth tissues.
The need for local anesthetics are
reduced and reduces the psychological
trauma to the patients
Simplifies infection control as hand
instruments can easily be cleaned and
sterilized

21.  This technique is simple enough to train non-
dental personnel or primary healthcare workers
 cost effective
 For use among children, fearful adults, physically
and mentally handicapped patients.
 Cariostatic property of GIC. Control caries
progression.
 Ease of repair of restorations.

22.  Unable to perform in inaccessible cavities.
 Inferior mechanical and physical properties of
the filling material in compared to Amalgam and
composite.
 Not suited for deep cavities with pulp exposure
or potential to expose pulp.
 Hand fatigue for the operator.
 Time consuming.

23. Atraumatic Restorative Treatment (ART)
for a disadvantaged Brazilian Community

24. Introducing the Atraumatic
Restorative Treatment (ART)
approach in South Africa. In
1997, twelve lay refugees in
the Liberian refugee camp
were trained in basic oral
health care including ART
according to WHO training
module. The 12 trained
refugees maintained an oral
health clinic in the camp,
where patients were treated
with ART.

25. Atraumatic Restorative Treatment (ART)
Programme in some rural areas of Turkey.
Dentists and often dental students visit the
rural areas including Bagivar, a small town
and Anatolia. ART restorations are performed
in school children, farm worker's children
living in tents or children working in cotton
fields.