Introduction to ART, Air Abrasion, Air Polishing, Ozone Therapy, Chemo-mechanical caries removal and Caries Infiltration procedures in Dentistry with indications, advantages and disadvantages.

1. Presentor:
Sana Mateen Munshi

3. Use of high speed
followed by low speed hand
pieces with different types of
burs available.

5. » Atraumatic restorative technique (ART).
» Simple and modified atraumatic restorative technique
(SMART).
 Chemomechanical caries removal (CMCR).
 Ozone therapy.
 Tooth preparation using air abrasion.
 Air Polishing.
 Tooth preparation using lasers.
 Caries infiltration.

6. “Minimum (or minimal)
intervention dentistry (MI) can be
defined as a philosophy of
professional care concerned with
the first occurrence, earliest
detection, and earliest possible
cure of disease on micro
(molecular) levels, followed by
minimally invasive and patient-friendly
treatment to repair
irreversible damage caused by
such disease.”

7.  Atraumatic Restorative Treatment is a method to remove
caries using only hand instruments and fill it with glass
ionomer cement, can be applied to restorative treatment
of primary teeth.
 Minimally invasive procedures
 The method is showed to obtain sufficient effect
comparable to composite resin fillings and amalgam
fillings , without inducing fear of children.
 Application in developing countries.
Ref: Amercian Academy of Pediatric Dentistry

8. ADVANTGES OF ART:
Non painful.
Biological approach with
minimum cavity
preparation.
It is simple to practice.
It is more effectively
reached to the community.
And can prevent extraction
in most cases.
Low cost.
Gain all the advantage of
GIC as a restorative
material.
INDICATIONS OF ART:
Great technique for root
caries.
Good alternative in outreach
programs.
Excellent for fearful children.
Good alternative in medically
compromised patients.
Good alternative in mentally
compromised patients.
Cannot be used in deep carious lesions as well as teeth that are
painful and pulp is exposed.

9. MOUTH
MIRROR
PROBE
PAIR OF
TWEEZERS
To reflect light onto the field
of operation
To view cavity indirectly and
to retract
To retract cheek and tongue
To identify where soft caries
dentin is present
DONOT poke into small
lesions
DONOT poke into deep lesions
To carry cotton wool rolls and
wedges.

10. • This instrument is used to
remove soft carious dentine.
• Small Excavator have a
diameter of 1mm. Used in
small cavities and for cleaning
the enamel/dentin junction.
• The diameter of medium is
1.5mm, It is used for removing
soft caries from large cavites.
• Rounded surface is used to
push the material in small
cavities.

11. • This instrument is used
for widening the
entrance to the cavity.
• For slicing away the
unsupported and
carious enamel left.

12. ANIMATION:
http://www.youtube.com/watch?v=Dntaxz7yNAw

13. • There has recently been
resurgence of interest in air
abrasion technology with
several different commercial
units available.
• With air abrasion machines,
aluminum oxide particles (27
or 50 um) are blasted against
teeth under a range of
pressures (30-160 psi) with
variable particle flow rates.

14. INDICATIONS OF AIR ABRASION
Cleaning and removing stains and incipient caries from pits
and fissures prior to sealant and PRRs.
Small class I, III, IV and V cavity preparations and selected
class II preparations.
Repair and removal of composites, glass ionomer and
porcelain restorations.
Cleaning and preparation of castings, orthodontic bands
and brackets prior to cementation.

15. ADVANTAGES DISADVANTAGES
Elimination of vibration, less voice
and decreased pressure.
Dust is a practical problem. Control
of dust containing free aluminum
oxide is an ongoing challenge.
Reduction in pain during cavity
preparation, 85% of patients do not
require local analgesia.
The technique cannot remove
leathery dentinal caries or prepare
extensive cavities requiring classical
retentive form.
Less damaging pulpal effects than
conventional hand pieces.
The tip does not touch the tooth and
there is no tactile sensation.
Less fracture and crazing of enamel
and dentine during cavity
preparation.
Ability to remove sound structure
rather than carious substrate.
Root canal access through porcelain
crowns without fracturing porcelain.
Potential risk of inhalation of
aluminum particles.
In the preparation of PRRs, this
technique gives good result than
conventional methods.

16. Air-polishing is another technique utilizing a mixture of water-soluble
sodium bicarbonate and tricalcium phosphate particles that
is applied onto the tooth surface using air pressure and shrouded in
a concentric water jet.
ANIMATION:
http://www.youtube.com/watch?v=MQzVPshI6Lc

17. ADVANTAGES DISADVANTAGES
The water jet helps the
abrasive not to escape far
from the operating field.
Detrimental surface of such
restoration and sound
tooth structure could be
the result of non selected
abrasive characteristic of
such method.
INDICATIONS:
 Indicated in coronal polishing, a cosmetic procedure designed to
remove extrinsic stains from the enamel surfaces of teeth.
 Several researchers suggested the use of that technique only for
removing carious dentin at the end of cavity preparation.

18. “It is clear that, among complementary approaches, ozone therapy has emerged
as the one that is well explainable with classical biochemical, physiological, and
pharmacological knowledge.”
(Velio Bocci- Ozone, a new medical drug)
The technique uses laser detection of caries and Ozone treatment for less
than two minutes. Ozone readily penetrates through decayed tissue,
eliminating the ecological niche of cariogenic microorganisms as well as
priming the carious tissue for remineralization.
ADVANTAGES DISADVANTAGES
This simple approach
Remineralization takes
avoids need of local
place with the aid of
anesthesia, drilling and
topically applied
filling.
fluoride and rinses.
Restricted to treat
superficial enamel and
root caries
Hand pieces are still
indicated for deep
carious lesions.
Ref: American College of Integrative Medicine and Dentistry (ACIMD) -“Ozone in Dentistry”

19.  NaOCl was diluted and buffered with sodium hydroxide, sodium
chloride and glycine producing a solution of 0.05% N-monochloroglycine
(NMG) having a pH of 11.4. This solution is
commercially known as GK101.
 The GK101 material is found to be more effective if glycine is
replaced by amino-butyric acid. The product is then known as N-monocholo
D2 amminobytyrate (NMAB) and named as GK101E.

20. ADVANTAGES DISADVANTAGES
The results indicated no
remnants of the demineralized
dentine were detected after
treatment and the remaining
dentine
was chemically and clinically
sound
Lengthy procedure is the only
apparent drawback.
reducing the use of conventional
drilling and the need for local
anesthesia
unpleasant taste
indicated by few patients
nominated system for treating
anxious, medically compromised and
pediatric dental patients.
Provides efficient removal of dental caries
with no harm expected either on the
healthy dentine or the pulp tissues.

21. Carbon
dioxide
lasers
• Soft tissue incision
• Aesthetic contouring of gingivae
• Treatment of ulcers
• Fraenectomy and gingivectomy
• De-epithelization of gingival
tissue during periodontal
regenerative procedures.
Neodymium:
YAG
• Similar to above plus removal of
incipient caries but because of
depth of penetration there is
greater risk of collateral
damage than with dioxide
lasers.
Erbium: YAG
• Caries removal
• Cavity preparation in both
enamel and dentine.
• Preparation of root canals
Argon lasers
Resin curing
Tooth bleaching
Treatment of ulcers
Aesthetic gingival contouring
Franectomy and gingivectomy

22. ADVANTAGES DISADVANTAGES
Laser use results in clean sharp
margins in enamel and
dentine.
Cost.
The pulp is protected and safe
as the depth of energy
penetration is negligible.
The laser tip does not impinge
dental tissue so there is no
proprioceptive feedback.
Patients report little or no
pain.
Technique sensitive.
Time taken for cavity
preparation is short.
 Erbium lasers are used for cavity preparation.

23. “Icon represents a new category of dental products,” says Tim Haberstumpf,
DMG America Director of Marketing. “It is the first product to bridge the gap
between prevention (fluoride therapy) and caries restoration. Icon’s micro-invasive
infiltration technology can be used to treat smooth surface and
proximal carious lesions up to the first third of dentin (D-1). In just one patient
visit, Icon can arrest the progression of early enamel lesions and remove
white spot lesions.”

24. Incipient caries before treatment
Cariogenic acids attack the enamel
and draw out minerals. The tooth
becomes porous.
After treatment
By sealing the pore system, acids can no
longer penetrate into the lesion, thus
stopping the progression of the caries at
an early stage.
Treat earlier - preserve longer
• Esthetic results on smooth surfaces
• Caries arrest at an early stage
• Preservation of healthy tooth structure
• Pain-free method, without anesthesia, or
drilling

25.  Bridging the gap between prevention and restoration.
White spot lesions dectected
Application of Icon Etch
Rinse remaining etchant
Dry with air
Applying Icon infiltrate
Light cure

26.  Effectiveness of air abrasion,
chemomechanical is less than that
of conventional drilling.
 Majority of patients preferred the
alternative means.
 Laser treatment for caries
removal is an effective substitute
for air- rotary hand pieces yet its
effectiveness is limited by
equipment cost and treatment
time.