This document provides an overview of Atraumatic Restorative Treatment (ART). It discusses the history and development of ART, which began in Tanzania in the 1980s as an alternative to traditional dental treatment for communities with limited access. The key principles of ART are removing decay using hand instruments only, restoring with adhesive materials like glass ionomer cement to bond to tooth structure. ART aims to be minimally invasive and reduce pain. It has advantages like low cost and releasing fluoride but also limitations like uncertain long-term outcomes and restricted use for small cavities. The document outlines the ART technique and its applications for increasing access to dental care.

1. Atraumatic restorative treatment
Dr. amrutha joy
Reader
Dept.of pediatric dentistry
Royal dental college

2. CONTENTS
• Introduction
• History
• Principles
• Indications and contraindications
• Armamentarium
• Technique
• Applications of ART
• Advantages and limitations of ART
• Conclusion

3. INTRODUCTION
• Dental Caries is a Major Public health problem .
• Communities with few dental facilities and providers, alternative measures
for treating caries are being developed.
• One alternative operative approach to manage carious lesions was tested in
Africa in the mid 1980s, which known as the Atraumatic Restorative
Treatment.

4. • The modified technique termed “Alternative Restorative Technique” by
the American Academy of Pediatric Dentistry.
• ART is based on knowledge about minimal intervention, minimal invasion
and minimal cavity preparation for carious lesion.

5. “Dental caries treatment procedure involving the removal of soft, demineralized tooth
tissue using hand instrument alone, followed by restoration of the tooth with an
adhesive restorative material, routinely glass ionomer”. - American Academy of Pediatric
Dentistry

6. What does Atraumatic mean?
• Atraumatic means treatment causes no or minimal trauma:
• To patient in terms of pain.
• To decayed tooth in terms of conservation of sound tooth tissue and
with respect to pulp.
• Any trauma experienced is less than in other invasive techniques.

7. HISTORY
• Pioneered in Tanzania as part of a community-based primary oral health
program by the University of Dar es Salaam – 1980.
• Official adoption of ART by WHO on Oral Health Day - 1994
• ART adopted by FDI at the annual meeting in Vienna - 2002

8. PRINCIPLES OF ART
• Removing carious tooth tissues using hand instruments only.
• Restoring the cavity with a restorative material that sticks to the tooth.
• Currently, ART is performed using Glass-Ionomer as restorative material.

9. Reasons for using hand instruments
• Restorative care accessible for all population groups.
• Conserves sound tooth tissues.
• Low cost of hand instruments.
• Limitation of pain.
• Simplified infection control.

10. Reasons for using Glass-Ionomer are
• Bonds chemically to both enamel and dentine.
• Fluoride is released from the restoration.
• Does not inflame the pulp or gingiva.

11. INDICATIONS
• Caries involving the dentine
• Cavity is accessible to hand instruments.
• Limited access to traditional care.
• Pediatric & Geriatric care.
• High caries risk management.
• Extreme dental fear/anxiety management.

12. CONTRAINDICATIONS
• Swelling or fistula near the carious tooth.
• Pulp of the tooth is exposed.
• Teeth - Painful for a long time.
• Mouth opening is inaccessible to hand instruments.

13. ARMAMENTARIUM
Instruments
• Mouth mirror
• Tweezer
• Explorer
• Small spoon excavator
• Medium spoon excavator
• Dental hatchet

14. Instruments
Mixing pad
Spatula
Carver
Applicator
Light Source

15. Materials
Petroleum jelly
Wedges
Plastic matrix
Clean Water
Gloves
Cotton rolls/pellets
High-viscosity, auto-cure glass ionomer.

16. TECHNIQUE
A. Operating positions and lighting
Operator's work posture and positions
• Sits firmly on a stool, with straight back, thighs parallel to the floor and both feet flat on the
floor.
• Most commonly used positions:
• Direct rear position (12 o'clock)
• Right rear position (10 o'clock

17. Seating Position of Assistant
• Assistant works at the left side of a right-handed operator.

18. Patient Position
• Patient is made to lie on the back on a flat surface.
e.g. a bamboo or wooden bed, a table.
• Headrest made of firm foam or a rubber ring with a cover.

19. Operating Light
• The light source can be natural or artificial.
• Artificial light - more reliable, constant and can also be focused on a particular spot.
• In a field setting a portable light source recommended e.g. headlamp, glasses with a
light source attached or a light attached to the mouth mirror.

20. B. Isolation
• Important aspect for the success of ART - control
of saliva.
• Cotton wool rolls quite effective at absorbing saliva.

21. C. Preparing the Cavity
• Remove plaque from the tooth surface with a wet cotton wool pellet, and
then dry the surface with a dry pellet.
• Widen the entrance by placing the blade of the dental hatchet into the cavity
and turning the instrument forward and backward like turning a key in a lock.
• If the cavity is very small, place a corner of the blade of the dental hatchet
in the cavity first and then turn.

22. • Carious dentine removed with excavator by making circular scooping
movements around the long axes of the instrument.
• Important to remove all the soft caries from the enamel-dentine junction
before removing caries near the pulp.

23. • Overhanging enamel must be removed with the blade of dental hatchet.
• .

24. D. Cleaning the Prepared Cavity
In order to improve the chemical bonding of glass-ionomer to the tooth
structures, the cavity walls must be very clean.
• Dentine conditioner
• Liquid supplied with the glass-ionomer itself.

25. • E. Restoration of prepared cavity
• Insert the mixture into the cavity in small amounts using the blunt end of
the applier/carver instrument.
• Rub a small amount of petroleum jelly on the gloved index finger and press
the soft restorative material firmly into the cavity and fissures.

26. Check Occlusion

27. • Excess material is removed with a carver.
• After 1 to 2 minutes check the bite.
• Cover the ART restoration with a new layer of petroleum jelly.
• Not to eat for at least 1 hour.

28. APPLICATIONS OF ART
• Originally introduced for economically less developed populations.
• Introducing oral care to very young children, not previously exposed to
dentistry.
• Patients with extreme fear/anxiety.
• Mentally and/or physically handicapped patients.
• Home-bound elderly and those living in nursing homes.

29. Advantages
• Use of easily available and relatively inexpensive hand instruments.
• Biologically friendly approach - results in relatively small cavities and
conserves sound tooth tissue.
• Limitation of pain, thereby minimizing the need for local anesthesia.

30. • Simple infection control practice.
• Chemical adhesion of Glass Ionomers.
• Leaching of fluoride from Glass Ionomer.
• Ease of repairing defects.
• Low cost.

31. Limitations
• Long-term survival rates for Glass-Ionomer ART restorations are not
available.
• Technique’s acceptance by oral health care personnel is not yet assured.
• Hand fatigue from the use of hand instruments over long periods.
• Use limited to small- and medium-sized, one-surface lesions.

32. CONCLUSION
• Greater part of world population has no access to restorative dental care.
• ART has potential to make oral health care available to larger part of worlds
population than before.
• Treating dental caries using the ART approach without emphasis on
preventive measures is a job only half done.

33. Thank you