atraumatic restorative treatment

1. traumatic
estorative
reatment

2. • A Innovative treatment approach for Dental Caries .
• ART is maximally preventive and minimally invasive approach
to stop further progression of dental caries.
•ART - Approach is not only logical but based upon sound
scientifically based principles.
•Method of preserving decayed teeth in people of all ages both in
developing countries and disadvataged communities --- where
resources are scarce.
• ART does not rely on electricity or expensive equipment –
treatment could be provided anywhere.
• ART is appropriate and valid in outreach situations in
developing countries.

4. J. Frencken

5. C. Holmgren.

6. DEVELOPMENT OF ART
 ART PIONEERED 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.

7. World
Health
Organisation

8. WHO presented ART on “World Health Day”
on 7th April 1994.
Beginning of the Oral Health Year-1994-95.
FDI recommended and advocated the ART
in 1998.

9. ART can be applied when:
- There is a cavity involving the dentine, and
- That cavity is accessible to hand instruments.
Contraindications:-
(1)In the presence of abscess or fistula near the tooth.
(2)Where there is pulp is exposed .in this case we have to do
root canal treatment.
(3)Painful teeth and the pulp inflammation.
(4)The opening of pulp is in accessible to the hand
instruments. eg-in the proximal caries there is clear sign of
cavity but the instruments cant reach that point.

10. The two main principles of ART are:
Removing carious tooth tissue
using hand instruments only
Restoring the cavity with glass
ionomer

11. GLASS IONOMER CEMENT
Glass ionomer is very useful as dental restorative
material because:-
(1)They can be applied to caries in very early lesions.
(2)It adheres to the tooth structure chemically.
(3)It is anticariogenic because it releases fluoride.
(4)It does not inflame the pulp and gingiva.

20. The ART Technique

22. Two layers of carious dentine
Outer (‘infected’)
 Bacterial
 Invasion
 Unreminerizable
 Dead
 Without
sensation
Inner (‘affected’)
 Few Bacterial
 Reminerizable
 Alive
 Sensitive

38. Instruments & materials for ART properly
Packed & placed in a basket for easy
Transportation in an outreach situation
(Thailand)
The use of ART at a courtyard
Of A primary school in Syria

39. ART in schools.
a). China
b). New Zeeland
c). Zimbabwe. Equipment
Layout in a class room.

40. CARISOLV
TM

41.  Earlier Chemo-Mechanical Preparation--CARIDEX
(1978)
 System based non-specific Proteolytic effect of
NaOCl.
 The development of Chemico mechanical caries
removal(CMCR) -- first initiated in 1980 by Swedish
Scientists at Malmo, and Goteborg, Sweden.
 Christer started MediTeam (MT) and had joint
collaboration with Biochemist, Lars Strid --
discovered the shortcoming of CARIDEX.

42.  During 1980 Ericcson improved the CARIDEX
formula.
 And later in 1990, in joint collaboration with
other Scientists developed CARISOLV.
 CARISOLV DEVELOPMENT -- NaOCl with three
naturally occurring amino acids -- Glutamic
acid, Leucine and Lysine.
 CARISOLV also contains Methyl cellulose and
Erythrocin.
 Ph of CARISOLV is 11.

43. Carisolv TM
Non invasive ,tissue – preserving
Caries removal

44. Step by Step treatment of root caries
lesions using CarisolvTM
Apply gel with the
Tip called star 3.
Wait 30 seconds

45. CLINICAL STUDIES AND EVIDENCE
CARISOLV did not affect healthy enamel and Dentin
compared with Phosphoric Acid etching which
increases surface roughness of both healthy Enamel
and Dentin ( Kalige et al, 1999).