مواضيع المحاضرة: atraumatic restorative treatment

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ATRAUMATIC RESTORATIVE TREATMENT(ART)

Dr. Omar S.M.J.Ali
PhD Orthodontic

The atraumatic restorative technique (ART) is a procedure based on removing carious tooth structure using hand instruments alone and restoring the cavity with an adhesive restorative material.
At present the restorative material of choice is glassionomer cement.

History

Atraumatic restorative treatment was pioneered in the mid 1980s in Tanzania.
• In 1991, a community field trial started in Thailand, comparing ART with traditional treatment using dental drilling equipment and amalgam.

Another community field trial was set up in Zimbabwe in 1993.

The results of the study has shown that through the careful application of ART, about 85% of one-surface restorations in the permanent dentition will be in a good to acceptable condition up to about 3 years.

The studies in Thailand and Zimbabwe, and also another community field trial, which started in 1995 in Pakistan,
have clearly shown that pain is rarely experienced with
this approach. In fact, if applied correctly ART is well received by the vast majority of patients.


In conclusion, ART is quality treatment applicable to all communities

Advantages of atraumatic restorative technique

1. ART provides care for decayed teeth, which is non threatening, low cost, and can prevent extractions in most cases.
2. ART is based on modern knowledge about minimal intervention techniques thereby requires minimal tooth removal.

3. Because it is a noninvasive procedure, there are great potentials for its use in children as well as in fearful adults.

4. It also provides a restorative option for special groups in the community, such as the physically or mentally handicapped people living in nursing homes and the home-bound elderly.

Indication of atraumatic restorative dentistry

• Done where there is no power supply to run the motors required for cavity preparation such as in very remote villages.
2. When many people have to be treated such as in refugee camps.

3. Areas where it is difficult to take heavy equipments. The equipments required for ART are few.

Contraindications

• 1. Presence of abscess or fistula associated with the tooth to be restored.
2. Presence of clinical pulp exposure.


3. Teeth that have been painful for a long time and may be associated with chronic inflammation of the pulp.

4. There is an obvious deep carious cavity.

Principles

The two main principles of ART are:

• 1. Removing carious tooth material using hand instruments only.
2. Restoring the cavity with a restorative material that adheres to the tooth surface.

Steps in preparing the cavity

1. Cotton rolls are placed alongside the tooth to be treated.
This will absorb saliva and keep the tooth dry.

2. Plaque and other deposits are removed from the tooth surface with a wet cotton pellet, and then the surface is dried with a dry cotton pellet.

3. The extent of the caries is judged.

4. The access to the caries is widened by placing dental hatchet into the cavity and turning the instrument forward and backward like turning a key in a lock. This movement chips off small pieces of carious enamel.


5. Carious dentin is then removed with the excavators by making circular scooping movements around the long axes of the instrument.

6. The unsupported enamel that may be present is very weak and is removed with the blade of the hatchet.

7. Restoring the cavity with glass ionomer cement.

References
1.Dentistry for the Child and Adolescent Dean, Avery. McDonald\ 2011\ ninth Edition \Mosby

2. Principles and practice of pedodontics arathiraomds\2012\jaypee brothers medical publishers (p) ltd new delhi • panama city • London\third edition





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