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Atraumatic Restorative Treatment is a procedure based on removing carious tooth tissues using hand instruments alone and restoring the cavity with an adhesive restorative material. The Atraumatic Restorative treatment (ART) is based on : 1. Modern knowledge 2. Minimal intervention 3. Minimal invasion 4. Minimal cavity preparation To achieve the goal TEETH FOR LIFE Pioneers of ART JOE FRANKEN and CHRISTOPHER HOLMGREN

1. Removing carious tooth tissues using hand instruments only

2. Restoring the cavity with a restorative material that sticks to the tooth

Reasons for using Hand Instruments rather than electric rotating hand pieces: 1. Biological approach

2. Low cost
3. Psychological trauma

4. Simplified infection control

Reasons for using Glass Ionomer

1. Chemical bonding
2. Fluoride release

4. Pulpal Irritation

3. Aesthetic

ART is carried out Only in small cavities Accessible cavities Public health programs


surface cavities

Pit and Fissures on the occlusal surface

Pit on lingual surfaces of upper molars

Buccal groove of molars

Cervical third of buccal surface

Proximal surfaces of the anterior teeth

Multi-surface cavities :

Occlusal and proximal surfaces of premolar and molars

Occlusal and lingual surfaces of molar

Proximal and buccal surfaces of anterior

ART should not be used when there is :

Swelling / Abscess / Fistula near the carious tooth

Pulp exposed

Chronic Inflammation

Proximal caries

Biological approach


No psychological trauma
No electrically driven instruments

Simple technique and Easy Repair

Cost effective

Class I cavities of comparable size, ART restorations with high strength GIC reach the same survival rates as Amalgam. Restorative care accessible to all population care It is a wonderful way of introducing a nervous patient to dental care thereby laying the foundation for a lifetime of good oral health care.

Average life of restoration 2years

May not be accepted by all Oral Health Workers

Hand fatigue




The operators work posture and position

Working alone

Patient position
Patients head position Operating Light


Tilting the head

Backward Forward Central Left or Right

Patient Head Position

Turning the head

Mouth opening

Fully open Partly closed

2. HYGIENE AND CONTROL OF CROSS INFECTION Universal infection control procedures followed: I. Place all the instrument in water immediately

II. Remove all debris from the instruments by scrubbing with brush in a soapy water. If an autoclave is not available; Prepare fire using the fuel available Put the clean instrument in a pressure cooker for sterilization.

3. RESTORING THE CAVITY Isolation Caries removal Widen the entrance of the cavity use enamel hatchet Remove carious dentine with spoon excavators Overhanginng enamel must be removed Well supported dental hatchet Excavation is easy when tooth is dry Care is to be taken when caries is removed at : 1. The enamel dentin junction 2. the floors in the deep cavities Multi-surfaced caries - Mylar strip correction of tooth contour Placing of a wedge

Isolation in upper and lower arch

Cotton rolls

Cotton pellets

Caries Restoration for single surface

Circular scooping movements of the excavator

Fracturing off unsupported enamel with a hatchet


the prepared cavity :

Dentin Conditioner 10% solution of polyacrylic acid

The liquid supplied with the GIC itself


Application of dentin conditioner

Precautions for Glass ionomer Cement : Restoring the Cavity:

The restorative process of a one-surface cavity in various stages a. The cavity and adjacent pits and fissures are overfilled b. Press the restorative material with gloved finger. Excess material is visible

Press-finger technique

c. Removal of excess material by the carver blade of the applier/carver

Caries Restoration for Multi surface

Using the spoon excavator to remove carious dentine in a multiple-surface cavity

The position of the dental hatchet for smoothing the proximal outline

For Posterior teeth

Plastic strip and wedge in position

Restorative material pushed into place under unsupported enamel

Slightly overfilled sealed restoration

Finished sealed restoration

For Anterior Teeth

Positioning of the strip between the teeth

Insertion of a wedge

The strip is pulled around the tooth while the mixture is setting

A straight instrument is pressed against the strip to shape the restoration

A restoration may not be acceptable or unsatisfactory if : 1. Restoration is completely missing Some reasons for the failure could be: Contamination with saliva or blood during procedure Mix too wet or dry ( Ideal Chewing Gum ) Not all soft caries removed Undermined enamel is left behind

2. Part of restoration has broken away :

It is probable that The restoration was too high Air bubbles trapped in the restoration during placement 3. The Restoration has fractured :

This most commonly happens when the restoration is too high

4. The Restoration has worn away:

Possible reasons: the patient eats very hard food frequently the paitent clenches his/her teeth frequently improper mix

5. Caries has developed in the adjacent fissures or surface :


Mouth mirror Explorer Pair of tweezers Dental hatchet Spoon excavator, small Spoon excavator, medium Spoon excavator, large Applier/carver Glass slab or paper mixing pad Spatula

Cotton wool roll Cotton wool pellet Clean water Glass-ionomer restorative material liquid, powder and measuring spoon Dentine conditioner Petroleum jelly Wedge Plastic strip Articulation paper

Examination gloves Mouth mask Operating light Operation bed / headrest extension Stool Methylated alcohol Pressure cooker Instrument forceps Soap and towel Sheet of textile Sharpening stone and oil

ART is a breakthrough that has broken many barriers and allowed delivery of restorative treatments possible despite unavailability of electricity or communities that cannot afford dental treatment.

ART is a combined preventive and curative oral care procedure which must be administered along with health promoting messages about : Prudent life Good oral hygiene Use of fluoride tooth paste Sealant application.