1. ATRAUMATIC 1. ART
RESTORATIVE
TREATMENT
2. ROTARY 2.HIGH / LOW SPEED BUR
3. SONIC OCILLATION 3.SONICSYS MICRO
4. CHEMOMECHANICAL 4.CARISOLV,ENZYMES
5. KINETIC 5.AIR ABRASION
6. HYDROKINETIC 6.LASER
7. OZONE TECHNOLOGY 7.O3
ATRAUMATIC RESTORATIVE
TREATMENT
DEFINITION
Pioneers
Frencken JoE, Makoni F. in Tanzania 1980
Principle
Removal of cariogenic
biomass
Seal & protect tooth
Place an adhesive
restorative material
ADVANTAGES OF ART
Easy Caries Removal
Conserve tooth structure
Hand Instruments
Limitation of Pain, Non threatening
Restore with an adhesive material
No local anesthesia
No high/low handpiece
No suction
No water
Simple infection control
Prevent secondary caries(Fluoride)
Ease of repair
Low cost
ART Indications
Instruments
Mouth mirror
Cotton Forceps
Explorer
Isolate
Access
Excavate
Condition
Insert
Press
Remove excess
Procedure
Procedure.Isolate
Procedure.Clean Surface
Procedure.Widen Entrance
Procedure.Remove Caries
Procedure.Pulp Protection
Procedure.Clean Preparation
Procedure.Condition
Procedure.Mix Restorative
Material
Procedure.Place Glass Ionomer
Procedure.Place coated gloved
finger on occlusal surface and
apply
light pressure
Procedure.Check Occlusion
Procedure.Remove Excess
Material
Procedure.Recheck Occlusion
Procedure.Cover restoration
with varnish, unfilled resin,
petroleum jelly
Procedure.Instruct patient not
to eat for at least an hour
Keys to a Successful Mission
Know your mission before you
go
Be prepared
HIGH OR LOW
SPEED ?
Gain access to carious dentin
through high speed bur later use
low speed bur or hand excavation
for carious dentin excavation.
Low speed bur More tactile
sensitive
Why not use high speed
bur for caries excavation ?
Discomfort and pain due to ..
Dream or Reality ?
Studies
Banargee et al 2000 .Rotary
excavation -low speed burs, Round
carbon steel burs-removal of
softened dentin.
Freedman et al 2003
Kidd et al 1993 Controlled
selective rotary excavation
SONIC OSCILLATION
(SONOABRASION)
SONO ABRASION
A lengthways A large
halved torpedo hemisphere 2.2mm
shape diameter
9.5mm
long,1.3mm wide
A small hemisphere
1.5 mm diameter
Torque Applied 2N
More pressure - dampens oscillations
Indications
Reagent
(NaOCl + Amino Acids )
Dental phobics
Deciduous teeth
Medically compromised patients
Mechanism of action
Dentin
Collagen Degradation
2 zones
CMCR Agent
Mechanism of Action
2 Syringes
Principle
Aluminum oxide
Alumina particles Alpha alumina, pure,
biocompatible, used in food and
medicine, prime ingredient in tooth paste
Polycarbonate resin alumina-
hydroxyapetite mixtures-selective in
removal of caries
Capable of removing tissue of equal
hardness
Abrasion variables
Pressure 40 -140psi
Tip Size 0.015II 0.027II
Tip Angle 40 -120 degrees
Tip Distance 2mm from target
Dwell time
Particle size 27micro meter
aluminium oxide powder
Applications of Air Abrasion
Cavity preparations
Internal cleaning of tunnel preparations
Removal temporary cement
Micro abrasion of white spot enamel
hyperplasia
Stain removal
Repair of acrylic ,composite, porcelain
Air abrasion cannot be used for
Crown preparation
Large carious defects
Amalgam removal
Class II Cavity preparations
Advantages
Non traumatic treatment
Biocompatibility
No Chipping
No micro fracturing
Decreased thermal build up
smooth margins
Less invasive procedure
No anesthesia
Less discomfort
Disadvantages
Lack of tactile sensation
Non contact based modality
Messy Spread of aluminium oxide
Danger of air embolism and
emphysema
Impaired indirect view
Damage to dental operatory
Contraindications
Asthma patients
Severe dust allergy
Chronic pulmonary disease
Recent extraction
Open wound in oral cavity
Sub gingival caries removal
Safety Issues
Masks
Rubber dam
Dry vaccum systems
Eye glasses
Disposable mouth mirror
High speed suction
Comparison between Drill and Air
Abrasion
High Speed Drills Air Abrasion
Prep Start
Studies
Baneerge et al 2000
Yazici et al 2002
Lasers
Laser Therapy
Lasers are devices that produce beams
of coherent high intensity light
Applications
Selective Hard Tissue Ablation
Selective Carious Dentin Removal
Destroy S.Mutans
Sealing of Fissures
Cut Dental Hard Tissue
Adjunctive treatment in caries prophylaxis
Modify structures of dentin and enamel
Lasers used for selective hard tissue ablation
Er:YAG :Yttrium Aluminium-Garnet and Nd:YAG
Neodymium-YAG-IR Emission
C02 Laser IR Emission
Excimer Lasers (ArF- Argon: Freon and XeCl Xenon :
Chlorine U.V.Emission
Holomium lasers
Dye enhanced laser ablation Indocyanine Green &
Diode Laser
Limitations
Expensive
Size of the instrument
Photo Activated
Disinfection (Photo
Dynamic Therapy)
OZONE
Initial Colonization
Development of Acidophilic organisms in a
specialized Niche environment
Acid production and demineralization
Re-De -Mineralization
How does ozone come to our rescue ?
Ozone completely eliminates acidophilic
bacteria ,fungi and viruses to create a
sterile environment
Sterile environment not only reverses
decay but also helps in re-
mineralization
10 secs of 2200 ppm ozone eliminates 99
% of the carious micro flora
Niche is very unlikely to re-develop
after re- mineralization
Ozone: The kiss of death for Mutans
and Lactos !!!
Ozone A powerful biocide
Quickly dissipates in water and kills microbes via
a mechanism involving the rupture of their
membranes
It is a strong oxidizer to cell walls and cytoplamic
membrane of bacteria
Ozone treatment leads to oxidative
decarboxylation of plaque pyruate.
It oxidizes volatile sulfur compounds precursor
methionine to its corresponding sulphoxide and
thus prevents malodour associated with caries.
It also oxidizes poly-unsaturated fatty acids
The Ozone Delivery Unit And Patient Kit For
Ozone Therapy
The Ozone Armamentarium Heal ozone Tec3,Curosone,USA)
of
Richard.P.Feynman
Conclusion
Think twice before you
pick up that hand piece
. .Because the
cutting edge is not a
dental bur anymore !!!
References
Mathilde.C.P.& Mclean. Concept Mathilde.C.P.&
McLean. Concept of Minimally invasive cavity
preparations.J.Adheive.Dentistry.2001:3:7-16