Atraumatic restorative treatment

Dental caries is a widespread problem all over the world. In many developing countries most of these cases are untreated leading to extraction. To meet this problem, ART technique was developed mainly for the developing countries. It was pioneered in the mid 1980s by Dr. Joe Frencken, in Tanzania as a part of the community based primary oral health care program for the refugees by the University of Dar es Salaam. In 1994, WHO introduced ART as a part of oral health for healthy life. This procedure involves excavating and removing caries with hand instruments and restoring with adhesive filling like Glass Ionomer Cement (GIC).

Advantages

• Non-threatening.
• Non-painful.
• Does not need local anesthesia.
• Expensive electrically driven equipments are not used, so it is cost effective.
• Only hand instruments are used.
• Requires minimal cavity preparation, so conservation of sound tooth tissues.
• Easy sterilization of hand instruments.

Indications

• It is indicated in teeth where caries is involving only dentin.
• In those areas where hand instruments are accessible.

Contraindications

• Not used in cavities reaching pulp and with periapical abscess.
• In those areas where hand instruments are not accessible.

Even non-dental professionals or primary health care workers can be trained for this procedure. This technique can be carried out in schools, primary health centers, villages and remote areas.

Instruments and Materials Used

All we need for operator is a stool and a flat surface for the patient to lie. Instruments used are:

1. Mouth mirrors.
2. Explorers.
3. Tweezers.
4. Spoon excavators (large and small).
5. Hatchets.
6. Hoes.
7. Carvers.
8. Mixing pad.
9. Plastic spatula.
10. Plastic strips.
11. Petroleum jelly.
12. Cotton rolls and pellets.
13. Wedges.
14. Articulating papers.

Glass ionomer is used as a restorative material because it chemically binds to the teeth, releases fluoride after setting and is dentin and pulp compatible.

Procedure

1. Isolation of the tooth.
2. Removal of caries using excavators and prepare the cavity with other hand instruments.
3. Dry the cavity.
4. Apply dentin conditioner.
5. Mixing of GIC powder and liquid.
6. Cavity and adjacent pits and fissures are overfilled.
7. Press the restorative material with petroleum jelly coated gloved finger.
8. Remove excess material with carver and apply varnish.
9. Check occlusion.

Limitations

• Long term survival rates for glass ionomer ART restorations and sealants are not yet available, the longest study reported so far is of three years duration.
• The techniques acceptance by oral health care personnel is not yet assured.
• The use is limited to small and medium sized, one surface lesions because of low wear resistance and strength of existing glass ionomer materials.
• The use of hand instruments over long periods can lead to hand fatigue.
• Unstandardized mix of the material because of hand mixing, variation among operators and different geographical/climatic situations.
• The apparent lack of sophistication of the technique.
• The misconceptions by the public that the new glass ionomer white fillings are only temporary dressings.

Atraumatic restorative treatment Resources
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