GUIDED BY- DR.

AWADESH KUMAR SINGH

HISTORY
INTRODUCTON OF ART
CARRIES PROCESS IN A TEETH
INDICATION FOR ART
CONTRAINDICATIONS
INSTRUMENTS&MATERIALS ESSENTIAL FOR ART
ART STEPS
SUCCESS REPORT FOR ART
ADVANTAGE OF ART TECHNIQUE
LIMITATINS OF ART
 It was first evaluated in Tanzania in the mid
1980s.
 Art was introduced in South Africa by its
DUTCH inventor, Prof Jo Franken in 1996,but
still widely unknown amongst the general
public takes the dread from the dentist visit
and has the potential to significantly
improve the state of the nation’s teeth.
 Atraumatic Restorative Treatment (ART), is
based on removing decalcified tooth tissue
using only hand instruments and restoring
the cavity with an adhesive filling material.

 A minimally invasive approach to both

prevent dental carious lesions and stop its
further progression.
 Initiated in the mid-eighties in Tanzania in response
to an inappropriately functioning community oral
health programme that was based on western
health care models and western technology.

 It consists of two components:

 sealing of carious-prone pits and fissures (ART

sealants)

 restoration of cavitated dentin lesions with

restorations (ART restorations)
 Adoption of ART by the World Health Organization
on World Health Day, in 1994 as an effective and
efficient method of caries control.

 This technique has achieved considerable interest

worldwide both in, developing countries where
skilled human and other resources are not readily
available underserved communities in the
industrialized world who are unable to afford for
care for dental caries by more conventional
means.
 Carried out in the absence of electricity, pipe
water and anesthesia.
 Performed not only by dentists but also by
other operating dental personnel, such as
dental therapists.
 This increases the chance for better oral health
in underserved communities in both developed
and developing countries.

 Minimize oral health related inequalities.

 Introduced in to clinical setting in 1990’s

 Acceptable method to treat anxious

patients with minimal discomfort and pain.
 Where conventional restorative
procedures are impossible .
 Anxious children and adults
 Patients who are
physically/medically/mentally
handicapped .
 Cavitated tooth .
 Cavity could be reached with hand
instruments
 Presence of swelling or fistula in relation to
the teeth.
 Tooth with pulp exposure.
 Painful tooth for a long time which
probably involves the pulp.
 There is an obvious carious cavity, but the
opening is inaccessible to hand instruments.
 There are clear signs of a cavity, eg: in a
proximal surface, but the cavity cannot be
entered from the proximal or the occlusal
direction
Instruments

MOUTH MIRROR

EXPLORER/PROBE

PAIR OF TWEEZERS

EXCAVATOR

DENTAL HATCHET

APPLIER/CARVER

MIXING-PAD and SPATULA

 GLASS-IONOMER CEMENT

 DENTINE CONDITIONER

 COTTON WOOL ROLLS

 COTTON WOOL PELLETS

 PETROLEUM JELLY

 PLASTIC STRIP

 WEDGES
1. Arrange a good working environment
Outside the mouth
Operators – posture and position
Assistance
Patient position
Operating light Inside the mouth
Control of Saliva
2. Hygiene and Control of Cross Infection
 Always wear gloves and mask.
 Cleaning and disinfection of the working place and
sterilization of instruments.
 Place all instruments in water immediately after use.
 Remove all debris from the instruments by scrubbing
with brush in soapy water.
 If an autoclave is available, follow the manufacturer's
instructions carefully
 If a pressure cooker is available, prepare fire using the
fuel available - wood, gas, charcoal, solar energy.
 Put the clean instruments in a pressure cooker and
add clean water to a depth of 2- 3cm from the
bottom and boil.
3. Caries removal
• Remove soft superficial carious tissues with the
spoon excavator.
• Not necessary to prepare a cavity.
• If the opening of the hole is narrow, widen the
entrance of the cavity by placing the blade of the
dental hatchet
• If TF is in place remove it completely
• After all the caries is removed from the cavity,
it is cleaned with wet cotton wool/water syringe.
4. Conditioning the cavity

 In order to improve binding of the material to the

tooth surface, smear layer on the dentine is
removed .

 The surface is therefore cleaned with dentine

conditioner- 10% Polyacrylic acid/GIC liquid

 Apply one drop of conditioner on a mixing pad or

slab.
5. Mixing the material

Follow the instruction according to the manufacturer.

 Place a scoop of the powder on a mixing pad

 Use the spatula to divide the powder into two equal
portions, and then put a drop of liquid next to the
powder.
 Spread liquid on the mixing pad with the spatula and
start mixing by adding one half portion of the powder
into the liquid.
 As soon as the powder particles are wetted the
second portion of the powder is included into the
mixture. Mixing should be completed within 20-30
sec.
 Final mixture should look smooth, glossy and putty
type.
6. Placing the filling material
 Insert the material into the cavity with a filling
instrument and
plug with slight pressure. Slightly overfill. (ART
restoration)
 Spread additional material on the occlusal surface to
cover pits and fissures (ART sealant).
 Rub some petroleum jelly on the gloved index finger
and place the index finger on the restorative material,
press and remove finger sideways after a few seconds.
 Remove visible excess of glass-ionomer with a carver
and free the occlusion.
 Cover the entire surface with a cavity varnish. Avoid
eating or drinking for one hour.
 After 12 months, Class II/ multisurface and Class
III/IV ART restorations have generally shown success
rates of approximately 55-75% and 35-55%
respectively.
 Failures were usually from restoration losses and
fractures.
 Class I & V/single-surface ART restorations have
had much better short-term success rates of
approximately 80-90%.
 ART is a biological approach that requires minimal
cavity preparation and conserves sound tooth
tissues.
 The need for local anesthetics are reduced and
reduces the psychological trauma to the patients.
 Simplifies infection control as hand instruments can
easily be cleaned and sterilized.
 This technique is simple enough to train nondental
personnel or primary healthcare workers.
 cost effective
 For use among children, fearful adults, physically
and mentally handicapped patients.

 Cariostatic property of GIC. Control caries

progression.

 Ease of repair of restorations.

 Unable to perform in inaccessible cavities.
 Inferior mechanical and physical properties of the
filling material in compared to Amalgam and
composite.
 Not suited for deep cavities with pulp exposure or
potential to expose pulp.
 Hand fatigue for the operator.
 Time consuming.