Art Art(atromatic restorative tretment)
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Transcript of Art Art(atromatic restorative tretment)
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ATRAUMATIC
RESTORATIVE
TREATMENT
BY HEMANT CHAURAHA
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CONTENTS
Introduction
History
Principles
Indications/contraindications
Material required
Steps
Advantages and limitations
Cost-effectiveness
Conclusion
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ART is a minimal invasive procedure
involves remaining markedly soften cenamel and dentine using only ha
instruments and then restoring the r
cavity with an adhesive materiaBy Jo Frencken 19
Introduction
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A NEW METHOD FOR TREATING DENTAL CARIESINVOLVES NEITHER DRILL WATER NOR ELECTRIWAS PRESENTED AT THE HEADQUARTER OF THGENEVA ON WORLD HEALTH DAY ON 7APRIL 199OCCASION THAT ALSO MARKED THE BEGINNINGTHE YEAR OF ORAL HEALTH, THE PROCEDURE CAS ATRAUMATIC RESTORATIVE TREATMENT.
HISTORY OF ARTART was pioneered in the mid 1980s in the tanjania by Jo Frencken.
It was found that the careful application of ART decreases 85% of chanc
caries for 3 years.
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Principles of ARTRemoving carious tooth
tissues using handinstruments only AND Restoring the cavit
restorative materisticks to the to
Currently, ART is performed using glass-ionomer as the res
material.
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Indications and Contra-Indications f In general ART is carried out only in
small cavities (involving dentine) andthat are accessible to hand instrume
ART is not used when:
1.There is an abscess (swelling) near tcarious tooth.
2.The pulp of the tooth is exposed.
3.Carious cavity not reachable with ha
instruments.
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Advantages of ART Easily available and relatively inexpens
instruments are used rather than e
electrically driven dental equipment.
A biologically friendly approach involving theof only decalcified tooth tissues, which r
relatively small cavities and conserve sou
tissue.
The limitation of pain, thereby minimizing the
local anesthesia.
The chemical adhesion of Glass Ionomer thathe need to cut sound tissues for retentirestorative materials.
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The leaching of fluoride from glass io
which prevents secondary caries deveand probably remineralizes carious de
The combination of a preventive and
treatment in one procedure.
The low cost. A straightforward and simple infection
practice without the need to use seq
electroclaved hand pieces.
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Limitations of ART Survival rate - the largest
reported so far is of 3 years dur
The techniques acceptance b
health care personnel is no
assured.
limited to small and medium
one surface lesions
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The possibility exists for hand fatfrom the use of hand instruments long periods.
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The reasons for using hand instruments rather thanrotating handpieces are:It makes restorative care accessible f
population- The cavity preparation conserves soutissues causes less trauma to the teeth- Low cost- Limitation of pain that reduces the nelocal anaesthesia and reduces psychotrauma to the patients.-Hand instruments can easily be cleanesterilized
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Restorative material for ARTGIC [Fuzi IX, Ketac molar]
The reasons for using glass-ionomer areas the glass-ionomer sticks chemically to bo
and dentine, the need to cut sound tooth tisprepair cavity is reduced,
-fluoride is released from the restoration to
and arrest caries and it is rather similar to h
tissues and does not inflame the pulp or gin
Material required
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Glass-Ionomer as a RestoratiMaterial
aluminum-oxide
calcium fluoride.Composition
powder silicon-oxide
liquid polyacrylic acid
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Mixing
Situation before
Mixing starts
Mixi
ion
First spread the liquid with the spatula over a surfabout 1.5 cm 2cm. Start mixing by adding one hapowder into the liquid using the spatula. Roll the pinto the liquid,gently wetting the particles withoutthem around the slab. As soon as all powder partiwetted, the second portion is folded into the mix. firmly while keeping the mass together. The mixinbe completed within 20-30 seconds,
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Restoring the Cavity Insertion of the mixture into the prep
cavity and over the remaining fissure
begin
immediately. Use the applier/carver t
small amounts of the mixture into th
This
technique will avoid air being trappebetween the floor of the cavity and t
ionomer
The entire application procedure mu
completed within 30-40 seconds.
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Applicationof ART
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Patient Position A patient lying on the backon a flat surface will providesafe and secure bodysupport and A headrest made of firm
foam or a rubber ring with acover, both stabilizes thepatient's head in the desiredposition and improves thecomfort of the patient.
Patient'sPositions
Backward tilt lifting thechin for access to upperteeth
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- Assuming that a table is present in most
communities, a very acceptable patient positi
created by attaching a head support to the entable.
- The patient is now positioned so that the sa
collects in the back of the oral cavity.
O ti P iti
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Position for Upper Anterior Toot
Position for Lower left Posterior Tooth Surfaces.
Position for Lower Right Posterior Tooth Surfaces
Position for Upper LeftPosterior Tooth Surfaces.
Position for Upper Right
Posterior Tooth Surfaces.
Operating Positions
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Operating LightGood vision is essential for working in
the oral cavity. The light source can be
the sun (natural) or artificial.Artificial light is more reliable and
constant than natural light and can also
be focused on a particular spot.
Therefore, in a field setting a portable
light source is recommended e.g. a
headlamp, glasses with a light source
attached or a light attached to the
mouth mirror.
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Arrangement in the mouth
A dry operating area, A very imp
aspect for the success of ART is cof saliva around the tooth being
Cotton wool rolls are quite effect
absorbing saliva and can provid
term protection from moisture /sa
HYGENE AND CONTROL OF CROSS INFECTIO
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HYGENE AND CONTROL OF CROSS INFECTIO
Always wear gloves.
Cleaning and sterilization is necessary tinfection.
Cleaning of the surface can be done by
and methyl spirit.
In the clinic the instruments can be steriautoclave or a pressure. cooker
All these preventive measures prevent t
of HIV and HBV.
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Preparing the Cavity The procedure for caries removal forone-surface cavities step-by-step1. Place cotton wool rolls along side
the tooth to be treated.
2. Remove plaque from tooth surfacwith wet cotton wool pellets.
3. Dry the tooth surface with drycotton wool pellets.
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4. If necessary, make the entrance ofthe cavity wider with a dental hatchet.5. Remove the carious dentine with
excavators starting at the enamel-dentine junction.6.Fracture off unsupported thin enamel
with the hatchet. Make sure the enameldoes not contain any carious spots.7. Clean the cavity with wet and thendry cotton wool pellets
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8. Remove the caries near the pulcarefully. 9. Clean the cavity again with wetwool pellets. 10. Check the relation of the tooth
restored with the opposing teeth basking the patient to bite. 11. Complete the procedure by drcavity with dry cotton wool pellet
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Clean the occlusal surface:All pits and fissures should
be clear of plaque anddebris as much as possible.
Rationale:The remaining pits andfissures will be sealed withthe same material used forfilling the cavity.
The Procedure for Restoring one
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The Procedure for Restoring one-
surface Cavities step-by-step
1.Check that all instruments and materia
are available and ready for use.2. Ensure that the tooth is kept dry durin
the restoration phase.
3. Mix restorative material according to
earlier description (20-30 seconds).4. Insert the mixture in small amounts in
the cavity and into the adjacent fissure
using the blunt blade of the carver.
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7. Remove visible excess of glass-i
with a medium or large excavator.
8. Wait 1-2 minutes till the materia
hard, whilst keeping the tooth dry.
9. Check the bite using articulation
and adjust the height of the restora
with the applier/carver if needed.
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10. Apply a new layer of petrol
jelly.
11. Remove cotton wool rolls.
12. Ask the patient not to eat f
least one hour.
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ART: What not to Forget
1. Removal of plaque,2. Counselling on proper diet,3. Application of fluorides,4. Application of antimicrobial age5. Application of sealants.
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Study in South Africa
1 surface amalgam 1 surf composite 1 surfa
Capital cost per
restoration
3.11 ZAR 3.09 ZAR 1.58 ZA
Multiple surface 21.05 ZAR 33.79 ZAR 19.60 Z
COST EFFECTIVENESS
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Conclusion:-It is not compromise but a peralternative treatment approacdeveloping countries.
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GOOGLETEXTBOOK SOBEN PETER
References