The advantages of ART include the following:
- The use of easily available and relatively inexpensive hand instruments rather than expensive electrically driven dental equipment.
- A biologically friendly approach involving the removal of only decalcified tooth tissues, which results in relatively small cavities and conserves sound tooth tissue.
- The limitation of pain, thereby minimizing the need for local anesthesia.
- A straightforward and simple infection control practice without the need to use sequentially autoclaved handpieces.
- The chemical adhesion of glass ionomers that reduces the need to cut sound tooth tissue for retention of the restorative material.
- The leaching of fluoride from glass ionomers, which prevents secondary caries development and probably remineralize carious dentin.
- The combination of a preventive and curative treatment in one procedure.
- The ease of repairing defects in the restoration.
- The low cost.
From experience gained thus far, the ART technique is a non threatening oral procedure. This characteristic has the great advantage of making oral care more popular among the population – in particular, the young. Fear inducing situations caused by threatening dental equipment are not involved, and there is no noise from a drill or from suction equipment. The maximum number of instruments in the mouth at anyone time is similar to that used during an oral examination, the mirror in one hand and a work instrument in the other. AFT is therefore, patient –friendly.
Obviously, one of the greatest advantages of ART is that it makes it possible to reach people who otherwise never would have received any oral care. The technique allows oral care workers to leave the clinic and to visit people in their own living environments, e.g. in senior citizen homes, institution for the handicapped, villages in rural and suburban areas in economically less developed countries, and in their own homes. From a health point of view, these possibilities must be considered a huge advantage.
Furthermore, ART supports health education and promotion programs, particularly in areas where oral care relies heavily on pain relief through extraction and oral health education. Using ART, a comprehensive package of education / promotion, prevention, curative treatment, and pain relief can be established and delivered to the population through a low cost, out reach oral health program.
The limitations of ART include the following:
- Long – term survival rates for glass ionomer ART restorations and sealants are not yet available; the longest study reported so far is of three year’s duration. The techniques acceptance by oral health care personnel is not yet assured.
- At the moment tissue is limited to small and medium sized, one-surface lesions because of the low wear resistance and strength of existing glass ionomer materials.
- The possibility exists for hand fatigue from the use of hand instruments over long periods.
- Hand mixing might produce a relatively unstandardized mix of glass ionomer, varying among operators and different geographical/climatic situations.
- The misapprehension that ART can be performed easily – this is not the case and each step must be carried out to perfection.
- The apparent lack of sophistication of the technique, which might make it difficult for ART to be easily accepted by the dental profession.
- A misconception by the public that the new glass ionomer “white fillings” are only temporary dressings.
Some of these disadvantages of glass ionomers, such as low wear resistance and reduced strength, are being addressed. When improved materials become available, larger one surface and small to medium sized multisurface lesions might also be managed with the ART technique. Also, the variation in mixtures of hand mixed glass ionomer can be reduced by making the materials more user friendly, a particularly important factor in the economically less developed countries where less than optimal operating conditions exist. The development of appropriate hand instruments will facilitate the execution of the ART technique and, one hopes, reduce the possibility of hand fatigue.
Read More......
As with any other oral treatment procedure, ART requires a proper patient-to-operator position. This requirement usually is not a problem in a dental surgery, but requires particular attention in other working environments. A number of devices have been developed and one that is very useful is a light weight, cushioned headrest attached to the short end of a table combined with a foldable cushion for the comfort of the person receiving the treatment.
Since its inception, the ART technique has undergone revisions aimed at improving the basic technique. Unlike many other restorative procedures, usually there is no need to give local anesthesia when using the ART technique because temperature induced pain from using a drill is avoided. Because the technique mainly involves the removal of decalcified tooth tissue, pain can be minimized, and often does not occur at all. Thus, fear of dental procedures is reduced.
The principal steps of ART are described below which are based on illustrations in the ART manual.
1. Isolate the tooth with cotton wool rolls. Only the tooth or teeth to be treated need to be isolated. Rationale : It is easier to work in a dry environment than a wet one. Cotton wool rolls are available in all parts of the world.
2. Clean the tooth surface to be treated with a wet cotton wool pellet. Have a small cup of water available. Separate the cotton wool pellets from each other. Then dry the surface with a dry pellet. Rationale : The wet cotton wool pellet removes debris and plaque from the surface, thus improving visibility. The extent of the lesion and any unsupported enamel then can be identified.
3. Widen the entrance of the lesion. This step is necessary only if the entrance is small. Place the working tip of the dental hatchet in the entrance and rotate it backwards and forwards. For opening very small cavities, the corner of the working tip is placed in the cavity first and rotated. Rationale : The hatchet replaces the bur. By rotating the instrument tip, unsupported enamel will break off, creating an opening large enough for the small excavator to enter.
4. Remove caries : Depending on the size of the cavity, use either the small or the medium sized excavator. Remove caries at the dentin-enamel junction before removing caries from the floor of the cavity. If working without an assistant, deposit the soft, excavated caries on the cotton wool roll placed next to the tooth. Thin unsupported enamel can be broken away carefully by placing the hatchet on the enamel and pressing gently downward. Wash the cavity with lukewarm water or a small cotton wool pellet. Rationale : All soft caries should be removed. Thin, often decalcified, unsupported enamel is relatively easy to break off. The enamel and the dentin-enamel junction need to be thoroughly cleaned to prevent caries progression and to obtain a good seal of the coronal part of the restoration. By cleaning the cavity in the proximity of the dentin-enamel junction before that closest to the pulp, any pain caused through the cleaning process is limited to a few moments at the end of cavity preparation.
5. Provide pulpal protection if necessary. This step is used only for very deep cavities and is achieved by applying a setting calcium hydroxide paste to the deeper parts of the floor of the cavity. The cavity floor does not need to be covered completely because it will reduce the area available for adhesion of the filling material. Rationale : Calcium hydroxide stimulates repair of dentin and glass ionomers are biocompatible. In a recent study on the fate of soft caries dentin left under glass ionomer fillings, hardening after seven months was reported.
6. Clean the occlusal surface. All pits and fissures should be clear of plaque and debris as much as possible. Use a probe and a wet pellet for cleaning. Rationale : The remaining pits and fissures will be sealed with the same material used for filling the cavity.
7. Condition the cavity and occlusal surface. Use a drop of dentin conditioner on a cotton wool pellet and rub both the cavity and the occlusal surfaces for 0 to 5 seconds. The conditioned surfaces should then be washed several times with wet cotton wool pellets. The surfaces are then dried with dry pellets. Rationale : Conditioning increases the bond strength of glass ionomers.
8. Mix glass ionomer according to manufacturer’s instructions. Do not alter the powder liquid ratio.
9. Insert mixed glass ionomer into the cavity and overfill slightly. The mixed material is inserted using the flat end of the applier, and plugged into corners of the cavity with the smooth side of an excavator or with a ball burnisher. Avoid the inclusion of air bubbles. The material also is placed over pits and fissures in small amounts.
10. Press coated gloved finger on top of the entire occlusal surface and apply slight pressure. Petroleum jelly (Vaseline) is used to coat the gloved finger to prevent the glass ionomer from sticking to the glove. Place the finger on top of the mixture, apply slight pressure for a few seconds, and remove the finger. Rationale : The finger pressure should push the glass ionomer into the deeper parts of the pits and fissures. Any excess material will overflow the occlusal surface and can be removed easily. A smooth restoration surface will result and reduce the need for carving.
11. Check the bite : Place articulating paper over the filling / sealant and ask the patient to close. The petroleum jelly (Vaseline) left on the surface will prevent saliva contact with the filling / sealant while the bite is checked.
12. Remove excess material with the carver. Usually only small corrections are required.
13. Recheck the bite and adjust the height of the restoration until comfortable.
14. Cover filling / sealant with petroleum jelly(Vaseline) once again or apply varnish.
15. Instruct the patient not to eat for at least one hour.
For restoring proximal cavities, a plastic strip and wedges are used to produce a correct contour to the filling.
Read More......
The atraumatic restorative treatment approach for dental caries is often abbreviated to the acronym ART.
In the ART approach, caries is removed by hand instruments only. The cavity and the pits and fissures in the same tooth surface are then carefully cleaned with a weak acid.
Restorative material that bonds chemically to tooth tissue is applied to the cavity and the pits and fissures of the same surface. In this approach, a restoration and a sealant are obtained in one procedure. It removes the need for expensive dental equipment – no drill, no electricity, just simple hand instruments.
ART is patient – friendly with only a minimal potential for pain.
Infection control is relatively simple, as only a small set of hand instruments is used.
Who benefits from ART ?
1.Remote communities with no dental services.
2.Towns and villages without electricity.
3.Housebound elderly.
4.Elderly living in nursing homes
5.The physically or mentally handicapped.
“Is ART really a new approach?”
The answer is both “yes” and “no”.
No, because for generations dentists have relied on hand instruments only; when equipment was out of order, electricity unavailable or the patient too frightened to accept the normal equipment in the dental office. However, only temporary filling materials were applied which would not last long. Such an approach was seldom studied and publications are hard to find.
And yes, because ART is an innovative approach for several reasons :
- ART is a determined effort to make long lasting restorations with hand instruments only.
- The idea of ART is strongly supported by the modern scientific approach to controlling caries : maximal prevention, minimal invasiveness and minimal cavity preparation. The use of hand instruments alone leads to preservation of tooth structure.
- Recent improvements in restorative materials, the chemical bonding to the tooth and fluoride release by, e.g., glass ionomers have given ART a solid practical basis.
- From the outset, a determined effort has been made to investigate the appropriateness, acceptability and effectiveness of ART
Read More......