atraumatic restorative treatment Flashcards
What is ART?
A tissue-saving caries management approach that uses hand instruments for opening caries cavities and removing decomposed carious dentine, followed by restoration with high-viscosity GIC.
Characterized by:
Sealing caries prone pits and fissures and restoring cavitated lesions with sealant-restorations
What are the potential issues with therapeutic sealing?
Staining perceived as recurrent caries
Inadequate seal/contamination
What are the methods of ART?
Preventative (94% effective)
Therapeutic (75% effective)
Why use ART?
It causes less pain and anxiety to patients than rotary instruments.
Useful when resources are limited.
Inexpensive
Conservative approach
No need for LA
Reduced secondary caries in GIC
What are the 2 year survival rates of ART restorations?
Single surface:
Primary teeth 93%
Permanent teeth 85%
Multi surface:
Primary teeth 12 - 60%
Permanent teeth 30%
When should GIC not be used?
ART using high viscosity GIC cannot be used for multi-surface cavities
Not recommended for class II cavities in primary molars
Why can’t primary tooth class 2 cavities be filled with GIC via ART?
Thinner enamel and dentine (1/2 of permanent teeth)
Direction of the enamel rods in cervical area is angled towards the occlusal surface.
In the permanent teeth they are towards the apical direction
Larger pulp in primary teeth relative to the crown
What is interim therapeutic restoration used for?
ITR may be used to restore, arrest or prevent the progression of carious lesions in young patients, uncooperative patients or patients with special health care needs
How is ITR performed?
Removal of caries using hand or rotary instruments with caution not to expose the pulp
Removing caries from the periphery of the lesion as much as possible.
Restoration with adhesive restorative material such as GIC or resin modified GIC
What are the disadvantages of ITR?
It is meant to be an interim restoration not definitive
High risk of failure is seen in multi-surface cavities
Reduces the levels of cariogenic bacteria but levels return to normal after 6 months
