Manual 4: Atraumatic Restorative Treatment (ART)

Question 1

What is atraumatic restorative treatment?

Answer 1

• minimally invasive treatment involving selective caries removal with hand instruments, then filling with Glass Ionomer Cement (GIC) restoration

Question 2

What cases is ART used for?

Answer 2

• managing cavitated and non-cavitated single surface lesions in primary and permanent teeth
  - must have clear band of dentine between lesion and pulp
• when cooperation is limited e.g. children
• not commonly used as definitive tx option in permanent teeth

Question 3

What does ART cavity preparation focus on ?

Answer 3

• establishing clean peripheral margins for good seal to prevent carious lesion progression

Question 4

What are the main advantages of ART?

Answer 4

• can be done without rotary instruments and LA

- non AGP

Question 5

Why is ART not recommended for restoring multi surface cavities ? why must you do in such cases e.g. child with multiple surface cavities

Answer 5

• lower success rate

- alternative options such as HALL technique

Question 6

outline ART procedure

Answer 6

1. inspect tooth
2. Remove debris with brush/ gently probe fissure patterns if needed
3. clean fissure patterns with damp cotton pellet
4. Isolate tooth and achieve moisture control
5. isolate tooth and achieve moisture control: cotton wool roll / dry guard
6. Modify peripheral margins of cavity with ART instruments, enamel chisels or sharp excavators - remove all thin, demineralised overhanging enamel
7. use excavators to remove loose, carious dentine from the periphery of the cavity
8. Ensure peripheral margin of cavity and dentine enamel junction is caries free (no need to unnecessarily remove caries from base of cavity)
9. Very gently remove soft excess debris with spoon excavator
10. Dry tooth with cotton pellet
11. Fill cavity with glass ionomer, if in capsule then delivery directly, otherwise use flat plastic to overfill
12. once cavity overfilled, use flat plastic and gently drug the GI to cover remaining fissures an d seal them
13. place finger over tooth, pressing for 2 mins
14. Remove finger and examine restoration whilst maintaining moisture control
15. when happy, place petroleum jelly on occlusal surface
16. floss adjacent contact points
17. check occlusion with articulating paper

Question 7

What advice must you give to patient following procedure ?

Answer 7

• don’t eat/drink for another hour except water