1. Atraumatic Restorative Treatment (ART)
Dr Hidayathulla Shaikh

2. Introduction
ART is based on modern knowledge about minimal intervention & minimal cavity preparation for carious lesions.
It is procedure based on removing carious tooth tissue using only hand instruments & restoring cavity with adhesive restorative materials.
ART was started in mid 1980s -- as part of Primary Oral Health Care at Dar-El-Salaam, Tanzania-- Jo E. Frencken.
First Clinical Trial conducted at Thailand (1991), Large scale Clinical Trial and Testing was done at Zimbabwe (1993).
Later it was tried at Pakistan (1995), subsequently tried in USA & Europe.

3. This procedure has been specially developed for people in less industrialized countries.
Also for special groups like institutionalized adults, physically and mentally handicapped people, refugees, people in deprived communities etc who cannot seek restorative care.
As it is a tooth friendly procedure, there are great potential for its use in children.
The two main principles of ART are –
Removing carious tooth tissues using hand instruments only.
Restoring a cavity with a restorative material that sticks to the tooth.

4. Reasons for using hand instruments rather than electric rotating headpieces are –
1) conserves sound tooth and causes less trauma.
2) low cost of hand instruments
3) Limitation of psychological trauma
4) Simplified infection control
Indications
Only in small cavities involving dentine
Cavities accessible to hand instruments
In public health programs

5. Contraindications
Presence of abscess, sinus or fistula near the carious tooth
Pulp exposure
Teeth having pain from a long time-chronic pulpitis
Obvious caries inaccessible to hand instrument
Advantages
Instruments are Easily available and less expensive
Conservation of tooth structure
No noise
No water and suction required
Minimal pain
Low cost of the whole procedure
Minimal operator training is required

6. PROCEDURE
Position
A. patient-supine on a simple table with head support
B. Operator near the head of table/patient

9. Instruments Mouth mirror Explorer Tweezer Spoon excavator Hatchet
Applier
Carver
Mixing pad and spatula

10. Steps in ART
1.Isolate the tooth with cotton
2.Clean the tooth surface to be treated with wet cotton

11. 3.Widen the entrance of lesion with hatchet and remove the unsupported enamel.

14. 4.Remove caries with excavator-circular scooping movements
5.Pupl protection-if necessary
6.Clean the occlusal surface

15. 7.Condition the cavity and occlusal surface with 10% polyacrylic acid
8.Mix GIC-mixing sec.final mixture should be smooth like chewing gum.

17. 9. Insert GIC into cavity and slightly overfill.
10.Press with coated gloved finger on entire occlusal surface and apply slight pressure

22. Check the bite
Remove excess material with carver
Cover filling with petroleum jelly and then apply varnish

23. Limitations Long term survival rate is questionable, so far-3years.
Can be done only in areas accessible to hand instruments.
Possibility of hand fatigue over a period of time.
Hand mixing of GIC-can result in improper mix and can cause weak strength of restoration
Questionable acceptance by dental profession.
People misunderstand it for a temporary filling.