ATRAUMATIC RESTORATIVE TREATMENT

• ATRAUMATIC RESTORATIVE TREATMENT is a procedure based on removing carious tooth tissue using hand instruments and restoring the cavity with an adhesive material.
• This technique is useful for nervous patients who are scared of drilling and restorative procedures.
• Removing carious tooth tissue using hand instruments only.
• Restoring the cavity with adhesive cement like GIC
• ATRAUMATIC RESTORATIVE TREATMENT was officially endorsed by the world health organization in 1994

Following are the reasons for using hand instruments only

1. Accessibility
2. Tooth conservation
3. Affordability
4. Limitation of pain
5. Reduce physical trauma
6. Infection control

GIC AS RESTORATIVE MATERIAL IN ART

• GIC is the most commonly used adhesive material in ATRAUMATIC RESTORATIVE TREATMENT
• Release fluoride after setting which helps in preventing caries around restorations
• Chemically bind to the teeth so the need to cut the sound tooth tissue to prepare cavity is reduced
• Harmless to dentin and pulp

INDICATIONS

• Only in small cavities
• Only in those cavities which are accessible to hand instruments

Operators working position and posture

• The work posture and position of the operator should provide the best view of the inside of the patient’s mouth .
• The operator should be positioned behind the head of the patient
• Patient should be placed on flat surface a bamboo or a wooden bed , portable dental bed or a table

INSTRUMENTS

• Mouth mirror
• Explorer
• Tweezers
• Spoon excavator
• Dental hatchet
• Carver
• Mixing pad and spatula

MOUTH MIRROR

• Providing indirect vision of any part of oral cavity
• To retract the lips cheek and tongue
• To provide direct illumination on the gums and teeth where direct light doesn’t reach.

EXPLORER

• For the identification of soft carious dentin

TWEEZERS

• For carrying cotton wool rolls , cotton wool pellets ,wedges

SPOON EXCAVATOR

• For removing soft carious dentin
• For removal of excess of GIC

DENTAL HATCHET

• For widening the entrance to the cavity
• Removing the unsupported and carious enamel

MATERIALS

• Cotton wool rolls
• Cotton wool pellets
• Petroleum jelly
• Plastic strips
• Wedges
• Glass Ionomer cement
• Mixing pad and spatula

PETROLEUM JELLY

• To keep moisture away from GIC
• To prevent gloves from sticking to GIC

RESTORATION OF A CAVITY PROCEDURE

• Prepare the restorative material
• Then we prepare a cavity
• Remove plaque from the tooth surface
• Dry the tooth surface with cotton wool pellets
• Remove carious dentin with excavator starting at enamel dentin junction.
• Clean the cavity with wet cotton pellets

PROCEDURE

• Dry the cavity with cotton pellets to complete the procedure
• Insert the mixture in small amounts in the prepared cavity using a carver
• Using press finger technique complete the filling.
• Remove visible excess of GIC with a medium or large excavator
• Apply a layer of petroleum jelly
• Remove cotton wool rolls
• Ask the patient not to eat for an hour

ADVANTAGES

• Painless
• Cost effective
• Less trauma to teeth
• Conservation of sound tooth tissues
• A friendly procedure , in children and in fear full adults.
• For special groups such as mentally and physically handicapped.