Atraumatic restorative technique (ART)
Atraumatic restorative technique (ART)
Suitable for:
- a primary tooth with either a single-surface lesion or a two-surface lesion suitable for an intra-coronal restoration
Aim: To prepare a cavity and carry out a restoration with minimal stress for the child.
The atraumatic restorative technique (ART) may not require local anaesthesia (as sound dentine is not removed) and uses hand instrumentation to prepare the cavity and then place a restoration using glass ionomer. ART has been found to be less stressful for children than using conventional techniques and may be advantageous for anxious children. However, it must be performed well using sharp hand instruments with the correct technique, prior to glass ionomer placement, to give a high-quality result.
Technique
The technique relies on the use of very sharp hand instruments: enamel chisels to cleave off unsupported enamel, and then excavators to remove carious dentine.
Images show:
- excavator and enamel margin trimmer (left)
- using a sharpening stone to sharpen instruments (centre)
- an excavator sharp enough to cut paper (right)
Ensure excavators and enamel chisels/gingival margin trimmers are sharp.
Advise the child that it will sound “scratchy” or “picky”.
Use a firm finger rest.
If the entrance to the cavity is too small with no access to the carious dentine, enlarge it by placing an enamel access cutter, dental hatchet or sharp small spoon excavator into the breach in the enamel/cavity and rotating the instrument. This cleaves off thin and unsupported enamel that might fracture when the restoration is placed enabling access to carious dentine.
Remove caries and prepare the cavity walls and floor as described in Selective caries removal.
- Using a cutting movement across the carious lesion minimises pain during instrumentation, which occurs when pressure is applied in a pulpal direction increasing dentinal tubule fluid pressure that is then transmitted to the pulp.
Clean the cavity with a wet cotton pellet.
Dry the cavity using a dry cotton pellet. Do not use the 3-in-1 syringe as this will overly dry the dentine.
Ensure proper isolation and maintain an environment uncontaminated by saliva or blood.
Use an encapsulated material.
Use high-viscosity glass ionomer. Do not use conventional glass ionomer materials for restoration of a multi-surface cavity due to the unacceptably high failure rate.
Use the finger press technique to cover the rest of the surface and hold there until the glass ionomer cement has set.
Immediately rub some petroleum jelly over your index finger and press again for 20 seconds (or follow manufacturer’s instructions).
Advise the patient to avoid eating for an hour after treatment.