KDA Annual Conference. , Panafric Hotel, Nairobi
Dental caries is a world-wide disease, having its aetiological factors involving cariogenic bacteria, saliva composition and flow-rate, exposure to fluoride, tooth integrity and dietary habits. The treatment of dental caries is two prong. First, through a surgical model, entailing the removal of carious materials from a dental cavity and sealing it with an appropriate dental restorative material. Second, a medical model which comprises the reduction of the risk to dental caries and controlling the carious process through a remineralization process.
Atraumatic restorative treatment (ART)
Atraumatic restorative treatment (ART) utilises only hand instruments for its application. This is one dental caries treatment method that incorporates certain facets of the two caries treatment models described above. ART is a simple clinical method that can be performed by any dental personnel with a reasonable clinical background knowledge on the management of dental caries. Once a tooth has been selected that needs to be treated using the ART approach, the operator isolates the tooth with cotton wool rolls. If necessary, the cavity entrance is widened using a hatchet or hoe, before removing the carious materials with an excavator. The cavity is rinsed and dried using wet or dry cotton pellets respectively. The dentine is conditioned with appropriate conditioner for 15 seconds.
After mixing the glass ionomer following the manufacturer's instructions, the mixture is inserted into the cavity using an applier or carver, overfilling it, so that by use of a gloved finger rubbed with petroleum jelly, the material is pressed into the prepared cavity and fissures (press finger technique). After 5 minutes, the excess material is removed with the carver and the occlusion checked. A thin layer of petroleum jelly is applied over the restoration to protect the restoration from moisture contamination, before discharging the patient with the instructions not to chew any food within the first one hour.
Materials used with ART
The preferred material for use with the ART technique is high viscosity glass ionomer cement (GIC). This glass ionomer cements have been developed specifically for use with the ART technique. Like the other glass ionomer cements, this material is self curing, adheres to the tooth tissues, has good marginal adaptation, fluoride releasing properties, reasonably good aesthetics and biocompatible with the oral tissues.what is of importance here is that the high viscosity GCs, though still possess lower material strength, their strength is much higher than the ordinary GICs. However, That is why they still posses same some pertinent shortcomings that include the poor physical strength, water sensitive, long setting reaction, low wear resistance, low compressive and tensile strength.
Advantages and Shortcoming of ART technique
ART is a simple technique to learn and apply and does not need sophisticated dental equipment. For this reason, ART approach can be applied in the field environment, even where there is no electricity or piped water systems. However, the technique has also got its own shortcomings that include hand fatigue, poor strength of the GIC material used with the technique, poor aesthetics due to discolouration of GIC, poor attitude by some dentists who consider the technique to be of low calibre.
Success rate of ART restorations
For periods ranging up to three years, the ART restorations have been reported to have success rates of 85% or higher for occlusal restorations, but of about 49% and lower for proximal restorations. This success rate is obviously dependent on the operator experience, the caries removal from the cavity, the effectiveness of the isolation method used, the size of the cavity, the post-restoration meal consumed by the patient soon after the placement of the restoration, the cooperation of the patient during the procedure and afterwards and the type of material used for the restoration.
Future of the ART technique
ART is not a compromise treatment but an alternative treatment method that is simple and practical for the prevention of dental caries, particularly, for developing nations with scarce resources. It is a technique that is less costly than the conventional methods. ART should be able to form part of a total oral health care for promotion and prevention of dental caries, potentially in children, fearful adults and the handicapped persons, especially in restoring class I and V cavities or as interim restoration in some other cases.