Atraumatic Restorative Technique

One of the main objectives of advanced dentistry is to make the existing procedures as atraumatic as possible. For regular dedicated practitioners, dentistry has presented itself with certain critical problems and cases, classics being - how to carry out simple dental procedures in physically and mentally challenged patients or patients with special needs.

Over a period of time, dentistry has developed its course deriving both from the conventional and future perspectives of the profession and one such technique is termed as Atraumatic Restorative Technique(ART). This technique was founded by Dr. Joe Frencken in 1996 who introduced it with a purpose of making dentistry minimally invasive and less traumatic. It is based on removing decalcified tooth tissue using only hand instruments and restoring the cavity with an adhesive filling material.

Indications & contraindications -

The main indications of this technique can be classified under two broad categories which, for the purpose of understanding can be termed as -

1. The patient requirement factors and
2. The environmental factors.

The patient requirement factors include

• Uncooperative patients like paediatric patients who show an absolute fear towards the airotor and dental chair and refuse to obtain treatment by such means.
• Patients who are differently abled or who require special needs. For example, patients with autism and various other mental challenges become very uncooperative when subjected to the sound of airotor and machineries, in such cases invasion using hand instrument is preferred.
• Patients where caries have been formed on attrited teeth or are at a compromising position and using airotors would either expose the pulp or increase the sensitivity. Here, minimising of trauma becomes an inevitable part of the treatment plan.

The environmental factors includes

• The cessation of electricity,
• Inability and malfunctioning of the mechanical instruments,
• Clinical cases demanding no invasion or minimal invasion like pits and enamel caries.

ART has few contraindications. It is not advised to carry out this procedure in any cavity which is wide, deep and inaccessible.

Armamentarium -

The armamentarium of ART includes hand instruments which can be classified based on the classification given by G.V Black -

1. Exploring instruments- used in the confirmation of depth and invasion of the caries along with their existence which include

• mouth mirror
• straight probes
• shepherd’s hook or explorer of no. 21 and
• a periodontal probe.

2. Hand cutting instruments- which are primarily used for removal of weak and friable enamel, demineralised dentin, debris of the hard tissues, soft caries etc. This list includes instruments like

• enamel hatchet
• hoe
• spoon excavators of different sizes
• chisels of different sizes and
• gingival marginal trimmers.

3. Condensing instruments - The next set includes instruments used to carry the adhesive restorative material to the cavity to be filled. This includes -

• plastic filling instrument or cement carrying instrument
• burnishers and
• carvers

With amalgam falling into a least used category in the generation, carvers are rarely used to remove highpoints and excess of restorative cement.

In rare cases, matrix bands preferably T band or tofflemire matrix, is used to maintain the marginal integrity and contact area and point with the adjacent teeth.

The restorative materials used are

• Glass ionomer cement in maximum cases. In case the patient complains of a reaction or bio-incompatibility to the cement, the other alternatives are -
• Composites
• Polycarboxylate cements.

The glass ionomer cement provides an excellent matrix and serves as an anticariogenic agent with variable strength in the range of 150 MPA.