traumatictraumatic

estorativeestorative

reatmentreatment

• A Innovative treatment approach for Dental Caries .

• ART is maximally preventive and minimally invasive approach to stop further progression of dental caries.

•ART - Approach is not only logical but based upon sound scientifically based principles.

•Method of preserving decayed teeth in people of all ages both in developing countries and disadvataged communities --- where resources are scarce.

• ART does not rely on electricity or expensive equipment – treatment could be provided anywhere.

• ART is appropriate and valid in outreach situations in developing countries.

J. Frencken

C. Holmgren.

DEVELOPMENT OF ARTDEVELOPMENT OF ART ART PIONEERED IN MID 1980s -- as part of ART PIONEERED IN MID 1980s -- as part of

Primary Oral Health Care at Dar-El-Salaam, Primary Oral Health Care at Dar-El-Salaam, Tanzania-- Jo E. Frencken.Tanzania-- Jo E. Frencken.

First Clinical Trial conducted at Thailand First Clinical Trial conducted at Thailand (1991).(1991).

Large scale Clinical Trial and Testing was Large scale Clinical Trial and Testing was done at Zimbabwe (1993).done at Zimbabwe (1993).

Later it was tried at Pakistan (1995).Later it was tried at Pakistan (1995). Subsequently tried in USA & Europe.Subsequently tried in USA & Europe.

WWorldorld

HHealthealth

OOrganisationrganisation

WHO presented ART on “World Health WHO presented ART on “World Health

Day” on 7th April 1994.Day” on 7th April 1994.

Beginning of the Oral Health Year-1994-95.Beginning of the Oral Health Year-1994-95.

FDI recommended and advocated the ART FDI recommended and advocated the ART

in 1998. in 1998.

ART can be applied when:- There is a cavity involving the dentine, and- That cavity is accessible to hand instruments.

ContraindicationsContraindications:-:-

(1)In the presence of abscess or fistula near the tooth.

(2)Where there is pulp is exposed .in this case we have to do root canal treatment.

(3)Painful teeth and the pulp inflammation.

(4)The opening of pulp is in accessible to the hand instruments. eg-in the proximal caries there is clear sign of cavity but the instruments cant reach that point.

The two main principles of The two main principles of ART are:ART are:

Removing carious tooth Removing carious tooth tissue using hand tissue using hand instruments onlyinstruments only

Restoring the cavity with Restoring the cavity with glass ionomerglass ionomer

GLASS IONOMER CEMENTGLASS IONOMER CEMENT

Glass ionomer is very useful as dental restorative material because:-

(1)They can be applied to caries in very early lesions.

(2)It adheres to the tooth structure chemically.

(3)It is anticariogenic because it releases fluoride.

(4)It does not inflame the pulp and gingiva.

The ART TechniqueThe ART Technique

Two layers of carious Two layers of carious dentinedentine

Outer Outer (‘infected’)(‘infected’)– Bacterial Bacterial

– InvasionInvasion– UnreminerizableUnreminerizable– DeadDead– Without Without

sensationsensation

Inner Inner (‘affected’)(‘affected’)– Few BacterialFew Bacterial– ReminerizableReminerizable– AliveAlive– SensitiveSensitive

Instruments & materials for ART properlyInstruments & materials for ART properlyPacked & placed in a basket for easyPacked & placed in a basket for easy

Transportation in an outreach situationTransportation in an outreach situation(Thailand)(Thailand)

The use of ART at a courtyard The use of ART at a courtyard Of A primary school in SyriaOf A primary school in Syria

ART in schools.

a). Chinaa). China

b). New Zeelandb). New Zeeland

c). Zimbabwe. Equipment c). Zimbabwe. Equipment Layout in a class room.Layout in a class room.

CARISOLVCARISOLV

TM

Earlier Chemo-Mechanical Preparation--CARIDEX Earlier Chemo-Mechanical Preparation--CARIDEX (1978)(1978)

System based non-specific Proteolytic effect of System based non-specific Proteolytic effect of NaOCl.NaOCl.

The development of CMCR -- first initiated in 1980 The development of CMCR -- first initiated in 1980 by Swedish Scientists at Malmo, and Goteborg, by Swedish Scientists at Malmo, and Goteborg, Sweden.Sweden.

Christer started MediTeam (MT) and had joint Christer started MediTeam (MT) and had joint collaboration with Biochemist, Lars Strid -- collaboration with Biochemist, Lars Strid -- discovered the shortcoming of CARIDEX.discovered the shortcoming of CARIDEX.

During 1980 Ericcson improved the CARIDEX formula.During 1980 Ericcson improved the CARIDEX formula. And later in 1990, in joint collaboration with other And later in 1990, in joint collaboration with other

Scientists developed CARISOLV.Scientists developed CARISOLV. CARISOLV DEVELOPMENT -- NaOCl with three CARISOLV DEVELOPMENT -- NaOCl with three

naturally occurring amino acids -- Glutamic acid, naturally occurring amino acids -- Glutamic acid, Leucine and Lysine.Leucine and Lysine.

CARISOLV also contains Methyl cellulose and CARISOLV also contains Methyl cellulose and Erythrocin.Erythrocin.

Ph of CARISOLV is 11.Ph of CARISOLV is 11.

Carisolv TM

Non invasive ,tissue – preservingCaries removal

Step by Step treatment of root caries lesions using CarisolvTM

Apply gel with theTip called star 3.

Wait 30 seconds

CLINICAL STUDIES AND EVIDENCECLINICAL STUDIES AND EVIDENCE

CARISOLV did not affect healthy enamel and CARISOLV did not affect healthy enamel and

Dentin compared with Phosphoric Acid Dentin compared with Phosphoric Acid

etching which increases surface etching which increases surface

roughness of both healthy Enamel and roughness of both healthy Enamel and

Dentin ( Kalige et al, 1999).Dentin ( Kalige et al, 1999).