Hand Instruments Used in ART Atraumatic restorative technique (ART), which is considered a temporary or transitional solution, involves the removal of carious enamel and dentin and the replacement of lost tooth structure with a glass ionomer or compomer material.

ART is used in situations where classical restorative care cannot be delivered. The purpose is to prevent tooth decay from worsening until more definitive care can be delivered or until care is no longer necessary owing to the exfoliation of a primary tooth. ART results in the reduction of bacterial mass through the removal of carious tooth structure and the remineralization of affected (not infected) dentin.

ART employs simple but effective techniques of hand instrumentation and slow-speed rotary preparation. It uses materials with low technique sensitivity, which is important for young children, who have short attention spans. No local anesthesia is required, and ART can be completed quickly—also important considerations when working with young children.

ART may be a good treatment choice when behavior or other factors (such as the inability to use pharmacological assistance owing to cost or to the parents’ wishes) make it impossible to deliver classical restorative dentistry. However, ART has limitations.

In deciding whether to use ART, the severity of dental caries must be considered. On a tooth-by-tooth basis, the lesions chosen for ART should be circumscribed by healthy enamel and should involve only dentin that is not close to the dental pulp. The tooth may have exhibited reversible pain or sensitivity, but it should be vital and, ideally, have no symptoms suggesting involvement of the pulp. Finally, ART requires frequent follow-up and should be confined to teeth that have a reasonable remaining functional life span to make the cost and effort worthwhile.

ART can be accomplished using the knee-to-knee technique, but this is recommended primarily when only one tooth is involved. It is preferable to place the child in the dental chair, if possible. (For more information about using the dental chair, see section 3.2 of this module.)

The use of etching and bonding is elective. A cooperative child will allow the dentist to take the time required to use an acid-etch-bond technique, but in most cases, lack of cooperation and the likelihood of contamination make this step difficult. Similarly, the choice between using rotary or hand instruments is driven by the risk to the child and by the dentist’s ability to stabilize the child.

The final restoration is covered with a sealant if etched or painted over with a tooth-colored fluoride varnish to maximize remineralization. Some finishing may be necessary before performing this last step to obtain a smooth and anatomic surface. ART is not useful for occlusal lesions and should be used primarily for facial or interproximal decay.

For more information on ART, see the American Academy of Pediatric Dentistry's Policy on Alternative Restorative Treatment (ART).

Photo reproduced with permission from Jo Frencken, D.D.S.

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