Minimal Intervention (ART)

• What are arrested caries?

  Arrested caries: dark, hard, non-progressive
• What did G.V Black say can arrest a carious process?

  Plaque control/ removal/ use of fluoride
• What is historic caries removal?

  - Remove all infected dentine- Remove stained dentine- Expose pulp and carry out Root Canal Therapy (RCT)
• What is the pulps response to caries?

  - dentine has a physiological defence- minerals plug tubules as the sclerose (creates translucent zone)- secondary dentine formation at pulpal site- tertiary dentine can form where rapid caries occurs
• What is deep caries associated with?

  Tertiary dentine
• What does tertiary dentine contain?

  Irregular tubules, do not connect with those of original dentine, so less permeable
• When does pulp death occur?

  When bacteria invade the pulp
• How does the pulp respond to cavity preparation?

  Pulp may be affected by heat and chemicals
• What is Stepwise caries removal technique?

  Mertz-Fairhurst et al – 1998  Showed sealing carious dentine without any cavity preparation at all results in non-progression of the lesions  Restorations can last 10 years in this state. Takes advantage of the reparative capabilities of the pulp. Operator leaves some soft demineralised dentine over the pulp. Peripheral caries is still removed (to allow tight seal between tooth and restoration). Remove sufficient tooth to allow for restorative material to be placed

  
• What is Stepwise cavity preparation?

  Soft dentine over pulp is left to prevent exposing it  Place GIC over pulp and restore cavity with GIC  GIC is adhesive so forms a good seal to cavity  Definitive restoration placed at either at time or 2-3 years after

  
• What is soft dentine?

  Deforms when a sharp probe is pressed into it, can be removed with a hand excavator with little force (Infected Dentine)
• What is leathery Dentine?

  Does not deform when a sharp probe is pressed into it. Can still be removed without much force, has a latent 'tackiness' (Affected Dentine)
• What is Firm Dentine?

  Physically resistant to hand excavation, needs pressure with an excavator to lift it
• What is Hard Dentine?

  Only a sharp cutting edge or a bur will lift it, scratchy sound when probe is taken over it (Sound Dentine)
• What does GIC do in cavity prep?

  eliminates air and carbohydrates leaking into the cavity - rendering bacteria inactive leaches fluoride and calcium ions to help remineralisation
• What is the Atraumatic Restorative Technique? (ART)

  Used in underdeveloped countries Hand instruments remove superficial infected dentine Affected dentine left over pulp GIC placed Do not replace tooth form, aesthetics and function
• When is ART good to use?

  For children or very nervous adults to stabilise caries short term. Teeth can be re-assessed later
• What are the two components of ART?

  - A preventative ART sealant- A restorative ART sealant
• What is ART sealant?

  High viscosity GIC (HVGIC) placed over pits and fissures prone to caries using finger technique. Excess removed by hand with excavator
• What is ART restoration?

  Removal of soft dentine with hand instruments and placement of high viscosity GIC