ART

[drmithila]

Glass-ionomers have significantly improved in recent years. Have you noticed any changes in the long-term outcome of ART restorations as a result of these developments?

The current high-strength glass-ionomer is accepted for simple posterior teeth restorations, but not yet for complex cases. Many dentists who do restorations regularly are awaiting improved glass-ionomers in terms of wear resistance, flexural strength and aesthetics.

Manufacturers have added ceramic or nano-apatite to the material in an effort to improve its mechanical properties, but as far as I know these developments have not reached market readiness. However, any improved or cheaper glass-ionomer or adhesive restorative material would certainly be welcomed as an alternative to dental restoration with mercury fillings.

Critics also claim that hand instruments cannot remove carious dentine completely. What are the limits of ART?

The overall question is: how clean must a cavity be before restoration? Prof. Edwina Kidd, Professor of Cariology at King’s College in London, put forward this question in 2004. What she found was that a certain amount of softened and demineralised dentine can be safely left under glass-ionomer restorations, provided the margin is completely sealed around its full circumference. Glass-ionomers can completely seal at the margin between the glass-ionomer and the tooth structure.

Coincidently, Prof. Kidd’s findings support ART, which has used glass-ionomer material from the very beginning. Moreover, an increasing number of papers support that partial caries removal can prevent accidental exposure of the pulp and cause less pain to patients. More important is that ART is a most conservative technique that saves sound tooth structure, which is now considered minimally invasive dentistry.

There is definitely a limitation to ART, which is similar to any dental restoration. For example, ART cannot be applied to completely exposed teeth, a fistula opening or in the case of a patient with a history of gum swelling or severe pain that needs endodontic treatment rather than normal restoration.

It is claimed that ART was developed in such a way that it can also be performed by non-dental health care workers. Is there any evidence that supports this?

Owing to the simple procedure of ART, it has been suggested that it could be performed by non-dental health workers to make the restoration more accessible to remote populations. However, those doctors need to be well trained and carefully monitored especially in terms of case selection, handling of the instruments and mixing of the glass-ionomer. To my knowledge, most countries do not allow non-dental personnel to perform any procedure in the oral cavity currently. Therefore, dental auxiliaries, such as dental therapists, dental nurses or even dental hygienists, are still the key performers of ART besides dentists.

The WHO and the FDI World Dental Federation consider dental caries a chronic disease, especially in developing countries. Do you think that ART could help to overcome the epidemic?

WHO has put much effort into health promotion as key to overcoming the epidemic of tooth decay, but there is already an existing caries problem in almost every age group, especially in children. ART could definitely be a suitable method for making dental restoration more accessible to people in developing countries. Joint initiatives between health promotion and ART for the future of cavity-free communities will definitely support the Global Caries Initiative put forward by the FDI.