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How to Place a Permanent Filling Using ART

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HealthWiki > Where There Is No Dentist > Chapter 10: How to Fill a Cavity > How to Place a Permanent Filling Using ART

Atraumatic Restorative Treatment (ART) is a way to place a permanent filling without using an expensive dental drill. This method was invented in Tanzania, East Africa, and it is now being used by dental workers in many parts of the world.

The process for placing a permanent filling using ART is similar to placing a temporary cement filling, but instead of cement you use a sticky material called glass ionomer. Once glass ionomer is in the cavity, it releases fluoride and helps prevent new cavities from forming.

The Instruments and Filling Material you need for ART

The dental instruments you need for ART are the same as the ones for cement fillings. You will also need petroleum jelly (such as Vaseline) and a material called glass ionomer. Glass ionomer comes in “low viscosity,” “medium viscosity,” and “high viscosity” forms (“viscosity” means ‘thickness’). High viscosity glass ionomer works best for ART because it is the strongest and lasts for a long time.

a jar of Vaseline and bottles of glass ionomer powder and liquid.

Glass ionomer is expensive, but sometimes local governments will provide it at lower cost. A package of glass ionomer usually comes with a bottle of liquid and a bottle of powder that you mix together for ART.

It is important to store glass ionomer in a cool place.

Follow steps 1 and 2 for cement fillings. Then return here for steps 3 to 6.

3. Clean the cavity. After you have removed the decay, clean the cavity so that the glass ionomer will stick well. The best way to do this is with the liquid from the glass ionomer.
illustration of the below: cleaning the cavity.
Be sure that the glass ionomer liquid you are using has acid in it and is not just water. If your glass ionomer liquid is just water, clean the cavity with polyacrylic acid or cavity conditioner instead.

Put one drop of glass ionomer liquid on the glass slab. Using the tweezers, pick up a piece of cotton, dampen it in water, then dip it into the glass ionomer liquid. Use the cotton to clean the cavity.

Use another piece of cotton dipped only in water to wash the cavity out. Use a new piece of cotton to wipe out the cavity and dry it.

Put a piece of cotton inside the cavity while you mix the glass ionomer. This will keep the cavity dry.

If a cavity goes down between two teeth, one other step is necessary. You need to take care that the glass ionomer does not stick to the other tooth or squeeze and hurt the gum.

Before you mix the glass ionomer, place something thin between the teeth such as the soft stem from a palm leaf, a toothpick, or a tooth from a comb. A small strip of tin foil or a strip of plastic cut from a plastic bottle will also work. Be sure it has a rounded edge to prevent damage to the gums.

a toothpick or stem placed between 2 teeth at the gum.
the teeth after removing the toothpick or stem.
space left
for the gum
before after
4. Mix the glass ionomer on a piece of smooth glass just before using it. The package of glass ionomer should have a bottle of liquid, a bottle of powder, a measuring scoop, and instructions for how much to use of each. Place a level scoop of the powder onto the glass, then close the powder bottle right away.

Put a drop of liquid separately on the glass. It is important for this liquid to have no air bubbles, so if your first drop has bubbles, keep holding the bottle upside down and place a second drop somewhere else on the glass to use for mixing.

Spread the liquid around a little, pull half of the powder to the liquid with the mixing tool, and mix them together quickly but carefully. Add more powder until you have used the full amount instructed. It is important to mix in all the powder and not add extra liquid so the filling is strong. The mixture should become thick and smooth like chewing gum.

Some dental workers use the first drop with air bubbles to clean the cavity for step 3.
2 drops on the glass, one with air bubbles.
DENT Ch10 Page 154-2.png
Now, take the cotton out from inside the cavity. Check to be sure the cavity is dry. If the cotton around the tooth is wet, change it.
5. Fill the cavity with the glass ionomer right away. Use your filling tool to carry a small amount of the glass ionomer mixture to the cavity. Carefully press the mixture against the sides of the cavity. Then add more glass ionomer to fill the center of the cavity.

illustration of the above: filling the cavity.
DENT Ch10 Page 154-4.png
DENT Ch10 Page 155-1.png
Remove your finger carefully from the side so you do not lift out the filling.
Keep adding glass ionomer until the cavity is over-filled. Put extra glass ionomer in any other pits on the surface of the tooth near the cavity. Rub petroleum jelly on your finger and press down firmly onto the filling for a few seconds, rolling your finger from side to side. This will make the filling smooth.
6. Remove extra glass ionomer from the tooth before it gets too hard. Use the spoon tool or the filling tool to quickly and carefully remove any loose pieces of glass ionomer.

Let the glass ionomer harden for less than 1 minute, then ask the person to gently close the teeth. The teeth should come together normally and not hit first against the filling.

DENT Ch10 Page 155-2.png
If you do not have carbon paper, darken some paper with a pencil.

Check to see if part of the filling is too high by having the person bite on a piece of carbon paper. If there is too much filling, the carbon paper will darken it. Scrape away the extra filling from that place using the filling tool and check again.

The person must not leave your clinic until the filled tooth fits properly against the other teeth.

Once the teeth fit together, spread petroleum jelly over the filling with your finger. Petroleum jelly will protect the filling from water and saliva for at least an hour while the filling fully hardens. Take out all the cotton.

After you have finished placing the filling, explain to the person how to take care of it, and clean your instruments.

This page was updated:19 Feb 2018