Hesperian Health Guides
How to Place a Permanent Filling Using ART
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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.
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.
|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.
|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.
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.
If you do not have carbon paper, darken some paper with a pencil.
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.