 Hello, everyone. Welcome back to a new session on dentistry. So today we have a very interesting topic that is a traumatic restorative treatment or art. So ART is based on removing decalcified tooth tissues using only hand instruments that is important hand instruments and restoring the cavity with an adhesive filling material commonly we use GIC. So it is a very minimal invasive approach to both prevent dental care isolation and stop its further progression. So let's see the historical part of ART. So it's initiated in the mid 80s in Tanzania in response to an inappropriately functioning community oral health program that was based on Western healthcare modern models and Western technology. So some people have gone from USA to do a community oral health program with all this sophisticated technology of dentistry. But what happens in Tanzania was there was no electricity. They could not function there all these machinery. So they tried to fill the cavity with using hand instruments and self adhesive stevens. So that's how it started practicing. There is a new invention of a new methodology which is known as a traumatic restorative treatment. So basically it consists of two components. One is sealing of this Carey's prawn pits and fissures. That is ART sealants and restoration of cavitated dentine lesions with restorations. So later this ART was adopted by World Health Organization in 1994 as an effective and efficient method of Carey's control. Because it has significantly achieved results all over the world, both in developing countries and developed countries, but mostly in developing countries where the skilled human and other resources are not readily available. Because the dentistry is always a costly business. So it is commonly distributed in the developing countries, sorry, the developed countries and developing countries are always devoid of this treatment pot. So they are suffering from the mortality of dental Carey's. So this part of developing regions or this ART might be a breakthrough and it can cause a significant reduction in the mortality by the dental Carey's. And also for undeserved communities in the industrialized world who are unable to afford for care for dental Carey's by more conventional means. So affordability is also a big problem for many of the people. So such people also can't LA men also can't do this ART need not to go to a dentist for a restorations. And which is carried out in absence of electricity pipe water and even anesthesia were found not only by dentists but also by other operating dental personals, which is dental therapist anyone can't do who have this basic idea of filling and this cement. So which has ultimately increased the chance for better oral health in undeserved communities in both developed and developed countries. And it reduces the minimize or reduces the oral health inequalities. So which is started into the clinical setting by 1990s, which is also can be accepted to treat anxious patients because it has minimal discomfort and pain. So this is how a Carey's process as we all know it start from here, here, here and ultimately it leads to the pulp then no point we need to go for an RCT. So what are the indications of ART? When conventional surgery procedures are impossible on anxious children and adults patients who are physically medically or mentally handicapped, cavitated tooth cavity could be reached with hand instruments. These are the indicator indications. So contraindications are there should be a presence of fistula or a swelling or the deep with pulpal exposure, pain on the tooth and there is a obvious Carey's cavity and the opening is inaccessible to hand instruments. There is a clear signs of cavity that is proximal surface but the cavity cannot be entered from the proximal or occlusion directions. In these cases, we are unable to perform a ART procedure. So what are the basic instruments which are common instruments like moth mirror, explorers, squeezes, excavators and dental hatches are the main thing and covers mixing pad and spatula. So this excavator and dental hatchet are the main instruments which this carry is removed. So materials we need to use glass iron or cement and conditional potent wood rolls, pellets, petrolemically and plastic strip and wedges. So the steps we know we need to arrange the patient operator assistance and we need to control the saliva and we need to maintain proper hygiene and control of cross infection always wearing gloves and mask and other hygiene measures. We need to keep our instruments sterile if boiling water or can we can use a pressure cooker. So Carey's removal by using hand instruments, spoon excavator or hatchet. We need to open the hole in the narrow widened hand entrance of the cavity by placing the blade of the dental hatchet. If temporary filling is there we need to remove it completely. We have to remove as much care as possible. Then we need to condition the cavity that is a fourth step in order to improve the binding of material. We need to remove the smear layer of dentin. So we always use 10% polyacrylic acid or we can also use a GIC liquid. Then we have to mix the material that is our glass iron or cement. We know how to mix the cement. So we need to use the powder and liquid. Then we need to place the material into the cavity and we can also use instruments or even thumb with a petroleum jelly with a gloved index finger to press and remove the finger sideways after a few seconds. This will remove the excess material from sides and will give a proper occlusion. And we need to instruct the patient not to eat or drink for one hour. So this is a finger technique. Once the material is placed we can use petroleum jelly and put it sideways. So that will be perfectly placed. We can also use instruments for removing the overhanging or the high points. So success rate is almost 55 to 75 percentage or 35 to 55 percentage in class 2 and class 3 cavities after one year. So what are the advantages of art? It is a biological approach that requires minimal cavity preparation and conserves sound to tissues and need for local anesthesia reduced. So psychological trauma also reduced. It simplifies infection control because we use hand instruments which can easily clean and sterilized and this technique is very simple. We can train non-tentral personnel or primary healthcare workers which is very much cost effective which can use on children's fearful adults physically and mentally and cap patients. Because of this carrier static properties of GIC the carrier's control will happen. The prevention of carrier's progression will be there and ease of repair of restorations. But the limitations are because we can't perform it on inaccessible cavities and the inferior mechanical and physical properties of the GIC compared to amalgam and composite and which is not suited in deep cavities with purple exposure or potential to expose bulb and also hand fatigue for the operator and which is also time consuming. Okay so that's all about art or a traumatic respiratory treatment. The most common two principles are usage of hand instruments and restoring the cavity with adhesive filling materials. These two are vital parts of art and we need to know the advantages disadvantages indications and contra-indications. So I'll come up with pit and fissure serums and PRR in my next videos. Thank you.