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ATRAUMATIC RESTORATIVE TREATMENT (ART): EXPERIENCE
REPORT
Ana Flávia Vieira Alves1
Anna Lídia Lima Silva2
Anne Caroline Ribeiro Lacerda3
Beatriz Vieira de Melo Carlini4
Laylen Kaylanne simplicio Oliveira5
Lívia Jordania Lino Figueredo6
Kádja Alves Freitas Cruz7
Thawan Robério Gomes Pereira de Souza8
Malvina de Souza Pereira9
Abstract: Dental caries is a disease with wide prevalence and impact on the oral health of the
population, being considered a public health problem and requiring an intervention, which depending
1 Undergraduate student in dentistry at the Soberana Faculdade de Saúde de Petrolina, 56308-
000, Petrolina – PE, Brazil.
2 Undergraduate student in dentistry at the Soberana Faculdade de Saúde de Petrolina, 56308-
000, Petrolina – PE, Brazil.
3 Undergraduate student in dentistry at the Soberana Faculdade de Saúde de Petrolina, 56308-
000, Petrolina – PE, Brazil.
4 Undergraduate student in dentistry at the Soberana Faculdade de Saúde de Petrolina, 56308-
000, Petrolina – PE, Brazil.
5 Undergraduate student in dentistry at the Soberana Faculdade de Saúde de Petrolina, 56308-
000, Petrolina – PE, Brazil.
6 Undergraduate student in dentistry at the Soberana Faculdade de Saúde de Petrolina, 56308-
000, Petrolina – PE, Brazil.
7 Undergraduate student in dentistry at the Soberana Faculdade de Saúde de Petrolina, 56308-
000, Petrolina – PE, Brazil.
8 Undergraduate student in dentistry at the Soberana Faculdade de Saúde de Petrolina, 56308-
000, Petrolina – PE, Brazil.
9 Master in pediatric dentistry from São Leopoldo Mandic – 13045-755, Campinas – SP, Brazil.
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on the extent of this lesion, can be treated with a minimally invasive restoration removing only the
infected dental tissue. Therefore, Atraumatic Restorative Treatment has been proposed as a viable
alternative to meet this need, in addition to the possibility of serving patients in social vulnerability
because it has: high cost-benet, easy technique and does not require electrical energy. Furthermore,
this work aims to report an experience lived in the Oral Health II discipline, estimating for the
population of the Monsenhor Bernardino School, in the State of Pernambuco, the prevalence of dental
caries; highlight the technique and use of Atraumatic Restorative Treatment, as well as its application.
Through the implementation of oral hygiene guidance (OHO), supervised tooth brushing, plaque
detection (IHO-S) and topical uoride application (ATF) in classrooms, dental kits were provided to
all students. These kits contained toothbrushes, toothpaste and dental oss, as well as some toys and
fun activities on oral care.
Keywords: Atraumatic Restorative Treatment, Oral Health, Glass Ionomer Cement, Dental Caries.
INTRODUCTION
Atraumatic Restorative Treatment is currently understood as a minimally invasive approach
that includes preventive, therapeutic and restorative measures in relation to dental carious lesions and
in the control of this disease, including the care of special patients. This type of treatment takes into
account that not all children can be taken to the ofce, thus being able to perform the procedure in the
eld. (SOBRINHO et al, 2022)
The caries disease has a multifactorial etiology, however, it is a destruction of the calcied
tissues of the tooth (called enamel, dentin and cementum) through the attack of acids produced by
bacteria present in the oral cavity. Enamel-restricted caries lesions can be contained through plaque
control, dietary changes, and uoride use. Subsequently, lesions that affect more dental tissues can be
treated using the ART technique, involving a minimally invasive and painless intervention, only for
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the removal of infected dental tissue, through cutting instruments, lling the cavity with restorative
material, usually Glass Ionomer Cement (VSD). On the other hand, conventional restorative techniques,
which require electricity to drive dental motors, ART is a feasible alternative for socioeconomically
disadvantaged populations. (NAVARRO et al, 2015)
In order for oral health promotion and intervention actions such as ART to be carried out, it is
of paramount importance to carry out epidemiological surveys, studies of cariological prevalence were
carried out in the community through dmft and dft in order to support the relationship between the
needs of different age groups and the forms of treatment performed, including referral to specialized
care at the teaching clinic of the Faculty of Health of Petrolina/PE-Soberana. (ARQUETI, 2024)
This study aimed to estimate, through a sample of the population of schoolchildren, the
prevalence of dental caries, to show the technique and use of Atraumatic Restorative Treatment, as
well as its application in view of facilitated care, cost-benet, acceptance of it through consent forms;
The lack of knowledge of the parents or guardians of the students about the technique to be used and
the distrust of its quality due to the non-use of traditional equipment, may justify the reduced number
of authorizations of the students’ guardians compared to the number of 348 students enrolled for them
to participate in the project, showing that in the next actions, it will be necessary to include a stage of
sensitization of the guardians.
MATERIAL AND METHOD
This work is a report of an experience that took place between March 2023 and November
2023 in a school in the municipality of Petrolina-PE. The Monsenhor Bernardino Municipal Full-
Time School has Elementary School classes, accounting for a total of 348 students in 2023. However,
for the development of this scientic article, a sample was chosen, the 5th grade “A” class, which had
29 (twenty-nine) students.
Before the start of the evaluations of the students, authorization forms were left with the
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school management and, later, delivered to the children’s guardians. The students were only assisted
by the presence of the form duly lled out and signed.
Oral hygiene guidance (OHO), supervised toothbrushing, plaque disclosure (IHO-S) and
topical uoride application (ATF) were carried out in classrooms, with dental kits being delivered
to all students. These kits contained brushes, toothpastes and dental oss, as well as some toys and
playful activities about oral care.
Figure 01. Classroom
Figure 02. Didactic Material
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Figure 03. IHO-S le.
Figures 04 and 05. Performing plaque evidence
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Figures 06, 07 and 08. Interaction with children
For the students who presented some type of alteration, there was a division between those
who could undergo the ART procedure and those who needed more invasive dental procedures,
which were classied as urgent (2) and specialized care (4). They were referred for assistance at the
teaching clinic of the Sovereign College. In addition, new evaluation forms were sent to carry out the
procedures.
The ART work was carried out by two operators, previously instructed with the Hands-
on with natural teeth made available by the 1st Human Teeth Bank of the São Francisco Valley
(BDHVASF), under the supervision of monitors from the last period of the Dentistry course, also with
the guidance of the advisor professor Malvina Souza. The actions were carried out during the school
year, on the school premises, in a toy library and in the library. For the positioning, there was an
adaptation due to the local reality, the children were accommodated at padded tables for the service.
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Figure 09. Students with Professor Malvina Souza
Figures 10 and 11. Realization of the ART
The materials handled were previously prepared and the instruments sterilized following the
biosafety protocol. Prophylaxis of all teeth was performed, followed by selective removal of caries in
a mild manner, with dentin spoons, only in the completely softened tissue of the surrounding dental
walls. The cavity was dried with autoclaved cotton balls and the CIV was manipulated on glass plates
with spatula n°24. The cavity was conditioned with the CIV’s Polyacrylic Acid, being inserted with a
microbrush. The Ionomer Cement, after spatulating, was inserted into the cavity with No. 1 spatulas
or 3s/3ss hollemback sculptor, using the technique recommended by Frencken (CIV, MaxxionR).
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Relative isolation was performed with cotton, in order to reduce contagion by salivary uids and its
exchange carried out repeatedly to maintain the dry work eld. To conclude, digital pressure was
applied to the tooth with solid petroleum jelly during the gelling of the material to avoid contamination
and preserve the properties of the material. The removal of excess was performed with a Hollemback
sculptor in the occlusals and with dental oss in the proximal ones. (MONNERAT et al, 2013)
Flowchart of the total number of students evaluated and attended in Petrolina-PE, 2023.
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Source: developed by the authors.
FINDINGS
For the epidemiological survey, a sample of 29 elementary school students was chosen, but
only 27 were present and with the consent forms duly lled out on the days of the evaluations. Of
these, 11 had dental needs, 6 of which were for more invasive procedures, classied as emergency (2)
and specialized care (4), which were promptly referred to the pediatric dental teaching clinic of the
Faculty of Health of Petrolina-SOBERANA, and 4 were selected to undergo ART.
The evidence of bacterial plaque (IHO-S) performed in 10 boys and 12 girls, found only
one with good oral hygiene, 11 regular results and 10 classied as having poor oral hygiene.
Of the 4 selected students, there were a total of 5 teeth that could be performed with ART
(mean number of children/teeth treated = 0.8).
Bacterial Plaque Disclosure (IHO-S)
Source: developed by the authors.
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DISCUSSION
The term “dental caries” is used to describe signs and symptoms resulting from the chemical
dissolution of the tooth surface caused by metabolic events that occur in the biolm (bacterial plaque)
covering the affected area (Frencken et al, 2012) emphasizing that one of the fundamental and effective
ways of its prevention: brushing. Correct hygiene associated with other care is responsible for this
antibacterial control and the adequacy of the oral environment. Despite the recognized importance of
oral health and the advances achieved, a signicant portion of the Brazilian population still does not
have access to dental services, being higher among the most socially vulnerable. (CARREIRO et al,
2017)
The development of oral health measures aimed at population groups implies knowledge of
their epidemiological situation. This can be achieved through epidemiological investigations using a
variety of tools, depending on the characteristics of each disease or condition.
The dental caries indices with the greatest applicability in the population are DMFT for
permanent teeth and dmft for temporary teeth. Since the 1960s, the World Health Organization
(WHO) has established standards for dental caries research to improve the validity and reliability
of data. (Calvo MCM, 1995) Through this study, it was found that 50% of the sample evaluated
constitutes regular oral hygiene. It also has high parameters of poor hygiene (45.5%).
ART has been meritorious since the 1980s, as an alternative for controlling dental caries.
(FEJERSKOV et al, 2017) This technique was developed to be applied to populations without
nancial resources and without conventional dental care. Providing as foundations the minimum
intervention, the interruption of the caries process and the use of materials that have the release of
uorides. (Monico et al, 1998)
Because it is not a technique disseminated to the community and follows a regulation where
there is no use of traditional dental equipment, in addition to the possible mistrust about its quality, it
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can therefore be considered as some of the causal factors why there was a low number of authorizations
signed by the guardians for the children to undergo the procedure.
The ART actions carried out in the school in the municipality of Petrolina are in line with
what is recommended by Figueiredo et al, who safeguard the use of atraumatic rehabilitation in
public schools and provided therapeutic care to numerous children in them. The authors emphasize
that, along with any treatment programs implemented in schools, educational prevention programs
should be encouraged, “avoiding both outbreaks of the disease and the emergence of new cases of the
disease.” Based on these assumptions, the implementers of this project recommend health education
activities that motivate students to take care of themselves in the area of oral health.
Thus, in order to have a greater number of students served, it is evident that it is essential
to include the awareness of those responsible for them about the technique, its quality, to ensure the
longitudinal effectiveness of the actions. (Souza et al, 2016)
FINAL CONSIDERATIONS
Based on this literature review and on the lived experience, it is evident that caries still has
a great impact on the oral health of the population and still requires restorative methods for more
effective and simple treatment, still being considered a public health problem due to its recurrence.
Thus, the Atraumatic Restorative Treatment (ART) came as a strategy to meet this demand, given its
low cost, easy execution, minimal invasion and acceptability by students because it is painless, does
not require anesthesia, in addition to the possibility of integrating all socioeconomic levels.
The realization of this action allowed us to verify the feasibility of performing the Atraumatic
Restorative Treatment, given its characteristics mentioned above, and the need to disseminate it to
the population, in its social context, especially for those groups that do not have dental care in a
conventional way, providing comprehensive care.
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