MINIMALLY INVASIVE DENTISTRY
SILVER MODIFIED ATRAUMATIC RESTORATIVE TECHNIQUE ( SMART ): AN ALTERNATIVE CARIES PREVENTION TOOL
Bernadette Alvear Fa 1a * , Jordan Arron Jew 2b , Allen Wong 3c , Douglas Young 3d
1
Department of Integrated Reconstructive Dental Sciences , School of Dentistry , University of the Pacific , San Francisco , CA 94103 , USA
2
Department of Behavioral Health , University of San Francisco , 2130 Fulton St , San Francisco , CA USA , Department of Research , University of the Pacific School of Dentistry San Francisco CA 94103 USA
3
Department of Dental Practice , School of Dentistry , University of the Pacific San Francisco , CA 94103 , USA a
DDS , Assistant Professor b
MS , Research Assistant c
DDS , EdD , Professor d
DDS , EdD , MBA , MS , Professor
ABSTRACT
Received : August 17 , 2016 Accepted : August 18 , 2016
Available online : August 21 , 2016
Cite this article : Alvear Fa B , Jew JA , Wong A , Young D . Silver Modified Atraumatic Restorative Technique ( SMART ): an alternative caries prevention tool . StomaEduJ . 2016 ; 3 ( 2 ): 243-249 .
Aim : Introduction of Silver Modified Atraumatic Restorative Technique as an alternative caries prevention tool advances the existing dental armamentarium . Summary : Caries management strategies have advanced far beyond simply “ drilling and filling ” teeth , which does nothing to halt the underlying causative disease process . Effectively treating the caries disease starts with a careful hard-tissue exam and caries risk assessment ( CRA ) followed by treatment intervention strategies based on the patient ’ s individual risk status . The latest addition to the caries prevention armamentarium , silver diamine fluoride ( SDF ), entered the US market in 2015 shortly after it was cleared by the United States Food and Drug Administration ( FDA ) in 2014 to treat tooth sensitivity . It is being used off-label to treat and prevent caries , using CDT billing code D1354 . The case presentation showcases a technique called Silver Modified Atraumatic Restorative Technique ( SMART ) in which SDF is applied and immediately restored or sealed with conventional GIC . Placement of SDF and GIC on the same appointment is especially useful when , for whatever reason , the patient will not be able to return for subsequent dental treatment and it is deemed advantageous to use a minimally invasive procedure rather than nothing at all . By placing SMART restorations you kill bacteria and cut off the nutrient source for any remaining bacteria by placing a chemically sealed restoration that will arrest and remineralize the caries lesion , preserving tooth structure and enhancing pulp vitality . The following case study showcases a different approach to using GIC material in combination with SDF . Keywords : cariology , minimally invasive caries treatment , dental armamentarium , restorative technique .
1 . Introduction Caries management strategies have advanced far beyond simply “ drilling and filling ” teeth , which does nothing to halt the underlying causative disease process . Effectively treating the caries disease starts with a careful hard-tissue exam and caries risk assessment ( CRA ) followed by treatment intervention strategies based on the patient ’ s individual risk status 1 . The ADA Caries Classification System ( ADA CCS ) was published to classify all stages of caries lesions and to help discern when surgical restoration ( verses chemical remineralization ) is likely needed 2 . The latest addition to the caries prevention armamentarium , silver diamine fluoride ( SDF ), entered the US market in 2015 shortly after it was cleared by the FDA in 2014 to treat tooth sensitivity . SDF is being used off-label to treat and prevent caries ³, using CDT billing code D1354 . The safety and efficacy of using SDF for caries treatment were reviewed by Horst and others in 2016 ³. Randomized clinical trials evaluated the efficacy of SDF and clearly demonstrate that repeated applications of SDF are required for more predictable caries arrest 4 , 5 ; however , on occasions , there may be a situation where the patient is not likely to return for subsequent treatment or have the ability to receive treatment elsewhere . In this
* Corresponding author :
Assistant Professor Bernadette Alvear Fa , DDS Department of Integrated Reconstructive Dental Sciences , School of Dentistry , University of the Pacific Arthur A . Dugoni 155 5th Street , San Francisco CA 94103 , USA Tel / Fax : ( 415 ) 749 3373 , e-mail : balvear @ pacific . edu
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