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SILVER MODIFIED ATRAUMATIC RESTORATIVE TECHNIQUE ( SMART ): AN ALTERNATIVE CARIES PREVENTION TOOL
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Figures 1A and 1B . Radiograph of distal D3 approximal lesion on tooth # 41
case , the healthcare provider has limited options : 1 . no SDF placement at all ( do nothing ), 2 . place SDF once knowing success may be limited , or
3 . place SDF and a glass ionomer cement ( GIC ) sealant / restoration during the same appointment to limit access of fermentable carbohydrates and improve chances of SDF caries arrest . The damage from acids affecting the tooth surfaces through the process of demineralization , as well as the process of remineralization to help replenish the lost substrates from the effects of the acid damage have both been extensively studied 6 . Perhaps what is more exciting are studies demonstrating that conventional GIC produces a sealed chemical bond and remineralized layer at the material-tooth interface 7 .
2 . Rationale The case presentation showcases steps when applying a technique called Silver Modified Atraumatic Restorative Technique ( SMART )* in which SDF is placed 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 . Some examples include , children , humanitarian dentistry in underserved populations , or when there are long wait times for hospital dentistry . The technique presented will combine advantages of three proven principles : 1 . the antibacterial and remineralizing effects of
SDF causing caries arrest 4 , 5 ,
2 . partial / incomplete caries removal on deep caries lesions approaching a vital and asymptomatic pulp 8 , 9 , and
3 . proper placement of a chemically sealed and bonded GIC restoration 10 . 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 .
3 . Case Study SDF Placement with Immediate Restoration Using GIC A 71-year-old female with a medical history significant for hypothyroidism , osteoporosis , gastroesophageal reflux disease , and schizophrenia presented to the practice . She was taking medication for hypothyroidism , osteoporosis . Her chief concern was to address her front teeth and to avoid extraction if possible . During her clinical exam and CRA , saliva appeared thick and ropey , multiple lesions presented throughout her mouth , and hygiene was relatively fair ( moderate plaque , moderate calculus , and multiple areas of bleeding upon probing ). The patient was diagnosed with moderate xerostomia , generalized mild chronic periodontal disease and extreme caries risk . The treatment plan proposed to the patient was limited scaling and root planning to address the periodontal health , and placed on 4 month recall . Upon vitality testing , tooth # 41 was diagnosed as vital and a treatment formulated to address the
244 STOMA . EDUJ ( 2016 ) 3 ( 2 )