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SILVER MODIFIED ATRAUMATIC RESTORATIVE TECHNIQUE ( SMART ): AN ALTERNATIVE CARIES PREVENTION TOOL
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Figures 2A and 2B . 2B ( Pre-Op ) Initial ICDAS 2 lesions2 present on teeth 24 and 25 . Tooth # 41 with an advanced lesion prior to treatment . Retraction cord is optional ; cotton roll isolation is recommended
Figure 3 . The lesion was desiccated prior to placing SDF
asymptomatic advanced lesion 2 ( Figs . 1A and 1B ). Due to extreme caries risk from xerostomia and numerous areas throughout her mouth with active carious lesions ( approximal and facial-lingual ), the patient was placed on high fluoride toothpaste , encouraged to drink water with medication , and to use an anti-cavity mouth rinse . In addition , treatment of GIC sealants immediately after SDF placement was appropriate in order to address the patient ’ s ICDAS 2 lesions on teeth # s 24 and 25 ( Fig . 2A ). Prior to beginning treatment , the patient was provided with an informed consent discussing the risks , benefits , and alternatives to agreed upon treatment . This included disclosing that the infected area of the tooth would turn a dark brown to black during the placement of SDF and may show through the restoration
especially at the marginal areas . Furthermore , oral hygiene instruction was delivered to the patient to emphasize the importance of better hygiene methods . Treatment of the anterior tooth # 41 , addressed the patient ’ s chief concern of avoiding extraction and applying restoration . After tooth # 41 was anesthetized , retraction cord and a cotton roll were placed for isolation ( Fig . 2B ), followed by desiccation of the lesion ( Fig . 3 ). After transfer of SDF using a microbrush , SDF was left in place for 1 minute ( Fig . 4A ). It is normal for the area of active disease to remain dark brown to black after application of SDF ( Fig . 4B ). The cavosurface margins were prepared using water , a hand piece and a round bur without removing axial decay to avoid pulp exposure ( Fig . 5A ). In order to achieve an ideal chemical bond with GIC , the tooth structure should be free of debris and decay . Using grey pumice or an air polisher to clean the entire tooth surface will ensure that biofilm or pellicle has been removed ( Fig . 5B ). A matrix system can be applied to create supportive walls for the GIC restoration . Apply polyacrylic acid to the cavosurface margins or clean the surfaces of teeth for 10 seconds ( Fig . 6 ). Rinse off polyacrylic acid for 10 seconds , and then blot dry . This particular step cleans the smear layer off and provides proper chemical bond with tooth structure . During rinsing , the assistant can mix the GIC capsule . Prior to placing GIC over the clean moist tooth surface , it is advisable to avoid desiccating the tooth surface . With the proper amount of moisture , the tooth surface should appear with no pooled water before
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