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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