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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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