Silver-Modified Atraumatic Restorative Treatment in Management of Early Childhood Caries

Objectives: To determine the restorative outcomes of ART in management of ECC at 12-month follow-up
To determine the restorative outcomes of SMART in management of ECC at 12-month follow-up
To compare the restorative outcomes of ART and SMART in management of ECC at 12-month follow-up
Methods: This community-based randomized control trial investigated a total of 108 children, aged 3-5 years with ECC. The study participants were equally assigned to two groups for restoration of carious cavities (International Caries Detection and Assessment System II code 3 to 5) in their primary molars. Children in control group received ART approach and test group received SMART approach. SMART is a revolutionary approach to halt the caries process by applying the surface with silver diamine fluoride and seal out the nutrient source for bacteria to survive by its antimicrobial and remineralization activity. After that the cavity was restored with high viscosity glass ionomer cement. Follow-up examinations were carried out at 6- and 12-month to assess restorative criteria and clinical examination.
Results: After 12 months, 101 (93.5%) children remained in this study. Success rates were 96.1% and 92.0% in evaluation of restorative criteria in SMART group and ART group respectively (p = 0.042). Furthermore, success rates were 100% in SMART group and 92.0% in ART group in evaluation of clinical assessment (p = 0.056).
Conclusions: SMART is not only more effective in evaluation of restorative criteria than ART and also comparable to evaluation of clinical assessment. Therefore, SMART is the non-invasive treatment that provides no noise, no drilling and no need to local anaesthesia for children in future columns of Paediatric Dentistry and also trusted technique for general dentists and paedodontists in management of ECC.