الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 181 |  |  |
| | | from | 181 | | |
Abstract
Dental caries is one of the most prevalent health conditions affecting children worldwide. The introduction of Minimal Invasive Dentistry (MID) has caused a revolution in management of dental caries, particularly among young children. Atraumatic Restorative Treatment (ART) and Silver Diamine Fluoride (SDF) treatment modalities come under the umbrella of MID as they aim to maximize conservation of tooth structure with the least psychological impact on the child.
Since decades, the ART approach has been used to meet the oral health needs of underserved or hard-to-reach individuals. The technique is based upon excavation of caries using hand instruments and restoring the tooth with glass ionomer cement (GIC), without administration of local anesthesia or use of any electric equipment. However, ART is time-consuming, and its success rate is questionable in multi-surface restorations. If used for treating multiple teeth consecutively it is, also, likely to cause operator’s hand fatigue.
SDF, on the other hand, is a caries arresting solution by virtue of its ability to arrest tooth decay and simultaneously prevent the formation of new carious lesions. Those effects are attributed to the combined benefits of bactericidal activity of silver nitrate, along with the remineralization efficacy of fluorides. SDF is a simple, painless, and affordable technique that is less operator dependent and less time consuming than ART. However, it causes black staining of the arrested lesions besides it does not restore tooth form or function.
Silver modified atraumatic restorative treatment (SMART) is a new technique which combines the use of SDF and ART philosophies. This novel approach brings together the capacity of SDF to kill bacteria with GIC’s ability to seal the tooth and restore its form and function. Although SMART constitutes a promising approach for conserving tooth structure, there is sparse evidence on its efficacy in managing dental caries. Against this background, the aim of the current study was to investigate the effectiveness of SMART as a cost-effective minimally invasive alternative approach for arresting caries progression in occlusal cavities in primary molars.
A randomized controlled trial was conducted over a period of 18 months in the Outpatient Clinic of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Ain Shams University. 119 carious primary molars in 67 children in the age range 5 to 9 years were treated using SMART or ART restorations. Effectiveness in caries arrest, and parental and child acceptance levels of both techniques were evaluated at 6-and 12-months. Other study outcomes such as the child pain perceptions and level of discomfort as well as time consumed in treatment were assessed following placement of restorations. Survival rates and cost effectiveness of both treatment modalities were also measured at the end of the follow up period.
Based on the current study findings, no significant differences were detected in caries arrest effectiveness or survival rates of occlusal ART and SMART restorations in primary molars after 1 year follow up. Both techniques presented low levels of pain and discomfort and were quite satisfactory according to both children and their parents despite significant differences in teeth appearance. SMART technique, however, had significantly shorter chair time and was proved to be more cost effective than ART after 12 months follow up.