Journal of Case Reports in Medical Science

Aim: To compare the effectiveness of silver-modified atraumatic restorative technique (SMART) and atraumatic restorative treatment (ART) in managing early childhood caries using a split-mouth case study approach.

Background: Early childhood caries remains a significant public health concern, and minimally invasive restorative techniques play a crucial role in preserving tooth structure and improving patient acceptance. SMART combines the antibacterial effect of silver diamine fluoride (SDF) with the restorative and fluoride-releasing properties of glass ionomer cement (GIC), while ART relies solely on GIC.

Study Design: A split-mouth case report was conducted on a 5-year-old child with bilateral mandibular second molar caries.

Methods: On the left mandibular second molar, SMART was performed with 38% SDF application followed by GIC restoration. On the right mandibular second molar, ART was carried out with GIC alone. Restoration integrity was assessed clinically using visual and tactile methods, alongside the presence or absence of secondary caries and pain. Follow-up was conducted at 1, 3, and 6 months.

Results: At 6 months, the ART-restored tooth showed secondary caries and marginal breakdown of the GIC restoration, whereas the SMART-restored tooth remained intact, caries-free, and asymptomatic. SMART demonstrated superior caries-arresting ability, better restoration integrity, and greater clinical longevity compared to ART.

Conclusion: This case suggests that SMART may provide a more reliable option for managing early childhood caries, especially in pediatric or community-based settings where minimally invasive, cost-effective approaches are preferred.