Silver Modified Atraumatic Restorative Technique (SMART): An Alternative Caries Prevention Tool

Radiograph of distal D3 approximal lesion on tooth #25
Radiograph of distal D3 approximal lesion on tooth #25. The technique known as SMART could help repair tooth damage and prevent caries without requiring multiple appointments.

What is it?

A technique to halt decay and seal teeth using two products: silver diamond fluoride (SDF) and glass ionomer cement (GIC) sealant/restoration in a single appointment.

What problem does it aim to solve?

While shown to be safe, SDF also normally requires repeated applications over multiple appointments to be effective. However, many patients have difficulty following up for subsequent treatment, and may not have consistent access to care. They may also have other health issues that can interfere with their oral health. Therefore, a treatment that could be protective against caries disease even after a single treatment might be desirable. The hope is that the SDF will halt decay and the GIC will seal out the nutrient source for any bacteria that survive the SDF under the restoration.

How does it work?

SDF entered the US market in 2015. It is approved to treat tooth sensitivity but is also used off-label to prevent and treat (arrest) caries. It has antibacterial and remineralizing properties. The GIC restoration cuts off the "food supply" to any surviving bacteria and protects the tooth area.

What are the real-world implications?

SMART could be a useful technique to successfully treat caries lesions, particularly when dealing with a patient population that may have trouble managing multiple appointments and lacks regular access to care. An additional benefit was demonstrated in this particular case: because they did not have to remove all of the decay first, they were able to preserve the tooth pulp following the SMART protocol.

What are the next steps?

This article presents a case study on the treatment of a single patient. A larger study following up on patient outcomes would demonstrate the effectiveness of the SMART method.


"Silver Modified Atraumatic Restorative Technique (SMART): An Alternative Caries Prevention Tool", Stoma.EDU Journal, (2016) 3 (2)


Bernadette Alvear Fa DDS, Assistant Professor
Department of Preventive and Restorative Dentistry (formerly the Department of Integrated Reconstructive Dental Sciences), Dugoni School of Dentistry

Jordan Arron Jew MS, Research Assistant
Department of Behavioral Health, University of San Francisco

Allen Wong DDS, EdD, Professor
Department of Research, Dugoni School of Dentistry

Douglas Young DDS, EdD, MBA, MS, Professor
the Department of Diagnostic Sciences (formerly the Department of Dental Practice), Dugoni School of Dentistry