# Atraumatic Versus Silver‐Modified Atraumatic Restorative Treatment in Primary Molars: A Randomized Clinical Trial on Minimally Invasive Caries Management and Oral Health‐Related Quality of Life

## TL;DR

This study compared two dental treatments for children's cavities and found similar success rates, with one showing a slight edge in stopping decay.

## Contribution

The study evaluates the clinical effectiveness of SMART versus ART in managing early childhood caries and their impact on quality of life.

## Key findings

- SMART and ART showed similar 6-month clinical success rates in primary molars.
- SMART showed a minor advantage in caries arrest, though not statistically significant.
- Class I restorations had higher success rates than Class II for both techniques.

## Abstract

To compare the 6‐month clinical success of atraumatic restorative treatment (ART) and silver‐modified atraumatic restorative treatment (SMART) in primary molars of children with early childhood caries (ECC), and to assess the impact of these treatments on oral health‐related quality of life (OHRQoL).

A randomized controlled split‐mouth trial included 32 children (aged 3–7 years) with 68 primary molars exhibiting active dentin carious lesions (ICDAS II scores 4 or 5). Each child received one ART restoration using high‐viscosity glass ionomer cement and one SMART restoration with silver diamine fluoride, followed by HVGIC in the same session. Clinical success was assessed after 6 months, using modified ART criteria. Parents completed the Arabic version of the Early Childhood Oral Health Impact Scale (A‐ECOHIS) at baseline and after 6 months to assess changes in OHRQoL. Data analysis included chi‐square, Fisher's exact test, Student's t‐test with effect sizes reported, and a significance level set at 95%.

Of the 68 restorations (34 ART, 34 SMART), 6‐month success rates were 67.6% for ART and 70.5% for SMART, with no statistically significant difference (p = 0.66). SMART showed slightly better caries arrest. Class I restorations had higher success rates than Class II for both techniques. Failures were mainly due to wear and marginal integrity loss. Mean ECOHIS scores improved from 16.9 at baseline to 10.13 at 6 months, though the change was not statistically significant (p = 0.125).

SMART and ART techniques showed similar short‐term clinical outcomes, with SMART showing a minor, nonsignificant advantage in caries management. Failures in ART were more often linked to active caries and pulp involvement, suggesting that SMART may enhance caries arrest. Placement of both restorations did not significantly affect OHRQoL.

Incorporating SDF may improve caries arrest and the effectiveness of GIC restorations in primary molars.

ClinicalTrials.gov identifier: NCT07023939.