Non-invasive management of initial occlusal enamel caries using silver modified atraumatic restorative technique and resin-based sealants: A randomised comparative split-mouth clinical trial

Introduction: Recently, child-friendly non-invasive or minimally invasive approach with the primary goal of preserving tooth structure, the best possible has gained momentum in management of caries disease as compared to conventional invasive surgical approach. The clinical relevance of antimicrobial and remineralising benefits of silver diamine fluoride (SDF) along with atraumatic restorative treatment in managing non-cavitated lesions is yet to be established. This research was conducted with the aim to compare the efficacy of novel silver modified atraumatic restorative technique (SMART) sealants to the gold standard resin-based sealants in managing occlusal enamel caries. Methodology: A total of 66 children with at least one pair of fully erupted contralateral first permanent molars with ICDAS II codes 1 and 2 were randomly allocated for this split-mouth study into two groups: Group - SMART sealant and Group – resin-based sealant. The sealants were applied according to the American Academy of Paediatric Dentistry guidelines and were evaluated at the end of 3rd, 6th, and 12th months. The clinical performance of sealants was gauged based on their retention and caries preventive effect. The data were statistically analysed using the Chi-square test at significance level P < 0.05 using SPSS, IBM version 23.0. Results: At 12 months' follow-up, 60.65% teeth in the resin group and 49.18% in SMART group had fully retentive sealants (P = 0.02). The caries occurrence at the end of the study was 8.19% in SMART as compared to 21.31% in resin sealant group and was statistically significant (P = 0.041). Conclusion: The resin-based sealants were more retentive as compared to SMART; however, the SMART sealants were superior in preventing caries. The use of SDF beneath GIC in atraumatic restorative sealants can provide protective effect against caries occurrence in the absence of sealant retention.