Evaluation of the success of single-visit versus two-visit silver modified atraumatic restorative technique (SMART) in primary molars- a randomized controlled trial.

OBJECTIVES: To compare the success of glass ionomer cement (GIC) restorations in carious primary molars using single-visit and two-visit silver modified atraumatic restorative technique (SMART). METHODS: This was a parallel-group, two-arm randomized controlled trial conducted in a tertiary-care hospital. 150 children aged 4-9 years with asymptomatic carious lesions were recruited and randomized to one of the two interventions: single-visit and two-visit SMART. For each participant, a single tooth was selected to receive one of the interventions. Caries excavation was performed until firm dentin using hand instruments. In single-visit SMART, silver diamine fluoride (SDF) application, and GIC restoration were performed on the same visit while in the two-visit SMART, the GIC restoration was performed one week after the SDF application. Children were followed up at 6 and 12 months for the evaluation of restorations. The primary outcome was the success of the restoration at 12 months. Secondary outcomes were the proportions of failures (minor and major) in two groups. Fischer-exact test, logistic regression, and Kaplan-Meier curve were used for statistical analyses. RESULTS: A total of 150 SMART restorations (single-visit=75, two-visit=75) were performed. At 12-months, 51 (68 %) restorations in the single-visit group and 62 (82.7 %) restorations in the two-visit group were evaluated as success (p = 0.051). Minor failures were observed in 21 teeth (28 %) in single-visit and 13 teeth (17.3 %) in two-visit SMART. Major failures were noted only in single-visit SMART in 3 teeth (4.0 %) (p = 0.052). CONCLUSION: There was no statistically significant difference in the success rates of GIC restorations in single-visit and two-visit SMART groups. CLINICAL SIGNIFICANCE: Both single-visit and two-visit SMART restorations showed comparable success rates, thus clinicians can choose either protocol based on the patient's needs and cooperation.