GC Fuji Automix LC SMART Technique
In one case, isolation was established with cotton rolls (Figure 1). Anesthesia and a rubber dam were unnecesary since SDF is a strong desensitizer and RMGI is applied to moistened teeth. The lesion was only spoon excavated (Figure 2), taking care to avoid pain response. A 20% polyacrylic acid conditioner (eg CAVITY CONDITIONER [GC America]) was applied for 10 seconds (Figure 3), rinsed, and dried, removing the smear layer and decreasing demineralization and sensitivity. Polyacrylic acid conditioner is not interchangeable with phosphoric acid etch; using a bonding agent before placing RMGIs is not indicated because it blocks mineral ionic exchange between RMGIs and the tooth.
SDF—an antimicrobial, remineralizer, desensitizer, and caries detector—was applied to the lesion and allowed to saturate for one minute (Figure 4). Tooth surfaces were kept moist with SDF. GC Fuji Automix LC shade A1, which would mask the underlying SDF black scar, was injected in 2-mm increments from the bottom up to avoid air bubbles (Figure 5). The RMGI was spread apically and side to side with a gloved finger and/or cotton applicator dampened with unfilled resin (eg GC Fuji COAT LC [GC America]). The material was light-cured for 20 seconds, temporarily turning the restoration dark only on the surface, which wore off in a few days.
The SMART restoration is remineralizing and antibacterial for treated and adjacent teeth. SMART acts as a silver ion and fluoride-releasing reservoir that prevents future decay elsewhere in the mouth, due in part to SDF and the RMGI’s high, rechargeable fluoride release for long-term protection against secondary caries. The adjacent permanent molar in the same arch was also sealed with GC Fuji Automix LC (Figure 6), providing extended caries-preventive effects. The occlusion was checked on tooth K and tooth No. 19 with articulating paper, and high spots were reduced as necessary.
