Public health pediatric and family dentists see many patients per day, making the speed, efficiency, and ease of efficacious caries preventive materials important. To encourage patient compliance with regular dental appointments, atraumatic dental protocols are significant in treating caries as the first approach, rather than surgical interventions that often lead to dental phobias and/or recurrent decay.
Silver diamine fluoride (SDF) and glass ionomers (GI) are components of Silver Modified Atraumatic Restorative Treatment (SMART), a minimally invasive approach for treating caries in vital, asymptomatic teeth. SDF and GIs are applied to arrest, remineralize, and/or restore noncavitated and cavitated lesions.
GIs have been used based on their remineralization and caries-prevention potential. Although technique sensitivity has deterred many dentists from using GIs, the new, easy-to-use, self-adhesive GC Fuji Automix LC (GC America) represents an efficient way to place bioactive restorations with exceptional fluoride release and moisture tolerance without the need for hand mixing, a triturator, opening foil packs, or handling capsules. Indicated and cleared for various clinical situations in primary and permanent teeth (eg, Class I, II, III, and V restorations; core build-ups; and bases/liners under sandwiched composite restorations), this author has also found GC Fuji Automix LC beneficial for SMART restorations and sealants.
An injectable and light-cured resin-reinforced GI restorative (RMGI), GC Fuji Automix LC is placed directly into preparations via a unique, lightweight and ergonomically designed dispensing system that requires low extrusion force and employs single-use, disposable automix tips, thus reducing chair time. Even when saliva is present, radiopaque GC Fuji Automix LC produces high bond strengths, with virtually no postoperative sensitivity.
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| Figure 1. Preoperative view of an 8-year-old patient who presented in need of a Class II SMART restoration on tooth K and glass ionomer sealant on tooth No. 19. | Figure 2. The caries lesion in tooth K was prepared by spoon excavation only. |
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| Figure 3. CAVITY CONDITIONER (GC America) was applied, rinsed, and dried. | Figure 4. SDF was applied to the lesion and allowed to saturate for one minute. |
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| Figure 5. GC Fuji Automix LC (GC America) in shade A1 was easily injected into the lesion from the bottom up, then spread apically and side to side with a gloved finger dampened in GC Fuji COAT unfilled resin. | Figure 6. The final SMART restoration on tooh K and sealant on tooth No. 19 after removing dark temporary surface stain caused by light curing the GC Fuji Automix LC with underlying SDF. |
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.
Conclusion
Designed for dentists who want to provide the benefits of GIs in an injectable restorative, GC Fuji Automix LC is easy to use and handle, moisture tolerant, and ideal for a variety of clinical situations. It achieves a predictable bond and excellent aesthetics and simultaneously delivers higher fluoride release, radiopacity, and polishability. The ability to light cure GC Fuji Automix LC eliminates the need to impose special dietary instructions required with self-cure GIs. For dentists treating many high-caries- risk patients daily, this technique proves antibacterial and remineralizing. With GC Fuji Automix LC, this author has found that dentists and their teams can work seamlessly by using the same material for SMART restorations and sealants.
For more information, call GC America toll-free at (800) 323-7063 or visit gcamerica.com.
Dr. Frachella is a pediatric dentist in Oregon and Maine whose career includes 32 years of service as the dental director of a free clinic for indigent children in Bangor, Maine, and 10 years as the director of federal clinics in Wheeler County, Ore. He also works in private practices across the country and lectures for NYU Langone Hospital—Brooklyn dental residency programs. He can be reached by phone at (541) 317-1887 or (207) 852-9904 or by email at johncf@bendnet.com.
