Current Concepts of Clinical Care
Silver modified ART (SMART) is becoming the gold standard of caries management. Riva Star is an adjunct to SDF treatment that enables dentists to heal caries in deciduous and permanent teeth in a single visit without pain, tissue removal or staining.
Riva Star has the following advantages
- FASTER Clinicians have to wait while SDF seeps into caries while Riva Star creates an immediate chemical reaction on the tooth surface that releases large amounts of fluoride and silver iodide.
- “LESS TOOTH REMOVAL” * As fluoride from Riva Star penetrates further into caries than SDF only the removal of a minimal amount of broken down dentin is required
- “DOUBLE THE FLUORIDE RELEASE” * When SDF reacts with KI, fluoride ions are released into carious dentin at twice the concentration and penetrate much further into the caries than fluoride ions bound to silver in SDF.
- “ARRESTS CARIES AND FORMS A BACTERICIDAL SHIELD” * The reaction of SDF and KI forms a bactericidal shield of AgI over the entire surface of carious dentin to a depth of 50 microns.
- NO STAINING As long as all the free silver ions have reacted, silver iodide is a creamy white precipitate that stabilizes as a tooth coloured precipitate once it becomes bound to protein within the carious dentin and enamel.
- Gain access to caries by removing an existing failed restoration as required.
- Prepare the surface by disrupting any biofilm or badly broken down caries with a dental explorer.
- It is important to etch the carious surfaces for 15 seconds to clean out any bioload in the dentinal tubules and expose carious collagen to enable the AgI to stabilize by bonding to the broken down Wash and dry the preparation.
- Apply SDF to carious surfaces avoiding any adjacent soft tissues.
- Immediately apply KI until the white precipitate becomes clear signalling the reaction of all free fluoride This will drop the pH of the SDF from 13 to 9.
- Wash away the reactant and dry.
- Apply Riva Self Cure or Riva Light Cure either as a restoration or a base for a composite resin overlay.
Although dentists have been aware of the benefits of SDF for almost 50 years it has never found traction within the dental profession due to the staining associated with it; apart from limited treatment of deciduous teeth, root caries and some public health systems.
Riva Star has the potential to revolutionize the global management of caries. It is approved by Health Canada and the Brazilian Government for Caries Arrest and should be approved around the world.
Geoff Knight is a general dentist and internationally noted dental speaker with special interests in Minimal Intervention Aesthetic Dentistry.
He has pioneered a number of innovative clinical procedures in aesthetic dentistry and the pharmacological management of caries and is named on several patents. He has consulted widely across the dental industry and currently works with SDI and PDS.
He has been published in Quintessence International, Australian Dental Journal and Journal of Periodontal Research. He has produced a series of clinical technique videos and written over 100 articles on aesthetic and adhesive dentistry many of which have been translated into a number of languages and published internationally.
*Knight GM, McIntyre JM, Craig GG, Mulyani, Zilm PS, Gully NJ. Inability to form a biofilm of Strep Mutans on silver fluoride and potassium iodide – treated demineralized dentin.
QI 2009; 40:156-161