Management of initial carious lesions of hypomineralized molars (MIH) with silver diamine fluoride or silver-modified atraumatic restorative treatment (SMART): 1-year results of a prospective, randomized clinical trial

Clin Oral Investig. 2022 Feb;26(2):2197-2205. doi: 10.1007/s00784-021-04236-5. Epub 2021 Nov 6.


Objectives: This study evaluated and compared the effect of silver diamine fluoride (SDF) and silver-modified atraumatic restorative treatment (SMART) sealants for the treatment of initial carious lesions of permanent molars affected by molar incisor hypomineralization (MIH).

Methods: One hundred and twelve hypomineralized permanent molars with ICDAS 1 or 2 lesions were selected in 48 children. The teeth were randomized into SDF and SMART sealant groups (n = 56 teeth/group) in a split-mouth fashion. Hypersensitivity, formation of caries, and enamel breakdown were evaluated in both groups. Hypersensitivity was assessed by Schiff Cold Air Sensitivity Scale (SCASS), and clinical assessments of SMART sealants were performed according to modified USPHS criteria at 1, 6, and 12 months. The data were analyzed statistically using Fisher's exact test, Kaplan-Meier analysis, Mann-Whitney U test, and Friedman test.

Results: Twenty-six hypomineralized molars with marked baseline hypersensitivity showed significantly lower SCASS scores at all evaluation periods (p < 0.001). There was no significant difference in hypersensitivity scores between the groups at the repeated applications of SDF at 1, 6, and 12 months. The cumulative survival rates of SMART sealants on occlusal and palatal surfaces were 88.7% and 58.8%, respectively.

Conclusions: In hypomineralized molars, both SDF and SMART sealants showed favorable short-term prevention against dental caries while providing effective desensitization. Marginal discoloration was the most common side effect of the SMART sealants as a result of SDF application.

Clinical significance: Both SDF and SMART sealants showed similar short-term effectiveness as non-aerosol procedures in arresting enamel caries and reducing hypersensitivity in hypomineralized molars.

Trial registration: Clinical Trials Registration Number: NCT03862014.

Keywords: Clinical trials; Dental caries; Molar incisor hypomineralization; Prevention; Silver diamine fluoride.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Child
  • Dental Atraumatic Restorative Treatment*
  • Dental Caries* / drug therapy
  • Dental Caries* / prevention & control
  • Dental Enamel Hypoplasia*
  • Fluorides, Topical
  • Humans
  • Molar
  • Pit and Fissure Sealants / therapeutic use
  • Prospective Studies
  • Quaternary Ammonium Compounds
  • Silver Compounds


  • Fluorides, Topical
  • Pit and Fissure Sealants
  • Quaternary Ammonium Compounds
  • Silver Compounds
  • silver diamine fluoride

Associated data