Dentin tubule occlusion by a 38% silver diamine fluoride gel: an in vitro investigation

Objective Silver diamine fluoride (SDF) is effective in treatment of dentin hypersensitivity and caries lesions. However, the non-viscous solution does not easily allow clinicians to control the application area. A 38% SDF experiment gel was compared in vitro to commercial SDF for its ability to penetrate and occlude dentinal tubules. Materials and methods Human root surface dentin specimens were treated with gelled or standard 38% SDF or negative control. Penetration behavior was established by Drop Shape Analysis. Precipitates at the surface and within tubules were analyzed by SEM and EDX after treatment; Results: penetration depths up to 500 µm were observed for both SDF formulations. Both formulations occluded dentinal tubules similarly. Precipitates on the dentin surface and within dentinal tubules were found for both SDF formulations, with a slight tendency for the experimental gel SDF product to be more abundant than the commercially available one. Discussion: behavior of the experimental 38% SDF gel formulation appeared indistinguishable from the commercial 38% SDF product with respect to dentinal tubule penetration and occlusion. Conclusions The experimental 38% SDF gel may be a suitable intervention for the prevention of dentin hypersensitivity.

Penetration of Silver Diamine Fluoride in Deep Carious Lesions of Human Permanent Teeth: An In Vitro Study

Background. When silver diamine fluoride (SDF) is used in conjunction with conservative caries removal in deep carious lesions, the distribution depth of silver is critical for safety and effectiveness. Objective. The purpose of this study is to determine the effect of selected caries removal on silver penetration when 38% SDF is applied to deep carious lesions in permanent teeth. Methods. Extracted permanent teeth with caries extending to the inner third of the dentin were used (N = 18). The periphery of the carious lesion was completely removed to the dentinoenamel junction (DEJ). In group A (n = 9), no further removal of carious tissue was performed, leaving necrotic dentin inner to the DEJ, whereas in group B (n = 9) superficial necrotic dentin was completely removed until leathery, slightly moist, reasonably soft dentin remained. SDF was applied for 3 minutes in both groups. Microcomputer tomography (micro-CT) and field emission scanning electron microscopy coupled with energy-dispersive X-ray spectroscopy (FESEM-EDS) were used to measure mineral density and silver distribution. The silver penetration depth/lesion depth (PD/LD) ratio was calculated for each sample. The Mann–Whitney U test was used to compare differences between the two groups. Results. The micro-CT analysis showed that the PD/LD ratios of group B (1.07–2.29) were marginally greater than those of group A (1.00–1.31). However, a statistically significant difference was not observed ( p value = 0.5078). When stratified by remaining dentin thickness (RDT), the PD/LD ratios of group B were still greater than those of group A only when RDT was >500 µm. The FESEM-EDS analysis indicated that silver particles precipitated throughout the entire thickness of the carious lesions. Conclusion. Applying SDF on a deep carious lesion and leaving the necrotic dentin pulpally did not affect silver penetration. However, the extent to which silver penetrates the remaining dentin beneath the lesions is dependent on the amount and characteristics of that dentin.

Bond Strength and Microleakage of a Novel Glass Ionomer Cement Containing Silver Diamine Fluoride

Objectives To investigate the shear bond strength and microleakage of glass ionomer cement (GIC) containing silver diamine fluoride (SDF). Materials and Methods Sound human permanent premolars were divided into the following three groups: 1) GIC (Fuji IX), 2) GICSDF-S: GIC + SDF (Saforide), and 3) GICSDF-T: GIC + SDF (Topamine). Shear bond strength (n = 14/group) was measured using a universal testing machine and compared between groups (one-way ANOVA and Tukey HSD, p < 0.05). Microleakage (n = 15/group) at enamel and dentin margins was scored using a stereomicroscope (10x) and compared between groups (Chi-square, p < 0.05). Results There were significant differences in shear bond strength between the GIC and GICSDF-S groups and between the GIC and GICSDF-T groups. The GIC group had the lowest shear bond strength among the groups; however, there was no significant difference between the GICSDF-S and GICSDF-T groups. The microleakage test results were not significantly different between groups at the enamel margin or dentin margins. Although the GIC group demonstrated a higher dye penetration score at the enamel and dentin margins, the difference was not significant. Conclusions Within the limitations of this study, we conclude that incorporating SDF into GIC results in higher shear bond strength while not increasing microleakage at the enamel and dentin margins.

In-vitro Assessment of Silver Diamine Fluoride Effect on Natural Carious Dentin Microhardness

This study aimed to assess the effect of silver diamine fluoride (SDF) on natural carious dentin microhardness and the correlation between tactile sensation, fluorescence, and microhardness on carious dentin. Permanent carious teeth scored ICDAS 4–6 were longitudinally sectioned into tooth slabs exposing carious dentin on one side and sound dentin on the other. Both sides were assessed for tactile sensation (soft/leathery/firm), fluorescence (red/pink/no fluorescence) with FACE technology (SiroInspect®, Dentsply Sirona, USA), and Vickers's microhardness (VMH). Samples were randomized into 3 groups based on SDF protocol (n = 30): Control/Group A- No SDF treatment; Group B- 38% SDF (Advantage Arrest™, Elevate Oral Care®, USA); Group C- SDF with potassium iodide/KI (Riva Star, SDI, Australia). After SDF application, all samples were stored for 1 week under 100% humidity at 37°C and re-assessed for tactile sensation, fluorescence, and microhardness. Change in microhardness (ΔVMH; mean ± SD), tactile sensation (ΔT), and fluorescence (ΔF) were calculated using the difference between pre-SDF and post-SDF values. Mixed ANOVA analysis showed that ΔVMH of carious and sound surfaces were statistically significantly higher for each of the experimental groups (Group B-sound: 20.22 ± 11.98 HV, carious: 19.76 ± 9.35 HV; Group C-sound: 14.26 ± 10.11 HV, carious: 22.51 ± 7.67 HV) than the control group (Group A–sound: 7.34 ± 8.28 HV, carious: 0.69 ± 3.53 HV) (p &lt; 0.0001). There was no statistically significant difference between the experimental groups themselves for carious surfaces (p = 0.146). On sound surfaces, Group B showed a statistically significantly higher ΔVMH than Group C (p = 0.026). There was no statistically significant interaction between type of surface and ΔVMH in Group B (p = 0.809). In Group C, sound surfaces showed a statistically significantly lower ΔVMH than carious surfaces (p &lt; 0.0001). Spearman rank-order correlation showed a statistically significant negative correlation between ΔVMH and ΔT (rs = −0.588, p &lt; 0.0001) and between ΔVMH and ΔF (rs = −0.269, p = 0.01). There was a statistically significant positive correlation between ΔT and ΔF (rs = 0.226, p = 0.032). In conclusion, the microhardness of SDF-treated dentin surfaces increased as compared to non-SDF-treated surfaces. SDF (Advantage Arrest™) increased microhardness of carious and sound dentin to a similar extent whereas, SDF/KI (Riva Star) increased microhardness of carious dentin more than sound dentin. An increase in microhardness was correlated with a firmer tactile sensation.

Silver diamine fluoride for managing carious lesions: A literature review

Though the prevalence and the severity of dental caries is decreased in past few years, still children from low socioeconomical status in many industrialized or developing countries are still suffering from ill-effects of dental caries. The antimicrobial effect of silver compounds has been proven by the 100-year-old application of silver compounds. Silver diamine fluoride (SDF) has been used to arrest dental caries during 1970s in Japan, but it was not exposed much to other parts of the world. Today in many countries a 38% (44,800 ppm fluoride) SDF solution is commonly used to arrest caries and also to reduce hypersensitivity in primary and permanent teeth. Application of SDF to arrest dental caries is non-invasive procedure and is quick and simple to use. Reports of available studies showed that there is no severe pulpal damage after SDF application. However, it has some drawbacks like black discoloration of the carious teeth and an unpleasant metallic taste. But, low cost of SDF and its simplicity in application suggest that it is an appropriate agent for use in community dental health programme. Thus, SDF appears to meet the criteria of both the WHO Millennium Goals and the US Institute of Medicine’s criteria for 21st century medical care, that is, it is a safe, effective, efficient, and equitable caries preventive agent.