The effect of silver diamine fluoride in preventing in vitro primary coronal caries under pH-cycling conditions

Effects of silver diamine fluoride on demineralization protection after a secondary acid challenge

OBJECTIVE

This investigation describes the effects of 5% sodium fluoride varnish and 38% silver diamine fluoride on demineralization protection of human enamel lesions of three different severities after a secondary acid challenge.

STUDY DESIGN

Specimens underwent color and enamel surface microhardness change measurements after demineralization and treatment events. Transverse microradiography was conducted following the secondary demineralization.

RESULTS

After treatments, enamel surface microhardness change showed that 24-hour lesions treated with fluoride varnish had less rehardening than 24-hour lesions treated with silver diamine fluoride (p<0.05), whereas 144-hour lesions from both treatment groups showed a beneficial decrease in surface microhardness change that was markedly better in samples treated with silver diamine fluoride (p<0.05). After the secondary demineralization, 24- and 144-hour lesions treated with silver diamine fluoride showed a sustained beneficial decrease in enamel surface microhardness change when compared to fluoride varnish-treated samples of the corresponding lesion severity (p<0.05). Transverse microradiography showed no difference between fluoride varnish- and silver diamine fluoride-treated samples of any corresponding lesion severity, indicating that remineralization in both fluoride varnish- and silver diamine fluoride-treated samples was proportional to each other after a secondary acid challenge.

CONCLUSIONS

Using silver diamine fluoride may have comparable benefits to fluoride varnish in mineral loss prevention.

Effect of 38% silver diamine fluoride on fracture resistance of leucite reinforced feldspathic ceramic CAD/CAM class I inlay restorations

INTRODUCTION

Silver diamine fluoride (SDF) is a topical agent that has recently gained popularity for its ability to stop and prevent dental caries.

Dental Pulp Response to Silver-Containing Solutions: A Scoping Review

Dentists used silver-containing solutions for deep cavity disinfection before restoration. This review aims to identify the silver-containing solutions reported in the literature for deep cavity disinfection and summarize their effects on dental pulp. An extensive search was performed using the search words "(silver) AND (dental pulp OR pulp)" in ProQuest, PubMed, SCOPUS, and Web of Science to identify English publications on silver-containing solutions for cavity conditioning. The pulpal response to the included silver-containing solutions was summarized. The initial search identified 4112 publications and 14 publications met the inclusion criteria. Silver fluoride, silver nitrate, silver diamine nitrate, silver diamine fluoride, and nano-silver fluoride were used in deep cavities for antimicrobial purposes. Indirect silver fluoride application induced pulp inflammation and reparative dentine in most cases, and pulp necrosis in some cases. Direct silver nitrate application caused blood clots and a wide inflammatory band in the pulp, whilst indirect silver nitrate application caused hypoplasia in shallow cavities and partial pulp necrosis in deep cavities. Direct silver diamine fluoride application induced pulp necrosis, while indirect silver diamine fluoride application induced a mild inflammatory response and reparative dentine formation. No evidence of the dental pulpal response to silver diamine nitrate or nano-silver fluoride was available in the literature.

Influence of salivary acquired pellicle on colour changes and minerals content of dentine after application of silver diamine fluoride followed by potassium iodide

PURPOSE

This study evaluated whether the presence of the salivary acquired pellicle (AP) had any effect on the dentin's darkening and on the caries arresting effect after the use of SDF + KI, in a cariogenic challenge.

METHODS

Human dentin specimens were standardised, submitted to artificial caries lesion formation, and divided into five groups (n = 20): C: control group-no treatment, SDF: 38% SDF, APSDF: SDF 38% and AP, KISDF: 38% SDF and KI, and APKISDF: 38% SDF, KI and AP, that were submitted to pH cycling. Colour evaluation (CIE L*a*b* system) and surface hardness were performed before and after the treatments/pH cycling.

RESULTS

SDF and APSDF groups showed no difference in colour. KISDF and APKISDF groups showed significantly different colours than the groups without KI. SDF, APSDF, and APKISDF groups had less mineral loss than C and KISDF. SDF, APSDF, and APKISDF revealed significantly greater mineral recovery, compared to KISDF and C.

CONCLUSION

The AP did not influence the dentin´s colour after SDF + KI, but had a protective role in modulating the dentin´s mineral gain/loss. KI used after SDF decreased the dentin´s darkening, and did not interfere with the dentin de/remineralization process.

Approaches to minimize tooth staining associated with silver diamine fluoride: A systematic review

OBJECTIVE

To the effectiveness of different strategies to overcome silver diamine fluoride (SDF)-mediated tooth staining.

MATERIALS AND METHODS

Four online databases (PubMed, ScienceDirect, Scopus, and Web of Science) were searched using different MeSH terms and Boolean Operators to retrieve the articles (until June 2021), followed by a hand-search of the reference list of the included articles. All full-text, original studies in English that evaluated SDF staining and at least one SDF modification/alternative were included.

RESULTS

Among the assessed studies, nine studies explored the stain-minimization effect of potassium iodide (KI) post-application following SDF treatment. Among these, eight concluded that KI application after SDF treatment significantly reduced tooth staining, while one showed marginal staining following glass ionomer restoration of the SDF-treated dentine. Additionally, one study applied potassium fluoride (KF) and silver nitrate (AgNO₃ ) concurrently to mitigate SDF-mediated staining. One study compared SDF staining with polyethylene glycol (PEG)-coated nanoparticles containing sodium fluoride (NaF), and another used nanosilver fluoride (NSF) for staining comparison with SDF.

CONCLUSIONS

Within the limitations of this study, the addition of different materials to SDF has proven to be a beneficial strategy for overcoming tooth staining associated with SDF. Future studies are warranted, particularly clinical trials, to validate these findings.

CLINICAL SIGNIFICANCE

SDF-mediated tooth staining is a serious concern that limits its clinical use. A review of various strategies to overcome this problem will help clinicians enhance its clinical use and patient acceptance.

Evaluation of the remineralizing capacity of silver diamine fluoride on demineralized dentin under pH-cycling conditions

OBJECTIVE

(1) to determine the effects of the silver diamine fluoride (SDF) and sodium fluoride (NaF) in demineralized dentin exposed to an acid challenge by pH-cycling, (2) to evaluate the remineralizing capacity of SDF/NaF products based on the physicochemical and mechanical properties of the treated dentin surfaces.

METHODOLOGY

In total, 57 human molars were evaluated in different stages of the experimental period: sound dentin - negative control (Stage 1), demineralized dentin - positive control (Stage 2), and dentin treated with SDF/NaF products + pH-c (Stage 3). Several commercial products were used for the SDF treatment: Saforide, RivaStar, and Cariestop. The mineral composition and crystalline and morphological characteristics of the dentin samples from each experimental stage were evaluated by infrared spectroscopy (ATR-FTIR), X-ray diffraction, and electron microscopy (SEM-EDX) analytical techniques. Moreover, the mechanical response of the samples was analyzed by means of the three-point bending test. Statistics were estimated for ATR-FTIR variables by Wilcoxon test, while the mechanical data analyses were performed using Kruskal-Wallis and Mann Whitney U tests.

RESULTS

Regarding the chemical composition, we observed a higher mineral/organic content in the SDF/NaF treated dentin + pH-c groups (Stage 3) than in the positive control groups (Saforide p=0.03; Cariestop p=0.008; RivaStar p=0.013; NaF p=0.04). The XRD results showed that the crystallite size of hydroxyapatite increased in the SDF/NaF treated dentin + pH-c groups (between +63% in RivaStar to +108% in Saforide), regarding the positive control. SEM images showed that after application of the SDF/NaF products a crystalline precipitate formed on the dentin surface and partially filled the dentin tubules. The flexural strength (MPa) values were higher in the dentin treated with SDF/NaF + pH-c (Stage 3) compared to the positive control groups (Saforide p=0.002; Cariestop p=0.04; RivaStar p=0.04; NaF p=0.02).

CONCLUSIONS

The application of SDF/NaF affected the physicochemical and mechanical properties of demineralized dentin. According to the results, the use of SFD/NaF had a remineralizing effect on the dentin surface even under acid challenge.

Anticaries Agent Based on Silver Nanoparticles and Fluoride: Characterization and Biological and Remineralizing Effects—An In Vitro Study

Objective

The aim of the study was to characterize and evaluate the stability, antimicrobial activity, cytotoxicity, and remineralizing effects of silver nanoparticles and fluoride anticaries agent (AgF) on staining dental enamel.

Materials and Methods

An experimental AgF solution was prepared and compared to silver diamine fluoride (SDF). First, the AgF was characterized and the stability was evaluated by transmission electron microscopy (TEM). Streptococcus mutans, Enterococcus faecalis, and Escherichia coli strains were used to evaluate the minimum inhibitory and bactericidal concentration and cytotoxicity performed using L929 fibroblastic cells by MTT test. Caries-like lesions induced by pH-cycling in human enamel were obtained, and then, the superficial microhardness, cross-sectional microhardness (CSMH), scanning electron microscopy (SEM), and energy-dispersive X-ray spectroscopy (EDS) were performed. Photographic images were taken to analyze the enamel staining.

Results

The AgF showed stableness in long term with bacteriostatic and bactericidal actions without cytotoxicity. Enamel remineralization, in surface and in depth (CSMH), was observed when the AgF was used, and it was similar to SDF. SEM showed enamel precipitation, and EDS observed the presence of P, Ca, Au, Ag, and Cl elements. Contrary to SDF, AgF did not stain the enamel.

Conclusion

The nano silver fluoride anticaries agent tested presented long-term stability, superficial and in-depth remineralizing capacity with antimicrobial potential and biocompatibility and did not stain the enamel.