Caries arrest and lesion appearance using two different silver fluoride therapies with and without potassium iodide: 6-month results

Influence of silver fluoride plus potassium iodine on adhesive properties of primary carious dentin-resin interface: An in vitro study

This paper evaluated the influence of different protocols of silver fluoride (SF) pretreatment of artificial carious lesions on the adhesive interface of composite resin restorations and remineralization of deciduous dentin compared to silver diamine fluoride (SDF). Sixty-four deciduous molar teeth were randomly divided into 8 groups (n = 8) according to the restoration time (immediately - IM; 30 days after SDF/SF treatment - 30 D) and treatment before restoration (SDF 38 %; SDF 38 % + potassium iodide - KI; SF 38 %; SF 38 % +KI). After SDF/SF application, teeth in the IM group were restored with self-etch universal adhesive system/composite resin. Samples in the 30D groups were stored in artificial saliva (37 °C) for 30 days before receiving the same restoring protocol. Beams were obtained from all groups and subjected to bond strength tests (µTBS), ultrastructural qualitative analysis (FEG) and mineral analysis (SEM/EDX; Micro-Raman spectroscopy). The µTBS data were subjected to three-factor ANOVA and multiple comparisons (Holm-Sidak method). Bond strength values (MPa) for IM groups were 16.9 ± 2.7 (SDF); 17.6 ± 3.5 (SDF + KI); 16.8 ± 5.5 (SF); 18.4 ± 4.1 (SF + KI); and 14.9 ± 4.2 (SDF); 16.0 ± 5.4 (SDF + KI); 14.1 ± 3.6(SF); 16.4 ± 5.4 (SF + KI) for 30D groups. Bond strength wasn't influenced by the moment of restoration (IM or 30D); the use of KI didn't alter adhesion characteristics; SDF/SF solutions resulted in similar adhesive strength; calcium and phosphate expressions were identified at the interfaces on IM and 30D moments. However, 30D presented qualitative increase in these ions, compatible with remineralization. It was concluded that the adhesion of composite resin restorations in artificial caries lesions of deciduous teeth treated with SDF (38 %) and SF (38 %) had similar effects in vitro; the use of KI or the moment when restorations were accomplished did not influence the adhesion and all tested protocols promoted remineralization of carious dentin.

Silver diamine fluoride with sodium fluoride varnish versus silver diamine fluoride in arresting early childhood caries: a 6-months follow up of a randomized field trial

BACKGROUND

Early childhood caries (ECC) is the most prevalent chronic health problem in young children, and it can be arrested using professionally applied fluoride such as Sodium fluoride (NaF) varnish and Silver Diamine Fluoride (SDF). This trial compared two interventions to arrest ECC lesions: 38% SDF combined with 5% NaF varnish versus 38% SDF and assessed whether the arrest rate was affected by baseline lesion severity measured by ICDAS.

METHODS

Children aged ≤ 4 years from 4 nurseries in a rural area in Alexandria, Egypt joined the study in March 2022. They were included if they had at least one active carious lesion with ICDAS codes ≥ 3. They were randomized to receive either 38% SDF with 5% NaF varnish or 38% SDF alone. In both groups, the agents were applied at baseline and after 6 months on the caries lesions. NaF was additionally applied on all teeth in the oral cavity, and it was also applied after three months. The primary outcome was lesion arrest status after six months. Parents' satisfaction with their children's appearance was the secondary outcome. Pearson Chi-Square test was used for bivariate comparison and multi-level multiple logistic regression was used to assess the effect of the intervention on caries arrest controlling for confounders. The interaction between the intervention and baseline lesion severity (categorized into moderate and severe lesions) was assessed and the p value was calculated.

RESULTS

The study included 1606 lesions in 220 children, median (IQR) age = 48(9) months. The percentages of arrested lesions after the application of SDF + NaF and SDF only were 77.7% and 73.2% (p = 0.035). In multivariable analysis, SDF + NaF had significantly greater caries arrest effect than SDF alone (AOR = 2.12, p = 0.03) with significant difference (p = 0.03) between moderate (AOR = 4.10, p = 0.005) and advanced (AOR = 1.92, p = 0.08) lesions. Most parents were satisfied with their children's appearance with no significant difference between groups (SDF + NaF = 84.5%, SDF = 78.18%, p = 0.23).

CONCLUSION

SDF + NaF had a higher arrest rate than SDF alone and this difference was significant in moderate but not advanced lesions. The findings have implications for the non-invasive management of ECC.

TRIAL REGISTRATION

This trial was registered in the clinicaltrials.gov registry (#NCT05642494).

Effectiveness of silver diamine fluoride versus sodium fluoride varnish combined with mother's motivational interviewing for arresting early childhood caries: a randomized clinical trial

BACKGROUND

Silver Diamine Fluoride (SDF) has gained attention as one of the minimally invasive modalities to manage ECC although it causes black staining of treated carious lesions. A possible affordable alternative may be Sodium Fluoride (NaF) varnish combined with good oral hygiene promoted by parental Motivational Interviewing (MI). The study compared the effectiveness of 38% SDF solution and 5% NaF varnish supported by parental MI in arresting ECC.

MATERIALS AND METHODS

Children aged ≤ 4 years old with at least one active carious lesion (ICDAS score ≥ 3) were randomly assigned to treatment by a single application of 38% SDF solution or a single application of 5% NaF varnish supported by two MI sessions for mothers at baseline and after three months. Chi-Squared test was used to compare groups and multilevel logistic regression analysis was used to assess the effect of the interventions on ECC arrest adjusting for confounders. The interaction between the type of intervention and baseline lesion severity, moderate (ICDAS 3/4) or advanced (ICDAS 5/6), was also assessed.

RESULTS

The study included 165 children with 949 active lesions. After 6 months, there were no significant differences between SDF and NaF/MI groups in overall caries arrest (63.7% and 58.1%, p = 0.08), and in moderate lesions (72.9% and 69.6%, p = 0.52). However, in advanced lesions, the arrest rate was significantly higher in the SDF than the NaF/ MI group (60.3% and 50.0%, P = 0.01). Multilevel multiple logistic regression showed no significant differences between the interventions (AOR = 1.56, P = 0.27) with significant interaction between the intervention and baseline lesion severity (p < 0.001). Moderate lesions treated with SDF (AOR = 3.69, P = 0.008) or NaF/MI (AOR = 3.32, P < 0.001) had significantly higher odds of arrest than advanced lesions treated with NaF/ MI with no difference between advanced lesions treated with SDF or NaF/ MI (AOR = 1.85, P = 0.155) in arrest rate.

CONCLUSION

NaF/ MI can be an alternative to SDF in arresting advanced and moderate ECC lesions without staining with stronger effect on moderate lesions (ICDAS 3/4).

TRIAL REGISTRATION

The trial was retrospectively registered at clinicaltrial.gov registry (#NCT05761041) on 9/3/2023.

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.

Potential discolouration of silver diamine fluoride versus silver diamine fluoride/potassium iodide in primary teeth: a randomised clinical study

Aim This study aimed to evaluate the potential discolouration and carious lesion arresting effect of silver diamine fluoride (SDF) and silver diamine fluoride/potassium iodide (SDF/KI) in the treatment of carious primary teeth.Materials and method A total of 30 carious primary canines were randomly assigned to treatment groups where Group I was treated with SDF while Group II was treated with SDF/KI. Caries arrest was assessed based on consistency and stability of lesion size while the discolouration of treated lesions was assessed digitally using a VITA Easyshade spectrophotometer.Results Both treatments demonstrated 100% efficacy in arresting active caries lesions. Regarding discolouration, the total colour difference represented by delta E (ΔE) was 16.45 ± 5.69 for Group I compared to 9.54 ± 3.09 for Group II immediately post-operative, with a statistically significant difference (p = 0.003). Both groups showed similar values at 1, 3, 6 and 12 months after the treatment, with no statistically significant difference. No incidence of serious adverse effects related to either treatment and the majority of parents/guardians were satisfied with both treatments compromising their child's aesthetic appearance.Conclusions Both SDF and SDF/KI are effective in arresting carious lesions in primary teeth but in terms of the discolouration potential, the use of KI significantly reduced the discolouration caused by SDF immediately post-operatively. Unfortunately, marked discolouration was recorded in the subsequent follow-up visits, compromising the aesthetic outcome.

Effect of Silver Diamine Fluoride and Potassium Iodide Solution on Enamel Remineralization and Discoloration in Artificial Caries

Silver diamine fluoride (SDF) is a strong fluoride agent for caries control, remineralization, and reducing the incidence of dental caries. This study used 38% SDF with potassium iodide (KI) on enamel remineralization and compared it with the currently used 38% SDF and 5% sodium fluoride (NaF) varnish to treat artificial caries. Bovine incisors were demineralized for 120 h and randomly distributed for treatment by the remineralization agents for 120 h as follows: control (n = 15), SDF/KI (n = 15), SDF (n = 15), and NaF (n = 15). Colorimetric analysis was performed using the ΔE value. The Vickers microhardness (VHN) was determined to evaluate the enamel remineralization of the specimens. Polarized light microscopy (PLM) and scanning electron microscopy (SEM) were performed to confirm the surfaces precisely and histologically. SDF/KI caused no significant difference in discoloration between the control and NaF groups. There was also no significant difference in the VHN after remineralization, but SDF/KI exhibited the highest mean microhardness. PLM revealed that SDF/KI had the greatest remineralization ability. In conclusion, SDF/KI is effective for dental enamel remineralization even with KI, which reduces discoloration.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of the 2020 professional literature in restorative dentistry to inform busy dentists regarding noteworthy scientific and clinical progress over the past year. Each member of the committee brings discipline-specific expertise to this work to cover this broad topic. Specific subject areas addressed include prosthodontics; periodontics, alveolar bone, and peri-implant tissues; implant dentistry; dental materials and therapeutics; occlusion and temporomandibular disorders (TMDs); sleep-related breathing disorders; oral medicine and oral and maxillofacial surgery; and dental caries and cariology. The authors focused their efforts on reporting information likely to influence day-to-day dental treatment decisions with a keen eye on future trends in the profession. With the tremendous volume of dentistry and related literature being published today, this review cannot possibly be comprehensive. The purpose is to update interested readers and provide important resource material for those interested in pursuing greater detail. It remains our intent to assist colleagues in navigating the extensive volume of important information being published annually. It is our hope that readers find this work useful in successfully managing the dental patients they encounter.

The effect of the combined use of silver diamine fluoride and potassium iodide in disrupting the plaque biofilm microbiome and alleviating tooth discoloration: A systematic review

Silver diamine fluoride (SDF) is used in minimally invasive dentistry for arresting dental caries. However, discoloration of teeth is a significant side effect that has limited the use of SDF. Hence, the application of potassium iodide (KI) following SDF has been proposed to ameliorate the staining. Although antimicrobial activity is one of the major mechanisms of the caries-arresting effect of SDF, the antimicrobial potency of SDF/KI combination is unclear. Thus, the primary objective of this systematic review was to appraise the studies on the antimicrobial efficacy of SDF/KI combination on cariogenic microbes. The secondary objective was to summarize the evidence on the potential of KI in reducing the discoloration associated with the application of SDF. Electronic databases of Medline via PubMed, Cochrane Library, Web of Science, and EBSCO host were searched for English language manuscripts from January 2005 to 15th November 2020. The reference lists of these manuscripts were manually searched for additional studies. Twelve studies were included in the final analysis, seven of which have investigated the antimicrobial efficacy of SDF/KI, and the rest have examined the anti-staining potential of KI. The exploratory findings from the reviewed articles revealed the promising antimicrobial potential of SDF/KI on cariogenic microbes associated with dentine caries. There is, however, contradictory evidence on the effect of SDF/KI on tooth color. The reviewed in-vitro studies indicated significant effectiveness of KI in preventing staining. A clinical trial on primary dentition showed 25% reduction in the incidence of staining by SDF after applying KI, while a clinical study on root caries in adults showed no significant effect. Within the methodological limitations of this review, we conclude that for arresting dental caries, SDF could be combined with KI, as there may be a lower likelihood of staining. Further, well-designed clinical trials on the antimicrobial and anti-staining effect of SDF/KI are needed to obtain more robust evidence.

Effectiveness of silver diamine fluoride and glass ionomer cement combined with fluoride varnish in arresting dental caries among intellectually disabled individuals: A randomized controlled trial

AIM

To assess the clinical effectiveness of 38% silver diamine fluoride (SDF) in arresting dental caries when compared to combination of fluoride-containing glass ionomer cement (GIC) and fluoride varnish(FV) (5%) among intellectually disabled (ID) individuals.

METHODOLOGY

A randomized controlled trial was conducted among ID (n = 82) individuals, in permanent posterior teeth with Nyvad score 2 and 3 (active caries) of dental caries, randomly allocated to experimental arm (38% SDF) (n = 41) and control arm (GIC along with FV) (n = 41). The caries arrest rate and caries preventive fraction was observed at 6-months among both groups.

RESULTS

The caries arrest rate was 94.5% with SDF and 90.1% with GIC and FV (p = 0.405).The caries preventive fraction of SDF over GIC with FV was 45%, with hazard ratio (-0.588) at 6 months (p = 0.292). The binary logistic regression revealed that the Odds of arresting caries in SDF group is two times when compared to GIC group with p value = 0.218 which is not significant.

CONCLUSION

The present study concluded that the SDF is as clinically effective as combination of GIC and fluoride varnish in arresting caries. Further research and longer follow-up required for more conclusive results.

Caries arrest and lesion appearance using two different silver fluoride therapies on primary teeth with and without potassium iodide: 12-month results

Background

Globally, has been an increase in the use of silver fluoride products to arrest carious lesions and a variety of products are available.

Objectives

To examine differences in caries arrest and lesion colour of primary tooth carious lesions.

Material and Methods

A four‐armed, parallel‐design cluster‐randomised controlled trial which investigated four protocols for caries arrest at 6m and 12m. Children in Group 1 and Group 2 received Rivastar Silver Diammine Fluoride (SDF), and children in Group 3 and Group 4 received a stabilised aqueous silver fluoride solution (AgF). Children in Group 2 and Group 4 received an additional application of KI immediately after the fluoride. Differences in caries arrest and lesion appearance were examined at 6m and 12m using two level logistic regression modelling.

Results

The arrest rate varied by group membership; group 1 and group 3 had higher arrest rates (77.3% and 75.3% respectively) than group 2 and group 4 (65.4% and 51.2% respectively). The use of KI was also associated with lower odds of arrest (12m OR 0.25; CI 0.19, 0.34) and higher odds of avoiding black discolouration (12m OR 6.08; 2.36, 15.67).

Conclusions

Globally, has been an increase in the use of silver fluoride products to arrest carious lesions and a variety of products are available. This study demonstrated that both AgF and SDF can effectively arrest carious lesions on primary teeth. The use of KI is associated with poorer caries control but better aesthetic outcomes.