Effect of silver diammine fluoride and glass ionomer on remineralisation of natural dentine caries

Silver modified atraumatic restorative treatment: a paradigm shift in dental caries management

Silver diamine fluoride (SDF) and atraumatic restorative treatment (ART) are treatment modalities that are minimally invasive and used for the prevention and control of dental caries. The amalgamation of these two techniques has led to the development of silver modified atraumatic restorative treatment (SMART). In this approach the carious lesion is restored with glass-ionomer cement (GIC) after SDF application. SMART effectively arrests caries without removing additional tooth structure, making it a promising option for caries management in children who lack cooperative ability.This article reviews the literature on SMART, the evidence regarding its applications in dental practice, its advantages, drawbacks, the scope for research, and clinical use.

Comparison of the Knowledge, Attitudes, and Practices Regarding Silver Diamine Fluoride (SDF) between Japanese Dental Students with Experience Using SDF and Those with No Experience Using SDF: A Cross-Sectional Study

BACKGROUND

The aim of this study was to evaluate the differences in the knowledge and attitude regarding silver diamine fluoride (SDF) between two groups, differentiated by whether they had experience in SDF use, of dental students and clinical trainee dentists in Japan.

METHODS

A survey was designed consisting of three dental classes (fourth, fifth, and sixth years) and clinical trainees at Kyushu Dental University. A survey was designed consisting of 32 questions about the knowledge, attitudes, esthetic acceptability, and potential barriers regarding the use of SDF.

RESULTS

A total of 286 surveys (response rate of 85.4%) were collected. Among all respondents, 21.7% had experience with SDF use in their clinical practice. Regarding the knowledge score for SDF (0 to 12 points), in the respondents with no experience of using SDF, the mean score was 3.06, and that of respondents with experience of using SDF was 1.66, which was a significant difference (p < 0.001). The mean esthetic acceptability score for SDF use (-8 to 8 points) of the clinical trainees was -1.00 and that of the fourth-year students was 0.74, which was a significant difference (p < 0.05).

CONCLUSIONS

the results indicate that dental students and clinical trainees need to increase their clinical experience with SDF.

A Wider Scope of Analysis on 38% Silver Diamine Fluoride

This research was conducted to further support previous studies on the effectiveness of 38% silver diamine fluoride on caries arrest. In addition, the number of applications, time between subsequent applications, type of teeth (primary vs. permanent), final restoration following treatment, and the type of restoration, if any, were assessed. It is a retrospective longitudinal study that was conducted using a chart review technique for which a waiver of informed consent was obtained. The research participants' privacy was ensured and protected. All participants' identities remained anonymous and confidential. Furthermore, consent was collected from participants' sitters during their appointments as a protocol prior to applying 38% silver diamine fluoride (SDF). The current research was reviewed and approved by the Research Ethics Committee at King Faisal Specialist Hospital and Research Center (KFSH&RC). All investigators abided by the rules and regulations of the Government of Saudi Arabia, KFSH&RC, and the Research Advisory Council. A population of pediatric patients with primary and/or mixed dentition at a tertiary care hospital who were treated at the dental office between the period from March 2020 to December 2022 were recruited. A consecutive non-random sampling technique was used. The inclusion criteria include cavitated, asymptomatic, and teeth with no signs or symptoms of pulpal involvement. The sample size estimation was done by considering different percentages of success in arresting dental carries by using 38% SDF, with different levels of precision of 95% confidence intervals and with 0.05 level of significance. A 95% success was assumed in arresting dental carries by using 38% SDF, with a precision of ±5%, and with α=0.05, the required teeth sample size was 101. Anticipating some incomplete information and documentation, the sample size may be dynamic. Nighty-seven teeth both primary and permanent were included in this study. Data were analyzed using IBM SPSS Statistical software version 26.0 (Armonk, NY: IBM Corp.) for Windows. Descriptive statistics (mean standard deviation, frequencies, and percentages) were used to describe the quantitative and categorical outcome variables. Pearson's chi-square test and Fisher's exact test were used to compare the proportion success of 38% SDF in relation to the characteristics of study subjects. The odds ratios were used to quantify the measure of association between the success and other categorical study variables. A binary multiple logistic regression was used to identify the independent variables associated with the success of 38% SDF in arresting dental caries. A p-value of <0.05 and 95% confidence intervals were used to report the statistical significance and precision of results. Our current research concluded that different variables associated with 38% SDF, such as the number of applications and the time-lapse between applications, had no significant effect on the successful results of the application. Moreover, receiving a final restoration did not affect the success of the treatment when compared to treating with 38% SDF alone. Additionally, the type of final restoration had no impact on the prognosis. Further research using standardized protocols for study designs, detection criteria, outcomes, and statistical designs is needed to support findings and establish treatment guidelines.

Effect of Antibacterial Agents on Dentin Bond Strength of Bioactive Restorative Materials

Treating dentin surfaces with antibacterial agents prior to bonding bioactive restorations might affect their mechanical properties. In this study, we evaluated the effect of silver diamine fluoride (SDF) and chlorhexidine (CHX) on the shear bond strength (SBS) of bioactive restorative materials. Dentin discs were treated with SDF for 60 s or CHX for 20 s and bonded with four restorative materials, namely Activa Bioactive Restorative (AB), Beautifil II (BF), Fuji II LC (FJ), and Surefil One (SO). Control discs were bonded without treatment (n = 10). SBS was determined using a universal testing machine, and a scanning electron microscope (SEM) was used for the evaluation of the failure mode and the cross-sectional examination of adhesive interfaces. The SBS of each material between different treatments and of the different materials within each treatment were compared via a Kruskal-Wallis test. The SBS of AB and BF was significantly higher than that of FJ and SO in the control and CHX groups (p < 0.01). In the latter, SBS was higher in FJ than SO (p < 0.01). SO had a higher value with SDF compared to CHX (p = 0.01). The SBS of SDF-treated FJ was higher than that of the control (p < 0.01). SEM showed a more homogenous and improved interface of FJ and SO with SDF. Neither CHX nor SDF compromised the dentin bonding of bioactive restorative materials.

Remineralization of Dentinal Lesions Using Biomimetic Agents: A Systematic Review and Meta-Analysis

The objective of this article was to systematically provide an up-to-date review on the different methods of remineralizing human dentine using different biomimetic agents. The authors performed a systematic search within PubMed, Scopus, and Web of Science in addition to the grey literature in Google Scholar^® using MeSH terms. The PICO question was P: human teeth dentinal sections; I: application of biomimetic remineralizing agents; C: other non-biomimetic approaches; O: extent of remineralization and physical properties of remineralized dentine. The initially identified studies were screened for titles and abstracts. Non-English articles, reviews, animal studies, studies involving the resin-dentine interface, and other irrelevant articles were then excluded. The other remaining full-text articles were retrieved. Bibliographies of the remaining articles were searched for relevant studies that could be included. A total of 4741 articles were found, and finally, 39 full-text articles were incorporated in the current systematic review. From these, twenty-six research studies used non-collagenous protein (NCP) analogs to biomineralize dentine, six studies used bioactive materials derived from natural sources, six studies used zinc hydroxyapatite, and one study used amelogenin peptide to induce hydroxyapatite formation on the surface of demineralized dentine. Additive effects of triclosan and epigenin were assessed when combined with commonly available NCPs. Overall, a moderate risk of bias was observed and, hence, the findings of the included studies could be acceptable. A meta-analysis of some similar studies was performed to assess the depth of remineralization and elastic modulus. Despite having high heterogeneity (I² > 90), all the studies showed a significant improvement in biomimetic remineralization efficacy as compared to the control. All the included studies carried out a functional remineralization assessment and found a 90-98% efficacy in the extent of remineralization while the elastic modulus reached 88.78 ± 8.35 GPa, which is close to natural dentine. It is pertinent to note the limitations of these studies that have been carried out in vitro under controlled settings, which lack the effects of a natural oral environment. To conclude, the authors suggest that the biomimetic remineralization of dentine using NCP analogs, bioactive materials, and natural products carries significant potential in treating dentinal lesions; however, more long-term studies are needed to assess their clinical applications in vivo.

Time-dependent structural changes and hypermineralisation of artificially demineralised dentine following treatment with silver diammine fluoride and glass ionomer cement

OBJECTIVES

This study aimed to evaluate the change of mineral content in dentine lesions over time and examine the effectiveness of the combined treatment with silver diammine fluoride (SDF) and glass ionomer cement (GIC).

METHODS

Sixty bovine dentine specimens were divided into 4 groups: cont, Fuji, Safo, and Safo+Fuji. The specimens were imaged and measured using microcomputed tomography (microCT) at 7 time points: pre-demineralisation, after demineralisation for two weeks, immediately after treatment, 1 week, 2 weeks, 1 month, and 3 months after treatment. The 3-month group was evaluated with a light microscope, attenuated total reflectance-Fourier transform infrared (ATR-FTIR) spectroscopy, and scanning electron microscope (SEM)/energy-dispersive X-ray spectroscopy (EDS). Data were analysed by Dunn's test and Wilcoxon signed rank test with Bonferroni correction for microCT, and Kruskal-Wallis test and two-way analysis of variance for EDS characterisation.

RESULTS

MicroCT images showed high mineral density beneath dentine lesions in Safo+Fuji. The mineral density at 600 μm in Safo+Fuji increased significantly over time, while Safo showed an opposite trend (adjusted p<0.005). In Safo+Fuji, EDS revealed significantly high energy of fluorine (p<0.05, at 300 μm) and a tendency towards high energy of calcium (p>0.05). However, Safo+Fuji showed lower energy of silver compared to Safo (p<0.001). ATR-FTIR revealed that phosphate groups had the highest peak at a depth between 300 and 400 μm in Safo+Fuji.

CONCLUSIONS

Safo+Fuji was effective in remineralising the deep lesion in dentine after one and three months, and a hypermineralisation zone generated beneath the lesion demonstrated additional benefit in this study.

CLINICAL SIGNIFICANCE

This long-term in vitro study showed that SDF+GIC treatment could strengthen the structure of decayed teeth when applied in the treatment of patients with advanced rampant caries.

Clinical and primary evidence of silver diamine fluoride on root caries management

Root caries is a growing problem for the worldwide aging population. Silver diamine fluoride (SDF) contains high concentrations of silver and fluoride ions, which prevents and arrests root caries, as well as dentin caries in the primary teeth of young children. Unlike other fluoride products that mainly reduce the formation of new carious lesions, 38% SDF is an effective agent that can efficiently arrest the carious process, remineralize the decayed dental tissues, and protect the tooth structure against the formation of new caries lesions. The use of SDF can result in more caries-resistant tooth structures. Despite these merits, its clinical disadvantages are the deep penetration of silver ions and sequential formation of silver compounds, which cause esthetic concern due to the discoloration and impaired efficacy of dentin bonding after using SDF. Thus, this narrative review, by addressing the primary experimental results and clinical applications of SDF on root caries, proposes management methods for root caries in conjunction with the application of SDF. We propose a two-visit treatment protocol to take advantage of the SDF application for root surface caries and utilize the discoloration caused by SDF.