Enhanced effectiveness of silver diamine fluoride application with light curing on natural dentin carious lesions: an in vitro study

Abstract

Background: Silver diamine uoride (SDF) is widely accepted as a dentinal caries arresting agent because of its effectiveness, easy handling, and short working time. When dealing with uncooperative patients, a reduced working time is desired. As SDF has been known to interact with light, the effects of light curing (LC) on SDF have not been investigated. This study aimed to compare mean mineral density difference and surface morphology between 10-and 60-second(s) SDF-applied dentin carious lesions and similarly SDF-treated teeth with additional 20s LC.Methods: Forty primary molar blocks with natural dentin carious lesions were measured for baseline lesion depth and mineral density at baseline using Image-Pro Plus software. Samples were distributed into 4 groups; 38% SDF applied for 1) 10s (10SDF), 2) 60s (60SDF), 3) 10s+LC (10SDF+LC), and 4) 60s+LC (60SDF+LC), then underwent a 7-day bacterial pH-cycling. Dentin carious lesions' mean mineral density difference was re-evaluated by digital subtraction radiographic analysis. Surface morphology and elemental pro le were assessed by scanning electron microscopy and energy-dispersive X-ray spectroscopy. The mean mineral density difference of the dentin lesions was analyzed using two-way ANOVA, generalized linear models analysis.Results: Light curing was the only factor affecting the mean mineral density difference (p=0.007). Mean mineral density differences in 10SDF+LC and 60SDF+LC groups were signi cantly higher than those without light curing (p=0.041 and 0.041, respectively). The 60SDF+LC group showed a signi cantly higher mean mineral density difference than the 10SDF group (p=0.010), while the 10SDF+LC group was not different from the 60SDF group (p=1.00). Scanning electron microscopy showed denser mineral content layers, which likely were silver and chloride, in 10SDF+LC and 60SDF+LC groups than 10SDF and 60SDF groups, respectively. Conclusion: Shortened application time with light curing enhanced SDF remineralization similarly to a conventional method. This could be valuable for managing dentin caries in young or uncooperative children and special-needs patients by reducing the SDF application time by 50% of the American Academy of Pediatric Dentistry recommendation while maintaining an adequate SDF remineralization effectiveness.

Effect of light curing on the efficacy of silver diamine fluoride: A systematic review

“…Six articles were considered for analysis after retrieval of an additional study through a manual search. 29 , 30 , 31 , 32 , 33 , 34 Sixteen studies were excluded for a variety of reasons 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 after electronic and manual searches ( Table 1 ). Table 2 demonstrates the main characteristics of the studies included in this systematic review, and Table 3 shows the data collected from the studies and the key conclusions.…”

“… Author/year Country Study design Randomisation Karnowakul et al. (2023) 33 Thailand In vitro Yes Wilson et al. (2022) 32 United States In vitro No Chanratchakool et al.…”

“… Author/year Sample type/substrate Caries type/specimen dimensions Sample size and grouping Measured outcome and equipment used Reported outcomes Karnowakul et al. (2023) 33 Extracted human primary molars/dentine Natural caries/1 × 1 × 0.9 cm (W × L × H) Total: 40 1: SDF for 10 s (10) 2: SDF for 60 s (10) 3: SDF for 10 s + LC for 20 s (10) 4: SDF for 60 s + LC for 20 s (10) mMDD (digital subtraction radiographic analysis) Surface morphology and elemental profile (SEM and EDS) 10 SDF + LC and 60 SDF + LC groups had considerably greater mMDD levels than the non-LC groups. The mMDD was much higher in the 60 SDF + LC group than the 10 SDF group, but was nearly equivalent between the 10 SDF + LC group and 60 SDF group.…”

Laser fluorescence assessment of dental caries arrest with two silver fluoride agents in patients with special needs– a preliminary report

“…Overall, both AgF/KI and AgF/SnF 2 were highly effective at arresting active lesions, with no statistically significant differences between them. Future studies should compare AgF/KI and AgF/SnF 2 with SDF and with SDF/KI, and to AgF alone, as well as consider the influence of factors such as the application time used for various products, since these may range from as short as 10 s to as long as 3 min [ 27 ]. An application time that is long will be problematic for uncooperative patients, including children, and adults with special needs [ 11 , 14 ].…”

“…The application of light could be an important way to drive the formation of peroxyiodide, molecular iodine, extracellular free iodine (I 2 /I 3 − ), and reactive iodine radicals [ 36 ]. There is growing evidence that using a dental curing light could enhance caries arrest by SDF [ 27 , 37 ]. There is even a suggestion that variations in SDF effectiveness between anterior and posterior teeth could reflect not just how easily the treated sites can be cleaned, but also how much natural and artificial light they are exposed to [ 38 ].…”