Remineralization of caries-affected dentin and color stability of teeth restored after treatment with silver diamine fluoride and bioactive glass–ceramic
“…A lower pH in fluoride-based agents promotes calcium fluoride formation, 34 35 as observed in a previous study where reducing the pH of the toothpaste enhanced the fluoride uptake in the dental biofilm. 35 36 37 In this study, both commercial and experimental fluoride toothpastes had a neutral pH (7.6 and 7.3, respectively), potentially limiting fluoride's effectiveness.…”
Section: Discussionmentioning
confidence: 89%
“…A previous study by Ferreira et al (2022), revealed that the treatment of caries-affected dentin with 10% BS and silver diamine fluoride yielded comparable microhardness values. 36 This suggests that both treatments have a similar remineralizing capacity. Other studies have also reported similar efficiency in remineralizing initial lesions when comparing a fluoride toothpaste to a fluoride-free toothpaste containing microcrystalline hydroxyapatite.…”
Objective This study evaluated the effect of incorporating biosilicate (Bio) particles into experimental toothpaste (ET) on their abrasiveness and remineralization capacity for white spot lesions (WSLs).
Materials and Methods Thirty-two fragments of bovine teeth (6 × 6 × 2 mm) were obtained. Initial microhardness (Knoop hardness number [KHN], HMV Microhardness Meter, Shimadzu) and surface roughness (Rugosimeter Surfcorder SE 1700) readouts were performed. Fragments were submitted to a cariogenic challenge to simulate WSLs and then divided into four groups: Control, conventional toothpaste (Colgate Smiles, Colgate-Palmolive Company); ETF, ET with fluoride (carboxymethylcellulose + glycerol + thickening silica + fluoride); ETB, ET with Bio; BS, biosuspension (10 in weight% Bio). Toothpaste treatments were performed through simulated toothbrushing (Pepsodent, MAVTEC, 14,600 cycles). BS was applied by immersion for 8 hours followed by 16 hours in artificial saliva at 37°C for 60 days, totalizing 1,440 cycles. After treatments, final KHN and surface roughness readings were performed, and scanning electron microcopy (SEM) was conducted (Jeol JSM-6610LV) for morphological analysis. Data were analyzed with one-way analysis of variance, Tukey's test (p < 0.05).
Results BS produced the least surface roughness change, different (p < 0.05) from all the other groups. ETB caused higher KHN than ETF (p < 0.05). SEM images revealed that ETB and BS resulted in abraded surfaces with deposition of particles.
Conclusion ETB resulted in similar abrasiveness to the control group, and it caused higher microhardness than the ETF.
Practical Implication Considering its higher KHN, ETB could be considered a proper alternative for the treatment of WSLs.
“…A lower pH in fluoride-based agents promotes calcium fluoride formation, 34 35 as observed in a previous study where reducing the pH of the toothpaste enhanced the fluoride uptake in the dental biofilm. 35 36 37 In this study, both commercial and experimental fluoride toothpastes had a neutral pH (7.6 and 7.3, respectively), potentially limiting fluoride's effectiveness.…”
Section: Discussionmentioning
confidence: 89%
“…A previous study by Ferreira et al (2022), revealed that the treatment of caries-affected dentin with 10% BS and silver diamine fluoride yielded comparable microhardness values. 36 This suggests that both treatments have a similar remineralizing capacity. Other studies have also reported similar efficiency in remineralizing initial lesions when comparing a fluoride toothpaste to a fluoride-free toothpaste containing microcrystalline hydroxyapatite.…”
Objective This study evaluated the effect of incorporating biosilicate (Bio) particles into experimental toothpaste (ET) on their abrasiveness and remineralization capacity for white spot lesions (WSLs).
Materials and Methods Thirty-two fragments of bovine teeth (6 × 6 × 2 mm) were obtained. Initial microhardness (Knoop hardness number [KHN], HMV Microhardness Meter, Shimadzu) and surface roughness (Rugosimeter Surfcorder SE 1700) readouts were performed. Fragments were submitted to a cariogenic challenge to simulate WSLs and then divided into four groups: Control, conventional toothpaste (Colgate Smiles, Colgate-Palmolive Company); ETF, ET with fluoride (carboxymethylcellulose + glycerol + thickening silica + fluoride); ETB, ET with Bio; BS, biosuspension (10 in weight% Bio). Toothpaste treatments were performed through simulated toothbrushing (Pepsodent, MAVTEC, 14,600 cycles). BS was applied by immersion for 8 hours followed by 16 hours in artificial saliva at 37°C for 60 days, totalizing 1,440 cycles. After treatments, final KHN and surface roughness readings were performed, and scanning electron microcopy (SEM) was conducted (Jeol JSM-6610LV) for morphological analysis. Data were analyzed with one-way analysis of variance, Tukey's test (p < 0.05).
Results BS produced the least surface roughness change, different (p < 0.05) from all the other groups. ETB caused higher KHN than ETF (p < 0.05). SEM images revealed that ETB and BS resulted in abraded surfaces with deposition of particles.
Conclusion ETB resulted in similar abrasiveness to the control group, and it caused higher microhardness than the ETF.
Practical Implication Considering its higher KHN, ETB could be considered a proper alternative for the treatment of WSLs.
“…In the six included studies, those groups in which samples were not restored [ 7 , 54 , 56 , 61 ], interventions were applied on enamel [ 58 , 61 ], and/or other remineralizing agent was used [ 55 ] were further excluded. Besides, outcomes from two studies judged to have no significant setting/methodological heterogeneity were pooled [ 7 , 55 ]. Fig.…”
Background
The desirable properties of silver diamine fluoride (SDF) make it an effective agent for managing dental caries and tooth hypersensitivity. There are several clinical instances that SDF application might precede the placement of direct tooth-colored restorations. On the other hand, SDF stains demineralized/carious dental tissues black, which might affect the esthetic outcomes of such restorations. Color is a key parameter of esthetics in dentistry. Therefore, this study aims to systematically review dental literature on color/color change of tooth-colored restorations placed following the application of SDF on dentine.
Methods
Comprehensive search of PubMed, Embase, Scopus and ISI Web of Science databases (until August 2023) as well as reference lists of retrieved studies was performed. In vitro studies reported color or color change of tooth-colored restorative materials applied on SDF-treated dentine were included. Methodological quality assessment was performed using RoBDEMAT tool. Pooled weighted mean difference (WMD) and 95% confidence interval (95% CI) was calculated.
Results
Eleven studies/reports with a total of 394 tooth-colored restorations placed following a) no SDF (control) or b) SDF with/without potassium iodide (KI)/glutathione dentine pre-treatments were included. Color change was quantified using ∆E formulas in most reports. The pooled findings for the comparison of resin-based composite (RBC) restorations with and without prior 38% SDF + KI application revealed no statistically significant differences in ∆E values at short- and long-term evaluations (~ 14 days: WMD: -0.56, 95% CI: -2.09 to 0.96; I2: 89.6%, and ~ 60 days: WMD: 0.11; 95% CI: -1.51 to 1.72; I2: 76.9%). No studies provided sufficient information for all the items in the risk of bias tool (moderate to low quality).
Conclusions
The limited evidence suggested comparable color changes of RBC restorations with and without 38% SDF + KI pre-treatment up to 60 days. The included studies lacked uniformity in methodology and reported outcomes. Further studies are imperative to draw more definite conclusions.
Protocol registration
The protocol of this systematic review was registered in PROSPERO database under number CRD42023485083.
“…Although positive effects have been reported in most studies, according to a recent systematic review, there is insu cient evidence for SDF + KI application [17]. Remineralization studies have been conducted with SDF + KI on animal and human permanent dentin tissue, but studies evaluating the use of SDF and KI for remineralization in deciduous dentin caries are limited in the literature [18,19].…”
Objectives: The aim of this study is to compare the effect of GSH (reduced glutathione) and KI (potassium iodide) on SDF (silver diamin fluoride) discoloration and dentin remineralization.
Materials and methods: Sixteen primary molars were utilized, yielding four dentin specimens each. Three specimens per tooth were allocated: one as a control and the others to experimental groups. Initial microhardness measurements were taken from one remaining dentin specimen per tooth. Subsequently, all groups underwent exposure to a demineralization solution. Colorimetry assessed specimen color, and post-second microhardness measurements on demineralized specimens, treatments were administered as follows: group 1 (control, n=16): 38% SDF, group 2 (n=16): 38% SDF followed by KI, group 3 (n=16): 38% SDF with 5% GSH added by weight. Following pH cycling across all groups, colorimetry reassessed 48 dentin specimens. Final microhardness measurements ensued, followed by statistical analysis. Normality was checked via Shapiro-Wilk, homogeneity via Levene's test. Independent samples t-test compared normally distributed groups; Mann-Whitney U compared non-normally distributed groups. ANOVA compared means of normally distributed groups; Kruskal-Wallis for non-normally distributed ones. Repeated measures ANOVA compared dependent groups with normal distribution, Friedman test for non-normal. Post-hoc Bonferroni analyses identified significant differences. IBM SPSS 25 conducted analyses.
Results: The mean ΔE* values for SDF and SDF+GSH groups were significantly higher than SDF+KI group (p<0.05). Significant differences in L* values during final color measurement were noted between SDF+KI group and both SDF and SDF+GSH groups (p<0.05). Although mean remineralization microhardness measurements were higher than mean demineralization microhardness measurements in all groups, statistical significance was observed only in SDF and SDF+KI groups (p<0.05).
Conclusion: The study found that adding 5% GSH by weight to SDF does not significantly affect discoloration. Additionally, the addition of 5% GSH to SDF may impact its remineralization potential. The application of KI after SDF reduces discoloration and does not affect the expected remineralization process.
Clinical relevance: In reducing discoloration, KI can be used following SDF applications. Repeated SDF applications may accelerate the expected remineralization process.
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