The Cytocompatibility of Silver Diamine Fluoride on Mesenchymal Stromal Cells from Human Exfoliated Deciduous Teeth: An In Vitro Study

Abstract

Silver diamine fluoride (SDF) has been used for many years for the treatment of caries, and minimally invasive dentistry concepts have made it popular again. The fact that its application does not require the administration of anesthesia makes its use in children more desirable. The aim of this study was to determine the cytotoxicity of two new commercial SDF products: Riva Star (SDI Dental Limited) and e-SDF (Kids-e-Dental) on mesenchymal stromal cells from human exfoliated deciduous teeth (SHEDs). SHEDs were exposed to SDF products at different concentrations (0.1%, 0.01% and 0.005%). Then different assays were performed to evaluate their cytocompatibility on SHEDs: IC50, MTT, cell migration (wound healing), cell cytoskeleton staining, cell apoptosis, generation of intracellular reactive oxygen species (ROS), and ion chromatography. Statistical analyses were performed using one-way ANOVA and Tukey’s post hoc test (p < 0.05). Riva Star Step 2 showed the same cell metabolic activity when compared to the control condition at any time and concentration. Meanwhile, e-SDF displayed high cytotoxicity at any time and any concentration (*** p < 0.001), whereas Riva Star Step 1 displayed high cytotoxicity at any time at 0.1% and 0.01% (*** p < 0.001). Only e-SDF showed a statistically significant decreased cell migration rate (*** p < 0.001) at all times and in all concentrations. At 0.1%, e-SDF and Riva Star Step 1 only showed 4.37% and 4.47% of viable cells, respectively. These results suggest that Riva Star has better in vitro cytocompatibility on SHEDs than does e-SDF. Riva Star Step 1 was found to be as cytotoxic as e-SDF, but it had better biological properties when mixed with Riva Star Step 2. Our findings suggest that Riva Star is more suitable when used in deciduous teeth due to its lower cytotoxicity compared to e-SDF.

Comparing cytocompatibility of two fluoride-containing solutions and two resin-based restorative materials—a pilot study

“…The cytocompatibility results therefore infer that the clinician should use their clinical judgment to prevent direct pulp contact if the healthy or carious dentine covering the pulp has a thickness of less than 1.5 mm. Riva Star, representing an SDF product in this pilot study, showed better cytocompatibility than other assessed SDF products from the literature ( 25 ). Therefore, Riva Star Aqua, from a cytocompatibility point of view, is a suitable clinical choice in addition to the other advantage it possesses over Riva Star of not containing ammonium iodide.…”

“…It is important to keep in mind that a dentine bridge of 1.5 mm is considered sufficient to limit the negative effects from eluates from dental materials, and with the carious structure above the pulp that will be remineralized with the SDF products, the possible exposure to the dental pulp also becomes more limited. In addition, the SDF products usually work as a step 1 and step 2 protocol, resulting in a more favorable result for cytocompatibility when combined ( 25 , 26 ).…”

“…It is important to keep in mind that a dentine bridge of 1.5 mm is considered sufficient to limit the negative effects from eluates from dental materials, and with the carious structure above the pulp that will be remineralized with the SDF products, the possible exposure to the dental pulp also becomes more limited. In addition, the SDF products usually work as a step 1 and step 2 protocol, resulting in a more favorable result for cytocompatibility when combined (25,26). Stela Light Cure as a restorative material compared to Riva Light Cure presented a non-significant better cytocompatibility at both time intervals, with the 48 h time interval having a greater cytocompatibility of 57.66% compared to the 27.41% cytocompatibility of Riva Light Cure.…”