Abstract
The effect of a 4% titanium tetrafluoride (TiF 4 ) varnish on enamel demineralization was evaluated. Twelve volunteers participated in this double-blind, randomized crossover study. Six enamel specimens were positioned in intraoral appliances throughout four treatment stages: 4% TiF 4 varnish (experimental varnish), 5% sodium fluoride (NaF) varnish (Duraphat ® ), placebo varnish, and negative control (deionized water). After 24 h, the varnishes were removed and plaques were allowed to accumulate. A 20% sucrose solution was dripped onto enamel blocks (10x/day). Enamel alterations were analyzed by surface microhardness (SMH), percentage of surface loss (%SML), cross-sectional microhardness (CSMH), scanning electron microscopy (SEM), and energy dispersive X-ray spectrometry (EDS). Student's paired t-test was used for SMH analysis and repeated-measures analysis of variance (ANOVA) for %SML and CSMH (∆Z) analyses (p-value=0.05). The TiF 4 varnish group had lower %SML than the placebo and control groups (p=0.044 and p=0.003, respectively), thus showing its capacity to inhibit surface demineralization. TiF 4 and NaF varnishes demonstrated a protective effect against mineral loss on the enamel subsurface. Both were statistically different from the control group when CSMH was analyzed (p=0.000). A titanium dioxide film was observed on enamel surfaces of the TiF 4 group SEM images. EDS confirmed the presence of titanium in all TiF 4 samples. The 4% TiF 4 varnish is a promising compound capable of reacting with enamel to protect it against surface and subsurface demineralization.
Highlights
Fluoride (F) products have been widely used in the prevention and control of caries and the fluoride ion (F-) present in these products has been considered the major determining factor for caries reduction in most industrialized countries.[1,2] Topical fluoride agents are known to promote remineralization and inhibit demineralization of dental hard tissues due to calcium fluoride (CaF2) reservoir.[1, 3]The formation of CaF2 and its protective effect on demineralization depend on pH, fluoride ion concentration, and type of fluoride salt.[3]
The sample size was calculated based on a 0.8 power to detect a significant difference of 50% in mean mineral loss (ΔZ) in each treatment group (4% titanium tetrafluoride varnish - 2.45% F - experimental varnish; sodium fluoride varnish - Duraphat® 2.26 % F - regarded as the “gold standard”) compared to control, using a one-sided test with 5% significance level (BioEstat 5.3, Instituto de Desenvolvimento Sustentável Mamirauá, Tefé, AM, Brazil) according to the results of a previous study with 4% TiF4 solution.[7]
Microhardness loss When comparing the surface microhardness (SMH) values for all enamel blocks before the experiment, no statistically significant difference was observed among groups, demonstrating data homogeneity (p=0.164; one-way analysis of variance (ANOVA))
Summary
Fluoride (F) products have been widely used in the prevention and control of caries and the fluoride ion (F-) present in these products has been considered the major determining factor for caries reduction in most industrialized countries.[1,2] Topical fluoride agents are known to promote remineralization and inhibit demineralization of dental hard tissues due to calcium fluoride (CaF2) reservoir.[1, 3]The formation of CaF2 and its protective effect on demineralization depend on pH, fluoride ion concentration, and type of fluoride salt.[3].
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