Abstract
This study aimed to assess the effect of silver diamine fluoride (SDF) on natural carious dentin microhardness and the correlation between tactile sensation, fluorescence, and microhardness on carious dentin. Permanent carious teeth scored ICDAS 4–6 were longitudinally sectioned into tooth slabs exposing carious dentin on one side and sound dentin on the other. Both sides were assessed for tactile sensation (soft/leathery/firm), fluorescence (red/pink/no fluorescence) with FACE technology (SiroInspect®, Dentsply Sirona, USA), and Vickers's microhardness (VMH). Samples were randomized into 3 groups based on SDF protocol (n = 30): Control/Group A- No SDF treatment; Group B- 38% SDF (Advantage Arrest™, Elevate Oral Care®, USA); Group C- SDF with potassium iodide/KI (Riva Star, SDI, Australia). After SDF application, all samples were stored for 1 week under 100% humidity at 37°C and re-assessed for tactile sensation, fluorescence, and microhardness. Change in microhardness (ΔVMH; mean ± SD), tactile sensation (ΔT), and fluorescence (ΔF) were calculated using the difference between pre-SDF and post-SDF values. Mixed ANOVA analysis showed that ΔVMH of carious and sound surfaces were statistically significantly higher for each of the experimental groups (Group B-sound: 20.22 ± 11.98 HV, carious: 19.76 ± 9.35 HV; Group C-sound: 14.26 ± 10.11 HV, carious: 22.51 ± 7.67 HV) than the control group (Group A–sound: 7.34 ± 8.28 HV, carious: 0.69 ± 3.53 HV) (p < 0.0001). There was no statistically significant difference between the experimental groups themselves for carious surfaces (p = 0.146). On sound surfaces, Group B showed a statistically significantly higher ΔVMH than Group C (p = 0.026). There was no statistically significant interaction between type of surface and ΔVMH in Group B (p = 0.809). In Group C, sound surfaces showed a statistically significantly lower ΔVMH than carious surfaces (p < 0.0001). Spearman rank-order correlation showed a statistically significant negative correlation between ΔVMH and ΔT (rs = −0.588, p < 0.0001) and between ΔVMH and ΔF (rs = −0.269, p = 0.01). There was a statistically significant positive correlation between ΔT and ΔF (rs = 0.226, p = 0.032). In conclusion, the microhardness of SDF-treated dentin surfaces increased as compared to non-SDF-treated surfaces. SDF (Advantage Arrest™) increased microhardness of carious and sound dentin to a similar extent whereas, SDF/KI (Riva Star) increased microhardness of carious dentin more than sound dentin. An increase in microhardness was correlated with a firmer tactile sensation.
Highlights
Evolving research in the field of cariology has brought about a paradigm shift in the understanding of the caries process and its management
In a worldwide consensus statement by the European Organization for Caries Research (ORCA) and the European Federation of Conservative Dentistry (EFCD) on recommendations for caries interventions in children, it was recommended that cavitated deep carious lesions in permanent posterior teeth may be treated by selective carious tissue removal and a well-sealed restoration [9]
A statistically significant increase in microhardness of both surfaces combined was seen in group B on receiving Advantage ArrestTM
Summary
Evolving research in the field of cariology has brought about a paradigm shift in the understanding of the caries process and its management. With respect to caries management, preserving natural tooth integrity by proper prevention, risk assessment, accurate diagnosis, and timely treatment procedures that do not compromise sound tooth structure is essential [1]. Selective caries excavation limited to the outer soft and friable carious dentin has gained popularity as a conservative and cost-effective alternative to complete caries removal with potential for reducing the risk of pulp exposures [6,7,8]. In a worldwide consensus statement by the European Organization for Caries Research (ORCA) and the European Federation of Conservative Dentistry (EFCD) on recommendations for caries interventions in children, it was recommended that cavitated deep carious lesions in permanent posterior teeth may be treated by selective carious tissue removal and a well-sealed restoration [9]. Selective caries removal continues to have a low acceptance rate among many clinicians due to concerns with leaving bacteria in the cavity [10,11,12]
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