Penetration of Silver Diamine Fluoride in Deep Carious Lesions of Human Permanent Teeth: An In Vitro Study.

Jutharat Manuschai,Supawadee Naorungroj,Supitcha Talungchit,Stefano Pagano

doi:10.1155/2021/3059129

Jutharat Manuschai, Supawadee Naorungroj + Show 2 more

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https://doi.org/10.1155/2021/3059129

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Abstract

Background When silver diamine fluoride (SDF) is used in conjunction with conservative caries removal in deep carious lesions, the distribution depth of silver is critical for safety and effectiveness. Objective The purpose of this study is to determine the effect of selected caries removal on silver penetration when 38% SDF is applied to deep carious lesions in permanent teeth. Methods Extracted permanent teeth with caries extending to the inner third of the dentin were used (N = 18). The periphery of the carious lesion was completely removed to the dentinoenamel junction (DEJ). In group A (n = 9), no further removal of carious tissue was performed, leaving necrotic dentin inner to the DEJ, whereas in group B (n = 9) superficial necrotic dentin was completely removed until leathery, slightly moist, reasonably soft dentin remained. SDF was applied for 3 minutes in both groups. Microcomputer tomography (micro-CT) and field emission scanning electron microscopy coupled with energy-dispersive X-ray spectroscopy (FESEM-EDS) were used to measure mineral density and silver distribution. The silver penetration depth/lesion depth (PD/LD) ratio was calculated for each sample. The Mann–Whitney U test was used to compare differences between the two groups. Results The micro-CT analysis showed that the PD/LD ratios of group B (1.07–2.29) were marginally greater than those of group A (1.00–1.31). However, a statistically significant difference was not observed (pvalue = 0.5078). When stratified by remaining dentin thickness (RDT), the PD/LD ratios of group B were still greater than those of group A only when RDT was >500 µm. The FESEM-EDS analysis indicated that silver particles precipitated throughout the entire thickness of the carious lesions. Conclusion Applying SDF on a deep carious lesion and leaving the necrotic dentin pulpally did not affect silver penetration. However, the extent to which silver penetrates the remaining dentin beneath the lesions is dependent on the amount and characteristics of that dentin.

Highlights

Maintaining pulp vitality is an important aspect for deep caries management
It was observed that the continuation of increasing mineral density of demineralized dentin was limited to the dentin underneath the carious lesion where its MDbefore was greater than MDsound
Silver penetration is critical for safety and effectiveness in this aspect. e evidence on this issue has been reported only in primary teeth [16]. erefore, this study assessed the penetration of silver into carious lesions in permanent teeth treated with 38% silver diamine fluoride (SDF) when necrotic dentin or soft dentin remained in pulpo-proximal areas

Summary

Introduction

Maintaining pulp vitality is an important aspect for deep caries management. Evidence-based practice suggests stepwise excavation and selective caries removal to soft dentin to reduce the risk of mechanical pulp exposure [1, 2].e intact dentin barrier protects the dental pulp and releases growth factors to stimulate a reparative process [3]. Evidence-based practice suggests stepwise excavation and selective caries removal to soft dentin to reduce the risk of mechanical pulp exposure [1, 2]. The therapeutic effects of calcium hydroxide might not cover the entire area of the carious lesion. When silver diamine fluoride (SDF) is used in conjunction with conservative caries removal in deep carious lesions, the distribution depth of silver is critical for safety and effectiveness. E purpose of this study is to determine the effect of selected caries removal on silver penetration when 38% SDF is applied to deep carious lesions in permanent teeth. E FESEM-EDS analysis indicated that silver particles precipitated throughout the entire thickness of the carious lesions. Applying SDF on a deep carious lesion and leaving the necrotic dentin pulpally did not affect silver penetration. The extent to which silver penetrates the remaining dentin beneath the lesions is dependent on the amount and characteristics of that dentin

Methods

Results

Conclusion