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.
Highlights
Invasive dentistry (MID) is an evidence-based concept that aims to preserve as much tooth structure as possible [1]
All the results obtained in the present investigation showed that Step 1 displayed less cytocompatibility than Step 2, being comparable to the results obtained in e-silver diamine fluoride (SDF); when the mix of Step 1 and Step 2 is observed, the cytocompatibility results improve in all experiments
Kim et al [27] concluded that all tested SDF dilutions had a remarkable cytotoxic effect, but when they added reduced glutathione, it had a protective action, and the cytotoxicity decreased. This means that depending on the composition of the SDF, the cytotoxicity could change, as our results showed that when Riva Star Step 1 is combined with Riva Star
Summary
Invasive dentistry (MID) is an evidence-based concept that aims to preserve as much tooth structure as possible [1]. Along with preventive procedures such as frequent control of biofilms, dietary advice, and improvement of oral hygiene habits, as well as the application of fluoride varnishes and silver diamine fluoride (SDF) to decrease demineralization and improve remineralization of the area affected by caries [2,3], the use of MID procedures has increased in dentistry after the COVID-19 pandemic with the concept of “non-aerosol” [4–6]. The application of SDF is painless and quick [9,12] It is a minimally-invasive procedure for arresting untreated dental caries [12] and can help keep the tooth in position to maintain the mesio-distal space, since the tooth is the best space maintainer in primary or mixed dentition, avoiding extraction of the tooth [7]. SDF paralyzes caries, turning it into chronic caries without the need to remove affected dentine [13], and helps prevent the appearance of secondary caries with its use before restoration [14,15]
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