Pulp Damage Research Articles

Establishment of Pulp Damage Repair Models in Miniature Pigs Using Diode Lasers.

Objective: To establish a controlled pulp damage repair model in miniature pigs by using a diode laser. Background: Laser is a novel kind of controllable energy, and it is widely used in dentistry. Methods: The premolars of four 24- to 28-month-old miniature pigs were divided into three laser groups, according to the output powers of a diode laser, and the nonirradiated first molars acted as controls. The teeth in laser groups were irradiated under three parameters (output powers 1.5, 2.5, 4 W, continuous wave, frequency 50 Hz for 60 sec). The dental and gingival morphology was observed at 0, 7, 14, and 21 days after laser irradiation. The animals were sacrificed for qualitative and quantitative pulp histopathological analysis. Results: The three laser groups present no seriously irreversible dental and gingival damage. In the 1.5-W group, dental pulp exhibited angiectasis and hyperemia with no inflammation, and did not significantly differ with the control groups at 21 days (p > 0.05). In the 2.5-W group, pulpal inflammation was highest at 7 days and then decreased significantly at 21 days, and the tissue repair appeared at 14 days (p < 0.05). In the 4-W group, pulpal inflammation was significantly highest at 7 days, with an increase in the degree of tissue repair (p < 0.05). Conclusions: The output power of 1.5 W developed a reversible pulpitis model; the output powers of 2.5 and 4 W within 7 days led to the development of irreversible pulpitis models, which proceeded as chronic pulpitis with obvious tissue repair.

Materiales de obturación radicular utilizados en dientes deciduos

La caries y traumatismos son las principales causas de urgencias en odontología pediátrica. Estas afecciones pueden llegar a ejercer un daño irreversible en el tejido pulpar comprometiendo la permanencia de los órganos dentarios afectados. Para limitar el daño pulpar y evitar la extracción de piezas temporales se han diseñado distintas técnicas que van desde recubrimientos pulpares hasta un tratamiento más radical como la pulpectomía. Ésta última consiste en la extirpación del tejido pulpar, la limpieza y desinfección del sistema de conductos y la obturación de los mismos. Diversos autores han descrito las características ideales que debe presentar un material obturador de conductos de la dentición temporal, en los que se incluyen actividad bactericida y bacteriostática, adecuado sellado tridimensional, biocompatibilidad y reabsorción del material a una velocidad similar que las raíces. Desde hace largo tiempo se han desarrollado diversos materiales para cumplir con las exigencias que demanda la técnica. Dentro de los primeros materiales surgidos con éste propósito se encuentran el Óxido de Zinc con Eugenol, Hidróxido de Calcio y materiales a base de yodoformo, con el tiempo surgieron combinaciones de estos materiales para aumentar las ventajas y disminuir las desventajas. De éstos, las pastas yodoformadas con Hidróxido de Calcio son los que han tenido mayor aceptación.

Clinical decision-making in managing deep carious lesions in primary teeth based on clinical experience among pediatric dentists-A cross-sectional study.

To explore the different treatment methods employed in managing deep carious lesions (DCL) of vital primary teeth among pediatric dentists practic.ing in Saudi Arabia. We also want to find out whether the experience of pediatric dentists has any influence on clinical decision-making in managing DCL in primary teeth. This online questionnaire-based cross-sectional study was carried out among pediatric dentists practicing in Saudi Arabia. We used a self-administered questionnaire consisting of five sections: demographic data, clinical decisions in managing DCL, clinical protocols, and dentist's knowledge about allowing carious dentin to remain under a restoration. The questionnaire was administrated electronically via SurveyMonkey. A total of 216 pediatric dentists participated in the study, in which nearly 60% were males. Most dentists reported that they preferred partial caries removal (63%), and the Hall technique (68%) was the mostly practiced method in managing DCL. Nearly 93.5% of the dentists reported performing indirect pulp capping before placing a permanent restoration, and the most preferred liner was Dycal (60%). About 47.2% of senior dentists reported practicing complete caries removal. Multivariate logistic regression analysis revealed that younger dentists (5-10 years) preferred practiced partial caries excavation two times more often than senior dentists (>10 years). Pediatric dentists should focus on minimally invasive approaches such as partial caries excavation for DCL treatment. Pediatric dentists, especially senior practitioners, should be educated and trained to adopt minimally invasive strategies in managing DCL, reducing unnecessary risks such as iatrogenic pulpal damage.

The Biological Effect of Laser on Dental Hard Tissues Review

Laser absorption in biological tissue is mostly owing to the existence of free water molecule, protein, pigment and other macromolecule. Absorbed laser can have three different consequences: photothermal, photomechanical and photochemical. The effect of laser on enamel at a low energy density may become more resistant to acid dissolution. While laser was used on dentine to limited thermal effect and reduce dentine sensitivity with energy irradiation. However, the laser irradiation result in more extensive pulp damage and reparative dentinogenesis was delayed . Root specimens have exhibited higher rates of inhibition of caries like lesion progression and resistance to acid dissolution than those seen in enamel specimens, after combined laser fluoride treatment.

Role of connexin 43 in odontoblastic differentiation and structural maintenance in pulp damage repair

Dental pulp can initiate its damage repair after an injury of the pulp–dentin complex by rearrangement of odontoblasts and formation of newly differentiated odontoblast-like cells. Connexin 43 (Cx43) is one of the gap junction proteins that participates in multiple tissue repair processes. However, the role of Cx43 in the repair of the dental pulp remains unclear. This study aimed to determine the function of Cx43 in the odontoblast arrangement patterns and odontoblastic differentiation. Human teeth for in vitro experiments were acquired, and a pulp injury model in Sprague-Dawley rats was used for in vivo analysis. The odontoblast arrangement pattern and the expression of Cx43 and dentin sialophosphoprotein (DSPP) were assessed. To investigate the function of Cx43 in odontoblastic differentiation, we overexpressed or inhibited Cx43. The results indicated that polarized odontoblasts were arranged along the pulp–dentin interface and had high levels of Cx43 expression in the healthy teeth; however, the odontoblast arrangement pattern was slightly changed concomitant to an increase in the Cx43 expression in the carious teeth. Regularly arranged odontoblast-like cells had high levels of the Cx43 expression during the formation of mature dentin, but the odontoblast-like cells were not regularly arranged beneath immature osteodentin in the pulp injury models. Subsequent in vitro experiments demonstrated that Cx43 is upregulated during odontoblastic differentiation of the dental pulp cells, and inhibition or overexpression of Cx43 influence the odontoblastic differentiation. Thus, Cx43 may be involved in the maintenance of odontoblast arrangement patterns, and influence the pulp repair outcomes by the regulation of odontoblastic differentiation.

Management of Consequences of Gold Enamel Tattooing in Maxillary Central Incisors: A Case Report

Gold enamel tattooing is a customary practice seen in various clans of Asia and the Indian subcontinent, for ages. The incidence of such cases is very low; hence they can be used as identification marks in forensic sciences and symbols of some tribes and clans. In India, these tattoos or chomps are frequently done by amateurish creatures, making gross harm to the physiology of the tooth and causing consequences like pulp involvement and periapical infection. Here, authors presents a case of 32-year-old male presented with chief complaint of dull, intermittent pain which aggravates with hot stimulus, particularly on taking hot tea and broken upper front teeth because of biting on a hard nut five days back. Patient also complaint of pus discharge over his front teeth for three days. The patient gave the history of gold inking his two maxillary central incisors, ten years back. Pulp damage and periapical lesion was noticed due to enamel inking in upper central incisors. A periapical abscess was resulted due to violation of enamel thickness of the tooth during tooth preparation. In dental clinics, traditional gold tattoos can be done with minimal invasive cavity preparation. Enamel thickness estimation in such cases plays a very important role to safeguard a healthy tooth from the consequences of structural damage.

Trends in Resin Composite Restoration Repair Teaching in Dental Colleges in Pakistan

Abstract Objective The paradigm shift from replacement to repair of defective resin composite restorations to implement minimal intervention approaches has been popular. Therefore, the teaching of composite repair strategies is included in contemporary dental curricula across the globe. Methods A validated 18-item questionnaire pertaining to existing educational practices related to the teaching of defective composite restorations repair was acquired form dental colleges in Pakistan. Results The response rate was 63% and the majority of dental colleges (67%) reported that they have included the teaching of composite restorations repair in the curricula, where four colleges (33%) implemented only didactic teaching and eight colleges (66%) reported a combination of didactic teaching and clinical training. The composite repair indications taught included tooth substance conservation 100% (12), reduced cost to patient 84.3% (10) and dentist 100% (12), reduced iatrogenic pulpal damage 100% (12), and reduced chair side treatment time 91.3% (11), restoration-related defects (66% preferred repair), anterior tooth fracture from incisal/proximal margin (80% teach repair), and in case of posterior tooth cusp fracture (20% teach repair). Our results revealed that the choice of mechanical and adhesive substrate surface conditioning depended on case selection. Conclusion The teaching of defective composite restorations repair was less widespread and certain variations in teaching were identified. Nearly all dental colleges reported to incorporate current evidence of minimum invasive strategies of composite repair in curricula in future.

Knowledge about composite restorations repair vs replacement- a survey among a subpopulation of saudi dental students

Objectives: the purpose of this study was to evaluate the knowledge among dental students at King Khalid University, Jazan University, and Najran University in the kingdom of Saudi Arabia about when to repair or replace defective direct composite restoration. Materials and Methods: A questionnaire-based survey was formulated, pursuing the information about management (repair/replacement) of defective composite restorations and distributed among 200 dental students of three universities in the southern region of the kingdom of Saudi Arabia.The data were collected with the help of an online questionnaire. Data entry and the analysis were done using the statistical software package SPSS version 20.0. It was presented using descriptive statistics in the form of frequencies and percentages for qualitative variables, and range means and standard deviations for age, quantitative variable. Analytic statistics ere done using Chi-Square tests (x2) to test the significant difference between categorical variables. The level of significance, the p-value was 0.01 (p &lt; 0.01). Results: The decision to choose between composite repair or replacement was influenced by whether this topic was taught to them at various undergraduate levels during Bachelor of Dental Surgery. The reason associated with the decision to repair defective composite restorations, 76% reported as cost-effective followed by Increased longevity (71%), the permanent filling (70%), patient’s preference for repair (65%), and least time consuming (50%). 67% participants preferred significantly (p&lt;0.001) repair due to secondary caries in the previously restored tooth with composite, followed by the small surface defect in a composite restoration (65%), risk of pulpal damage significantly (p&lt;0.001) in a defective composite restoration (62.5%) and more invasive and destructive treatment option (35%). More than half of respondents 123 (61.5%) reported that they were not taught about composite repair during the Bachelor of Dental Surgery. Conclusion: It is suggested with the help of our study that didactic and clinical training components regarding composite repair should be seriously included in the teaching curriculum of dental institutions as it is in the best interest of the patient. Dental students should be provided with clinical training on this topic so that they can follow proper decision-making protocols available during repair or replacement of defective resin composite restorations. Other researches in the future can be carried out for refining the guidelines and techniques utilized for composite repair. KEYWORDS Composite restoration; Discoloration; Polymerization shrinkage; Secondary caries.

Spontaneous repair of iatrogenic root perforation by an orthodontic miniscrew: A case report

Background and OverviewOrthodontic miniscrews have become popular tools for providing temporary anchorage during orthodontic treatment. Although they are easy to insert, damage to the periodontal ligament or dental root during insertion is an unfavorable iatrogenic complication. Root perforation during miniscrew insertion in human teeth has been reported in a few articles. In this article, the authors describe the spontaneous repair of an iatrogenic root perforation in a mandibular first molar that occurred during insertion of an orthodontic miniscrew in a young girl undergoing orthodontic treatment. Case DescriptionA 15-year-old girl with malocclusion was undergoing orthodontic treatment when the mesial root of her mandibular right first molar was damaged by an orthodontic miniscrew. The miniscrew and corresponding bracket were immediately removed to avoid any unnecessary forces on the tooth. Because the pulp remained vital without any additional damage and infection for 6 months, orthodontic treatment was resumed and completed in 9 months without any pulp damage or unfavorable symptoms. Serial periapical radiographs and cone-beam computed tomographic images showed that the injured area was surrounded by reparative tissue without any apical lesion. Conclusions and Practical ImplicationsThe findings of this case suggest that immediate removal of unnecessary forces provides an environment for spontaneous repair in cases of iatrogenic root perforation by orthodontic miniscrews, even when the damage involves the pulp. If force stimulation is avoided for a certain period, which was 6 months in this case, it may be possible to complete the orthodontic treatment without unfavorable symptoms.

Comparison of the effect and safety of Er:YAG laser combined with fluoride and methylene blue-photodynamic therapy on caries prevention

To compare the anti-caries effect and safety of Er:YAG laser combined with fluoride and methylene blue-photodynamic therapy (MB-PDT). A total of 28 rat dental caries models were established and randomly divided into seven groups: photodynamic therapy (PDT) group, laser combined with fluoride group, laser group, sodium fluoride group, and 0.9% saline control group. Spectrophotometric optical density was used to reflect the growth of Streptococcus mutans. Laser-induced fluorescence diagnostic (LF) instrument was utilized to detect the demineralization degree of dental caries. Histopathological sections were employed to observe the damage of dental pulp and buccal mucosa. The optical density (OD) value of the PDT and combination groups was significantly lower than that of other treatment groups (P<0.05). An increase in LF value and demineralization occurred in varying degrees with different treatment methods. Histopathological observation showed that pulp and buccal mucosa injury was more obvious in the combination group of 70 mw·cm⁻² and Er:YAG laser group compared with other groups. Under the same parameters, the combined group and PDT have good germicidal efficacy, but PDT has fewer adverse reactions and less damage. It is an effective and safe method for caries prevention.

Adverse effects of orthodontic tooth movement on endodontically treated teeth-An overview

Orthodontic tooth movement (OTM) can be possibly be performed on endodontically treated teeth with remarkable outcomes. There is however a scarcity of adequate knowledge and data regarding the crisp association between endodontics and orthodontic treatment. This association comprises of various effects involving the pulp and periodontium that occurs as a result of orthodontic treatment. It is hence always suggested to apply adequate and appropriate amount of occasional forces that would bring about satisfactory tooth movement. This would in turn restrict pulpal damage, and also aid in its healing. Thus, proper evaluation of such endodontically treated case with a thorough clinical and radiographical assessment before orthodontic treatment is primarily important prior to orthodontic treatment. Hence, this review portrays a brief image about the various adverse effects of OTM on endodontically treated tooth.

Role of Lasers in Composite Restorations

The term LASER is an acronym for ‘Light Amplification by the Stimulated Emission of Radiation’. The first laser was introduced in the 1960’s by Miaman. Laser is used to treat a number of various dental conditions like composite restorations etc.. It is most commonly used in restorations for treating hypersensitivity, tooth decay, gum diseases and whitening teeth. Various kinds of lasers such as ND:YAG, Er:YAG, Er:Cr:YSGG are used in various dental procedures. Laser seems to be made for effective removal of dentine and enamel with only minor side effects such as thermal damage. The capability of Er:YAG lasers for the removal of hard tissues in dentistry was exhibited as of now in 1989, Er:YAG (erbium-doped yttrium aluminum garnet) lasers have been progressively utilized in dental practices and are turning out to be increasingly more an agreeable technique for caries evacuation for patients, as conventional cavity drilling may cause noise and pain. Laser received FDA approval for caries removal and cavity preparations. The use of laser therapy also seems to be promising from many recent researchers. Laser therapy induces surface roughness or even improves bond strength or decreases marginal leakage. There seems to be a general consensus on the fact that Er:YAG is one of the best suited types of lasers because it’s efficiency in dentine is very good without any damage of pulp. Er:YAG lasers are a lot utilized in small scale blasts that may bring visible irregularities. In addition, pain reduction in comparison to bur assisted preparation of cavities has been clearly demonstrated.

&lt;p&gt;Conservative Composite Resin Restoration for Proximal Caries – Two Case Reports&lt;/p&gt;

The paradigms of contemporary caries management have shifted to minimal intervention dentistry. Conservative restorative procedures are recommended to replace the complete removal of all carious tissues in the management of dental caries. This article reports two clinical cases of conservative restorations of proximal caries. Different conservative cavity designs and restorative techniques were performed in the two cases. Proximal caries in posterior teeth were prepared using the box-only preparation technique or the proximal tunnel preparation technique. The cavities were restored directly with resin composites. The advantages of using the box-only preparation with fissure sealant included the maximum conservation of tooth hard tissues and the prevention of unnecessary tissue removal in the occlusal surface. The tunnel preparation preserved the marginal ridge and protected the restored tooth from fracture. The filling of composites into the tunnel demonstrated a better marginal adaptation than other restorative materials. These two techniques allowed for the preservation of more healthy dental hard tissue compared with traditional techniques. Potential problems in the restoration included the high incidence of the inappropriate removal of dental hard tissue, damage of the vital pulp and the microleakage due to the polymerization shrinkage. The solutions to minimize the risk of these problems in the operative procedures were discussed.

Can We Determine an Appropriate Timing to Avoid Thermal Pulp Hazard During Gingivectomy Procedure? An In Vitro Study with Diode Laser.

Objective: Diode laser (DL) is a frequently preferred tool for soft tissue incision and ablation in oral surgery. The aim of this study was to find the most effective irradiation time protocol to avoid potential harmful temperature rise in pulp during DL-assisted gingivectomy. Materials and methods: Ninety human freshly extracted teeth (30 anterior, 30 premolar, and 30 molar) were irradiated using a 940 nm DL with power output of 1 and 2 W and exposure time of 10, 20, 30, 40, 50, and 60 sec per specimen. Intrapulpal temperature was evaluated with thermocouple. Additionally, the effect of dark deposits on root surface for intrapulpal temperature rise was investigated. Temperature differences with every 10 sec were evaluated for three different teeth types, and statistical analyses were performed. Results: Anterior and premolar teeth exceeded the threshold values earlier than molar teeth for both 1 and 2 W. Despite the significant differences among the types of teeth, at 10 sec, temperature rise recorded for all types of teeth was below the critical value of 5.6°C, which cause pulp damage. Dark deposits on teeth surface boosted thermal effect of DLs (p < 0.01). Conclusions: Gingivectomy with DLs at 1 W on anterior, premolar, and molar teeth for 20, 40, and 60 sec, respectively, generates acceptable temperature rise; however, it should be <10, 20, and 40 sec at 2 W, respectively. Especially in the anterior teeth, DLs should be performed with caution to avoid pulp damage.

Bulk Fill flow resin contraction using 3D finite element model and calibration by Fiber Bragg Grating measurement

Contraction due to polymerization of dental resin can cause failure on the adhesive interfaces, can lead to problems such as the appearance of gaps in the interfaces, postoperative sensitivity, pulp damage and the return of the caries. The objective of this work is the study of stresses on the dental adhesive that are generated by the process shrinkage of resin associated with biting forces. A laboratory experiment measured the strains and temperature inside the FiltekTM Bulk Fill Flow resin during the process of polymerization using Fiber Bragg Grating sensors in an ex vivo tooth. From tomographic images a three-dimensional geometric model of the tooth was reconstructed. A pre-tension was calibrated to simulate the residual contraction on the resin 3 D model. Finally, an Finite Element Method analysis was performed to access the adhesive stresses at the interface enamel/dentin with the adhesive, considering as loading the residual polymerization contraction of the dental resin and also biting loads. The model was able to represented the strain obtained in the laboratory experiment. The results of the stress analysis shows that the outer regions of adhesive are more prone to failure, as veried by dental surgeons in clinical practice.

Oxidative stress induced antimicrobial efficacy of chitosan and silver nanoparticles coated Gutta-percha for endodontic applications

Root canal treatment is the most effective treatment for irreversible pulpal damage. However, it suffers the risk of failure due to micro-leakage at the Gutta-percha-sealer-tooth interface. Concerning the issue, it is important to enhance the antimicrobial properties of Gutta-percha. The current study describes a novel coating of the Gutta-percha with chitosan and silver nanoparticles to increase their antimicrobial efficacy. They were coated with chitosan and silver nanoparticles with concentrations of 1%, 2% using chemical methodology. Coated Gutta-percha were evaluated for their antimicrobial efficacy against E. faecalis, which is frequently isolated microorganism in failed endodontic cases using standard microbiological methods like growth curve analysis. Detailed analysis of the antimicrobial activity was performed by live-dead analysis with the help of flow cytometry and fluorescent microscopy. Although, the experimental analysis showed concentration-dependent antibacterial activity by both chitosan and silver NP coated Gutta-percha, the silver NP coating exhibited higher antibacterial activity compared to the Gutta percha coated with chitosan nanoparticles. Mechanistic evaluation unveiled the cause of antibacterial activates due to action of induced oxidative stress and membrane damage to the bacteria by coated nanoparticles. The information will be useful for the endodontist to have an alternative filling material with higher antibacterial potency for higher success rate of root canal therapies in clinical procedures.

EXPANDING HORIZON IN CARIES PREVENTION WITH SILVER DIAMINE FLUORIDE- A REVIEW

Dental caries is the most common pandemic on the globe, affecting various age bars in all countries with varying degree of severity. Silver diamine fluoride provides an alternative care path for those patients in whom traditional restorative treatment cannot be done. Application of SDF to arrest dental caries is a non-invasive procedure that is quick and simple to use. Reports of available studies found no severe pulpal damage after SDF application. However, it has drawbacks like black discoloration of the carious teeth and an unpleasant metallic taste. But, the low cost of SDF and its simplicity in application suggest that SDF is an appropriate therapeutic agent for use in community dental health projects.&#x0D; Keywords: Silver diamine fluoride; Dental caries; Caries arrest

Heat stress defense in dental pulp stem cells

Many dental treatment procedures can generate excessive heat within a short period of time. The heat on the tooth surface can be transduced to the dental pulp chamber and lead to alteration of dental pulp stem cells, vascular structures and sensory neurons within the chamber. It has been reported that elevation of temperature by 5.5°C in the pulp chamber caused 15% irreversible pulpal damage. However, the molecular changes of dental pulp cells post heat stress has not been characterized. In this study, we explored the changes in human dental pulp Stem Cells from the Exfoliated Deciduous teeth (SHED) after exposure to heat stress.Lysate of SHED cells were collected after exposure to heat stress at 42°C or normal culture temperature at 37°C. Western blots were used to examine the expression of Heat Shock Proteins (HSP). Human cytokine arrays (AAH‐CYT‐5, RayBiotech) were used to evaluate the changes in the expression of 80 human cytokines in SHED cells after heat stress.Short term exposure to heat stress induced phosphorylation of HSP27. Prolonged exposure further increased expression of other heat shock proteins, which have been reported to play an important role in cell protection under stress. In addition, transient exposure to heat stress caused differential expression of cytokines in SHED cells, suppressing expression of cytokines as IL‐1a and IL‐10, while increasing expression of glial cell derived neurotrophic factor (GDNF) and insulin‐like growth factor ‐1 (IGF‐1).The results showed HSPs and multiple cytokines play important role in detecting and responding to heat stress on the SHED cells. These factors could potentially protect SHED cells from thermal damage and promote stem cell regeneration post thermal damage.Support or Funding InformationFaculty Scholarly/Artistic Activities Award DDNA12‐013 University of the Pacific.

Interaction of hydraulic calcium silicate and glass ionomer cements with dentine

Restoration of missing tooth structure may require the use of a dentine replacement material to protect the dental pulp. Hydraulic calcium silicate cements and glass ionomers have been reported to exhibit ion exchange at the interface, and this interaction may be enhanced by removal of the smear layer that is formed when dentine is cut. The nature of the interaction and effects of smear layer have not been investigated for hydraulic cements. Biodentine and Chemfil Rock were used as dentine replacement materials in human molar teeth. The dentine was either left untreated or was functionalized by application of 17% ethylene diamine tetracetic acid (EDTA) or 20% polyacrylic acid applied for 1 min. The interface and dentine interaction were assessed by confocal microscopy (CM) with Rhodamine B, atomic force microscopy (AFM), scanning electron microscopy (SEM) and elemental mapping and by bond strength evaluation. Two extra groups with Rhodamine B were observed by AFM and SEM to assess the effect of Rhodamine B on the material and interfacial characteristics. The addition of dye to the materials effected the material properties and modified the interfacial zone. The mineral infiltration zone is an artefact caused by specimen preparation for CM, thus the use of Rhodamine B is not recommended for assessment of tooth-material interface. Dentine functionalization with EDTA improved the Biodentine contact to the tooth structure. Silicon migration from the material to the tooth structure occurred for Biodentine and the clinical implications of this need to be investigated further. Statement of significanceThe interaction of pulp preservation materials with the underlying dentine is important for maintenance of pulp vitality. This interaction is usually based on ion exchange of calcium between the material and dentine and is affected by the smear layer which is formed when the dentine is prepared with rotary instruments. These interactions are studied by various microscopy techniques with the confocal microscopy being very popular as the fluorescent dye clearly maps out the material interaction with the substrate. Unfortunately, the fluorescent dyes affect the interface and the level of penetration. The presence of a mineral infiltration zone, which is linked to the hydraulic tricalcium silicate cements is an artefact. Dentine functionalization with calcium chelators could be an alternative to the use of weak acids and could be more clinically acceptable to avoid pulp damage in deep cavities.

Silver diamine fluoride as a proactive anti-caries tool: A review

The management of ECC by the regular stereotyped restorative methods alone is incapable, particularly in a vast community or developing countries like India, where we lack free availability of dental equipment and manpower. The announcement of silver diamine fluoride (SDF) as another fluoride delivery system is a breakthrough therapy with evidences of caries lesion arrest rates of about 70 percent. SDF presents as an advantageous modality and is favoured as a satisfactory interim treatment option for its less invasive nature and its inexpensiveness. Most of the researchers have reported SDF to be undeniably more potent cariostatic agent than the fluoride varnishes in arresting caries. Its anti -caries effectiveness was found to be alike on incipient dental caries, non-cavitated and cavitated lesions and no severe pulpal damage after SDF application has been reported. Hence it is justified to state that SDF is a competent, efficient, secure and a reasonable caries preventive tool which is time saving and also patient oriented. Keywords: Silver diamine fluoride (SDF), Cariostatic agents, Fluoride delivery systems, Early childhood caries (ECC), Caries prevention, Fluoride varnishes.