International Journal of Clinical Pediatric Dentistry

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VOLUME 15 , ISSUE 6 ( November-December, 2022 ) > List of Articles


Comparison of Cariostatic and Remineralizing Potential of Two Commercial Silver Diamine Fluoride Preparations Using Confocal Laser Microscopy and EDX-SEM Spectroscopy: An In Vitro study

Sagar D Misal, Prasanna T Dahake, Mukul Jain

Keywords : Confocal laser scanning microscopy, Dental caries, Fluoride, Silver diamine fluoride, X-ray emission spectroscopy

Citation Information : Misal SD, Dahake PT, Jain M. Comparison of Cariostatic and Remineralizing Potential of Two Commercial Silver Diamine Fluoride Preparations Using Confocal Laser Microscopy and EDX-SEM Spectroscopy: An In Vitro study. Int J Clin Pediatr Dent 2022; 15 (6):643-651.

DOI: 10.5005/jp-journals-10005-2454

License: CC BY-NC 4.0

Published Online: 14-02-2023

Copyright Statement:  Copyright © 2022; The Author(s).


Aim: To investigate the cariostatic and remineralizing effect of two commercial silver diamine fluoride (SDF) preparations on enamel and dentinal caries using a bacterial plaque model. Materials and methods: A total of 32 extracted primary molars were divided into two groups (n = 16), group I (FAgamin), and group II (SDF). Plaque bacterial model was used to induce caries on enamel and dentin. Preoperative evaluation of samples was done using confocal laser microscopy (CLSM) and energy-dispersive X-ray spectroscopy-scanning electron microscope (EDX-SEM). All samples were treated with test materials and evaluated for postoperative remineralization quantification. Results: Energy-dispersive X-ray spectroscopy (EDX) revealed that mean preoperative levels (in weight %) of silver (Ag) and fluoride (F2) in carious enamel lesions were 0.0 and 0.0, which increased postoperatively to 11.40 and 31.05 for FAgamin and 13.61 and 31.87 for SDF, respectively. For dentinal caries, EDX revealed mean preoperative levels (in weight %) of Ag and F2 were 0.0 and 0.0, which increased to 11.47 and 48.71 for FAgamin and 10.16 and 47.82 for SDF, respectively postoperatively. Both the groups showed evident demineralization with exposed collagen under SEM. The mean value of enamel lesion depth for the group I and II were 38.64 and 39.30 µm, that reduced to 28.02 and 28.70 µm while for dentinal caries, the mean depth from 38.05 and 38.29 µm that reduced significantly to 28.96 and 30.10 µm, respectively (p < 0.001). Caries depth declined significantly after the application of both FAgamin and SDF (p < 0.001). Conclusion: FAgamin and SDF show similar cariostatic and remineralization potential for dental caries. The bacterial plaque model used in this study is an efficient method to induce artificial carious lesions in teeth. Clinical significance: A comparative evaluation of these two cariostatic and remineralizing agents will aid in identifying the efficacy of both commercial products in treating initial caries lesions in an effective noninvasive and child-friendly manner.

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  1. Momoi Y, Hayashi M, Fujitani M, et al. Clinical guidelines for treating caries in adults following a minimal intervention policy–evidence and consensus based report. J Dent 2012;40(2):95–105. DOI: 10.1016/j.jdent.2011.10.011
  2. Suzuki T, Nishida M, Sobue S, et al. Effects of diammine silver fluoride on tooth enamel. J Osaka Univ Dent Sch 1974;14:61–72.
  3. Llodra JC, Rodriguez A, Ferrer B, et al. Efficacy of silver diamine fluoride for caries reduction in primary teeth and first permanent molars of schoolchildren: 36-month clinical trial. J Dent Res 2005;84(8)721–724. DOI: 10.1177/154405910508400807
  4. Chu CH, Lo EC. Promoting caries arrest in children with silver diamine fluoride: a review. Oral Health Prev Dent 2008;6(4):315–321.
  5. Chu CH, Mei L, Seneviratne CJ, et al. Effects of silver diamine fluoride on dentine carious lesions induced by Streptococcus mutans and Actinomyces naeslundii biofilms. Int J Paediatr Dent 2012;22(1):2–10. DOI: 10.1111/j.1365-263X.2011.01149.x
  6. Mei ML, Li QL, Chu CH, et al. The inhibitory effects of silver diamine fluoride at different concentrations on matrix metalloproteinases. Dent Materials 2012;28(8):903–908. DOI: 10.1016/
  7. Liu BY, Lo EC, Li CM. Effect of silver and fluoride ions on enamel demineralization: a quantitative study using microcomputed tomography. Aust Dent J 2012;57(1):65–70. DOI: 10.1111/j.1834-7819.2011.01641.x
  8. Chu CH, Lo EC. Microhardness of dentine in primary teeth after topical fluoride applications. J Dent 2008;36(6):387–391. DOI: 10.1016/j.jdent.2008.02.013
  9. Momoi Y, Shimizu A, Hayashi M, et al. Root caries management: evidence and consensus based report. Curr Oral Health Rep 2016;3:117–123. DOI: 10.1007/s40496-016-0084-0
  10. Mei ML, Ito L, Cao Y, et al. Inhibitory effect of silver diamine fluoride on dentine demineralisation and collagen degradation. J Dent 2013;41(9):809–817. DOI: 10.1016/j.jdent.2013.06.009
  11. Thanatvarakorn O, Islam MS, Nakashima S, et al. Effects of zinc fluoride on inhibiting dentin demineralization and collagen degradation in vitro: a comparison of various topical fluoride agents. Dent Mater J 2016;35(5):769–775. DOI: 10.4012/dmj.2015-388
  12. Savas S, Kucukyilmaz E, Celik EU, et al. Effects of different antibacterial agents on enamel in a biofilm caries model. J Oral Sci 2015;57(4): 367–372. DOI: 10.2334/josnusd.57.367
  13. Arnold WH, Gaengler P, Sabov K, et al. Induction and 3D reconstruction of caries-like lesions in an experimental dental plaque biofilm model. J Oral Rehabil 2001;28(8):748–54. DOI: 10.1046/j.1365-2842.2001.00755.x
  14. Smith LA, O'Brien JA, Retief DH, et al. Microleakage of two dentinal bonding restorative systems. J Dent Res 1988;67(3).
  15. Bullard RH, Leinfeider K, Russell CM. Effect of coefficient thermal expansion on microleakage. J Am Dent Assoc 1988;116(7):871–874. DOI: 10.14219/jada.archive.1988.0291
  16. Fejerskov O. Concepts of dental caries and their consequences for understanding the disease. Community Dent Oral Epidemiol 1997;25(1):5–12. DOI: 10.1111/j.1600-0528.1997.tb00894.x
  17. Marsh PD, Bradshaw DJ. Dental plaque as a biofilm. J Ind microbiol 1995;15(3):169–175. DOI: 10.1007/bf01569822
  18. Silverstone L. The surface zone in caries and in caries-like lesions produced in vitro. Br Dent J 1968;125(4):145–57.
  19. Arnold WH, Gaengler P, Kalkutschke L. Three-dimensional reconstruction of approximal subsurface caries lesions in deciduous molars. Clin Oral Investig 1998;2(4):174–179. DOI: 10.1007/s007840050066
  20. Buchalla W. Histological and clinical appearance of caries. Caries management–Science and clinical practice. Stuttgart 2013:39–63.
  21. West NX, Joiner A. Enamel mineral loss. J Dent 2014;42(suppl 1):S2–11. DOI: 10.1016/S0300-5712(14)50002-4
  22. Mei ML, Ito L, Cao Y, et al. An ex vivo study of arrested primary teeth caries with silver diamine fluoride therapy. J Dent 2014;42(4):395–402. DOI: 10.1016/j.jdent.2013.12.007
  23. Wahengbam P, Tikku AP, Lee WB. Role of titanium tetrafluoride (TiF4) in conservative dentistry: a systematic review. J Conserv Dent 2011;14(2):98–102. DOI: 10.4103/0972-0707.82598
  24. Cao Y, Mei ML, Xu J, et al. Biomimetic mineralisation of phosphorylated dentine by CPP-ACP. J Dent 2013;41(9):818–825. DOI: 10.1016/j.jdent.2013.06.008
  25. Mei ML, Ito L, Cao Y, et al. The inhibitory effects of silver diamine fluorides on cysteine cathepsins. J Dent 2014;42(3):329–335. DOI: 10.1016/j.jdent.2013.11.018
  26. Mei ML, Lo EC, Chu CH. Arresting dentine caries with silver diamine fluoride: what's behind it? J Dent Res 2018;97(7):751–758. DOI: 10.1177/0022034518774783
  27. Zhao IS, Gao SS, Hiraishi N, et al. Mechanisms of silver diamine fluoride on arresting caries: a literature review. Int Dent J 2018;68(2):67–76. DOI: 10.1111/idj.12320
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