An ex vivo study of arrested primary teeth caries with silver diamine fluoride therapy

• Published in: Journal of dentistry Vol. 42; no. 4; pp. 395 - 402
• Main Authors: Mei, May L, Ito, L, Cao, Y, Lo, Edward C.M, Li, Q.L, Chu, C.H
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-04-2014
• Subjects: Calcium - analysis; Cariostatic Agents - therapeutic use; Chemical Phenomena; Child; Collagen; Collagen - ultrastructure; Crystallography; Dental Caries - drug therapy; Dental Caries - metabolism; Dental Caries - pathology; Dentin - chemistry; Dentin - drug effects; Dentin - ultrastructure; Dentine; Dentistry; Durapatite - analysis; Fluorides - analysis; Follow-Up Studies; Humans; Image Processing, Computer-Assisted - methods; Imaging, Three-Dimensional - methods; Incisor - chemistry; Incisor - drug effects; Incisor - ultrastructure; Microscopy, Electron, Scanning; Microscopy, Electron, Transmission; Phosphorus - analysis; Quaternary Ammonium Compounds - therapeutic use; Silver - analysis; Silver diamine fluoride; Spectrometry, X-Ray Emission; Tooth Remineralization - methods; Tooth, Deciduous - chemistry; Tooth, Deciduous - drug effects; Tooth, Deciduous - ultrastructure; X-Ray Microtomography - methods; Silver diamine fluoride; Dentine; Collagen
• ISSN: 0300-5712; 1879-176X
• DOI: 10.1016/j.jdent.2013.12.007

Abstract Objectives This ex vivo study compared the physico-chemical structural differences between primary carious teeth biannually treated with silver diamine fluoride (SDF) and carious teeth without such treatment. Method Twelve carious primary upper-central incisors were collected from 6-year-old children. Six teeth had arrested caries after 24-month biannual SDF applications and 6 had active caries when there was no topical fluoride treatment. The mineral density, elemental contents, surface morphology, and crystal characteristics were assessed by micro-computed tomography (micro-CT), energy-dispersive X-ray spectrometry (EDX), scanning electron microscopy (SEM), and transmission electron microscopy (TEM). Results Micro-CT examination revealed a superficial opaque band approximately 150 μm on the arrested cavitated dentinal lesion. This band was limited in the active carious lesion. EDX examination detected a higher intensity of calcium and phosphate of 150 μm in the surface zone than in the inner zone, but this zone was restricted in the active cavitated dentinal lesion. SEM examination indicated that the collagens were protected from being exposed in the arrested cavitated dentinal lesion, but were exposed in the active cavitated dentinal lesion. TEM examination suggested that remineralised hydroxyapatites were well aligned in the arrested cavitated dentinal lesion, while those in the active cavitated dentinal lesion indicated a random apatite arrangement. Conclusions A highly remineralised zone rich in calcium and phosphate was found on the arrested cavitated dentinal lesion of primary teeth with an SDF application. The collagens were protected from being exposed in the arrested cavitated dentinal lesion. Clinical significance Clinical SDF application positively influences dentine remineralisation.