The In Situ Effect of Titanium Tetrafluoride Gel on Erosion/Abrasion Progression in Human Dentin

Abstract

Erosion incidence is increasing and its control is still a challenge in clinical practice. This study evaluated 4% TiF 4 -gel effects on eroded human dentin subjected to in situ erosive/ abrasive episodes. Seventy-two previously eroded dentin slabs (0.05 M citric acid, pH 2.3, 20 min) were allocated to 6 groups (n=12) according to the treatment to be performed during the in situ phase and number of erosive/abrasive cycles, as follows: 4% TiF 4 -gel applied once (TiF 4 1), twice (TiF 4 2) or three times (TiF 4 3) followed by 1, 2 and 3 erosive/ abrasive cycles, respectively. Gel was applied before the beginning of the next cycle. Control groups were subjected to 1 (C1), 2 (C2) and 3 (C3) erosive/abrasive cycles only. A seventh group (n=12) comprised in vitro uneroded samples (UN) subjected to 3 erosive/ abrasive cycles. Each cycle corresponded to 2 days of erosive (citric acid 0.5%, pH 2.6, 6x/day) and abrasive (electric toothbrush, 10 s/sample, 1 x/day) challenges. Samples were evaluated under profilometry and environmental scanning electron microscopy (ESEM). Atomic force microscopy images (AFM) were also made (n=3). Repeated measures 2-way ANOVA and Tukey test (p<0.001) showed that TiF 4 2, which did not differ from TiF 4 1 and TiF 4 3, revealed a significant reduction in surface loss compared to all control groups. TiF 4 1 and TiF 4 3 showed no significant difference from C1, but both groups demonstrated significantly smaller surface loss than C2 and C3. ESEM and AFM micrographs suggested alterations on treated surfaces compared to samples from control groups, showing reduced diameters of dentinal tubules lumens. Therefore, TiF 4 was able to reduce the progression of erosive/abrasive lesions.

Effect of Artificial Saliva on the Corrosion Behavior of Dental Alloys: A review

“…However, in the absence of modification of the patient habits, there may be the need of new TiF4 applications so its action is prolonged and may prevent the continuation of the erosive process. Within the limitations of the study, 4% gel TiF4 was able to reduce the progression of erosive/abrasive lesions in dentin in the first application and multiple applications reduced the evolution of the erosive process [35].…”

Xylitol Fluoride Varnish: In Vitro Effect Analysis on Enamel by Atomic Force Microscopy

“…The ability of conventional fluoride products, such as NaF varnish, to prevent erosive/abrasive processes has been described in the literature [ 34 , 35 ]. Regarding the presence of xylitol, it probably did not increase the protection capacity of the product against mineral losses.…”

Titanium Tetrafluoride (TiF4) in the Treatment of Dental Erosion

“…Since TiF 4 enables the formation of this acid-resistant layer, it is responsible for the production of a diffusion barrier and a reservoir of F ions, which may delay the dissolution of dental tissue exposed to acidic challenges 25 . For this reason, its effect on erosion has been studied and has obtained promising results in both enamel 19,20,30,39,42 and dentin 43 . These results are dependent on the concentration, form of presentation, pH and time of application of TiF 4 26,30,39 .…”

“…As for the excipient that should be used for TiF 4 application, the simplest would be to incorporate this fluoride into dentifrices, although, it is known that under low pH conditions, the product presents better results in the formation of precipitate on the dental surface and reduction of demineralization 39 , maintaining its protection against erosion even after abrasive challenges 43,44 . A lower pH may favor the penetration of F -ions into the partially demineralized tissue layer 45 , since exposure of the organic matrix increases the surface area of dentin and creates diffusion zones 40 , which promotes the retention of CaF 2 also in the intratubular region of the dentin 45 .…”

“…Besides, prolonged application times, between 2 and 4 minutes, may favor the retention of F -on the dental surface 35 and decrease mineral loss by dental tissue under acid action 19 . The ideal clinical application frequency has not still been determined, but it is known that TiF 4 is capable of modifying surface morphology since its first application 43 , leading to the formation of a smoother surface 49 and covered by precipitate both in enamel 38 and in dentin 50 . However, re-application of the fluoride may favor the reduction of substrate loss after tissue exposure to erosive solutions 43 and to promote certain obliteration of tubule entrance 49 , which could also lead to reduction of dentin hypersensitivity.…”