Biomineralization of Dental Tissues Treated with Silver Diamine Fluoride

Abstract

Silver diamine fluoride (SDF) is a dental biomaterial used to arrest dental caries. To better understand SDF’s mechanism of action, we examined the localization of silver within the tissues of SDF-treated teeth. Carious primary teeth fixed within 2 min of SDF application (SDF-minutes, n = 3), at 3 wk after SDF application in vivo (SDF-weeks, n = 4), and at 2 y after multiple SDF applications in vivo (SDF-multiple, n = 1) were investigated in this study. Carious primary teeth without SDF application (no-SDF, n = 3) served as controls. Mineral density and structural analyses were performed via micro–X-ray computed tomography and scanning electron microscopy. Elemental analyses were performed through X-ray fluorescence microprobe and energy-dispersive X-ray spectroscopic techniques. SDF-treated teeth revealed higher X-ray–attenuated surface and subsurface regions within carious lesions, and similar regions were not present in no-SDF teeth. Regions of higher mineral density correlated with regions of silver abundance in SDF-treated teeth. The SDF penetration depth was approximated to 0.5 ± 0.02 mm and 0.6 ± 0.05 mm (mean ± SD) for SDF-minutes and SDF-weeks specimens, respectively. A higher percentage of dentin tubular occlusion by silver or calcium phosphate particles was observed in primary teeth treated with SDF-weeks as compared with SDF-minutes. Elemental analysis also revealed zinc abundance in carious lesions and around the pulp chamber. SDF-weeks teeth had significantly increased tertiary dentin than SDF-minutes and no-SDF teeth. These results suggest that SDF treatment on primary teeth affected by caries promotes pathologic biomineralization by altering their physicochemical properties, occluding dentin tubules, and increasing tertiary dentin volume. These seemingly serendipitous effects collectively contribute to the cariostatic activity of SDF.

Peptide-Enabled Nanocomposites Offer Biomimetic Reconstruction of Silver Diamine Fluoride-Treated Dental Tissues

“…However, in the treated regions of the SDF-treated control dental tissue, a significantly greater Ca/P ratio was demonstrated for both SDF-treated enamel and dentin regions, as compared with untreated regions of the same sample and from the untreated control samples. A 2021 study investigated the effects of SDF on carious primary teeth regions and found SDF treatment promoted pathologic mineral by altering physiochemical properties of the tooth structures [ 82 ]. Their detailed results include structural and elemental analysis of SDF-treated teeth which reported EDS results consistent with our findings [ 82 ].…”

“…A 2021 study investigated the effects of SDF on carious primary teeth regions and found SDF treatment promoted pathologic mineral by altering physiochemical properties of the tooth structures [ 82 ]. Their detailed results include structural and elemental analysis of SDF-treated teeth which reported EDS results consistent with our findings [ 82 ]. The increased Ca/P ratio in the SDF-treated control sample indicates that in these carious lesions of the tooth, the SDF treatment creates a more stable CaP material closer resembling a calcium-deficient apatite [ 44 , 61 , 83 ].…”

“…Another approach to mask or reduce the staining caused by SDF has focused on remineralization of the affected dentin and enamel. Bacteria associated with dental caries works to break down the tooth structure, and the fluoride component of SDF treatment promotes natural remineralization of a treated tooth [ 25 , 82 , 92 ]. We, and colleagues, have previously established multiple peptides capable of directing remineralization of calcium phosphate materials and thus wanted to explore a synergistic approach using bifunctional peptides to anchor to the SDF-treated regions and direct new mineral growth [ 44 , 45 , 51 , 52 , 61 , 77 ].…”

Radiographic Changes to Silver Diamine Fluoride Treated Carious Lesions after a Rinsing Step

“…Our findings suggest that SDF application increases the radiopacity of the entire carious lesions. This is likely due to the presence of silver ions [ 11 ]. However, other compounds such as Calcium Fluoride (CaF2) could also have formed and contributed to the change in radiopacity of the carious lesion after SDF application [ 7 ].…”

Interface between Materials and Oral Biology

“…Securing durable adhesion to tooth surfaces using strategies that modify and/or chemically interact with components in the dentin surface is discussed in 3 articles (Alkattan et al, 2021; Cai et al, 2021; Maravic et al, 2021). Biomineralization mechanisms and arrest of carious lesions are explained (Sulyanto et al, 2021). Mineralization as it relates to regeneration of dentin, as well as pulp regeneration with stem cells and innovative scaffolds, forms the basis of 3 additional articles (Chang, Ma et al, 2021; Soares et al, 2021; Zou et al, 2021).…”