THAILAND: Study on Silver Diamine Fluoride and Glass Ionomer Cement

According to a study published in the European Journal of Dentistry, adding silver diamine fluoride to glass ionomer cement improves shear bond strength without causing more microleakage at the enamel and dentin borders.

Tooth caries, which is characterized as a localized, multifactorial pathological process that softens dental hard tissues and leads to the development of cavities, is still a common condition worldwide. Recent advancements in the understanding of the caries process and the development of restorative materials have made it possible to practice dentistry with consideration for a minimally intrusive philosophy. Since the early 1970s, a topical fluoride solution called silver diamine fluoride [Ag(NH₃)₂F] (SDF) has been used all over the world to prevent dental cavities. Its concentration is 38% (44,800 ppm fluoride). Also, GIC-containing SDF (GICSDF) has not been studied for its bonding effectiveness or microleakage.

"There are restrictions with SDF treatment, however it can stop current caries and stop the emergence of dental problems. The cavitated teeth's chewing ability may not be enhanced by restoring the tooth cavities, and the black stain on the SDF-arrested caries lesions may raise aesthetic issues," the authors added.

As stated by the researchers, SDF can reduce micro/nanoleakage and secondary caries associated with GICs while GICs can disguise the stained carious lesion associated with SDF.

The researchers sought to examine the shear bond strength and microleakage of glass ionomer cement (GIC) incorporating silver diamine fluoride (SDF).

A standard GIC (Fuji IX) served as the control (GIC). Two different brands of 38% SDF, Saforide and Topamine, were added to the liquid part of the GIC (P/L = 3.4:1 [w/w]) and hand-mixed with the GIC powder to create the experimental GICs (GICSDF-S and GICSDF-T). 87 removed human premolars were gathered for the purpose of assessing bond strength and microleakage. A universal testing device was used to assess shear bond strength (n = 14/group), which was then compared between groups using one-way ANOVA and Tukey HSD (p < 0.05). A stereomicroscope was used to score the microleakage (n = 15/group) at the enamel and dentin margins, and the results were compared between the groups (Chi-square, p 0.05).

Conclusive points of the study:

• Between the GIC and GICSDF-S groups and between the GIC and GICSDF-T groups, there were considerable differences in the shear bond strengths.
• The shear bond strength of the GIC group was the lowest of the categories, although there was no distinction between the GICSDF-S and GICSDF-T groups.
• The findings of the microleakage test at the enamel or dentin edges did not substantially differ between groups.
• The difference was not significant, despite the GIC group showing a higher dye penetration score at the enamel and dentin edges.
• Although GIC-containing SDF might be a promising restorative material, the authors recommended conducting a lengthy clinical trial of GIC-containing SDF to evaluate its intra-oral performance.

Reference

Auychai P, Khumtrakoon N, Jitongart C, Daomanee P, Laiteerapong A. Bond Strength and Microleakage of a Novel Glass Ionomer Cement Containing Silver Diamine Fluoride. Eur J Dent. 2022 Jul;16(3):606-611. doi: 10.1055/s-0041-1736329. Epub 2021 Dec 17. PMID: 34921382; PMCID: PMC9507574.