Silver diamine fluoride and cleaning methods effects on dentin bond strength.

PURPOSE: To assess the effect of silver diamine fluoride (SDF) application on bond strength of current adhesive systems to caries-affected dentin and cleaning procedures to overcome SDF's influence on adhesion to dentin. METHODS: 64 human third molars were randomly divided in eight groups for microshear bond strength testing (MBS). Samples of sound and artificial caries-affected human dentin were treated or not with 38% SDF and restored with an etch-and-rinse or a self-etch bonding system. For the cleaning part, water, aluminum oxide, and pumice paste were used after SDF application to determine whether SDF affected the bond strength to dentin. Fracture mode was evaluated under scanning electron microscope. Data were statistically analyzed by ANOVA. RESULTS: SDF application resulted in the lowest MBS for the self-etching adhesive system on caries-affected dentin (P< 0.05). Cleaning with pumice slurry maintained the MBS in SDF groups when compared to the control groups (not treated with SDF). Fracture evaluation showed more adhesive failures on adhesive systems groups. EDX analysis showed no silver particles when pumice paste was used for cleaning. CLINICAL SIGNIFICANCE: Self-etch adhesive systems do not seem appropriate for bonding SDF-treated dentin restorations. Cleaning SDF-treated dentin with pumice paste reduced the negative effect of SDF on resin-dentin bond strength. Etch-and-rinse adhesive systems seemed not be affected by 38% SDF.

The effect of silver diamine fluoride and cleaning methods on bond strength of glass-ionomer cements to caries-affected dentin.

PURPOSE: To evaluate the effect of silver diamine fluoride (SDF) application on the microshear bond strength (MBS) of glass-ionomer cements (GIC) to caries-affected dentin (Part 1) and dentin cleaning methods to reduce SDF's potential effect on MBS (Part 2). METHODS: For Part 1, 56 extracted human teeth were randomly divided into eight groups with GIC, 38% SDF application and dentin substrate. Samples of artificial caries-affected human dentin were treated or not with 38% SDF and restored with conventional or resin-modified GIC. The same procedures were performed in sound dentin tested for MBS test after 24 hours. In Part 2, different dentin cleaning agents (water, aluminum oxide, and pumice slurry) were tested after SDF application. The procedure was performed on the group that presented the worst values for MBS in Part 1. Fracture mode was evaluated under scanning electron microscope. Data were statistically analyzed by ANOVA. RESULTS: MBS was affected by the presence of caries and the type of material, with the conventional GIC the most affected (P< 0.05). Pumice slurry was superior in comparison to the other agents in cleaning SDF-treated dentin. Fracture evaluation showed more mixed failures in all the groups. CLINICAL SIGNIFICANCE: Clinicians should have caution when selecting the glass-ionomer cement (GIC) for restorations in silver diamine fluoride (SDF)-treated dentin. The mechanical properties of conventional GIC restorations were more affected than resin-modified GICs. Pumice slurry was the most effective cleaning method to minimize the negative effect of SDF on dentin.

Abfraction lesions: etiology, diagnosis, and treatment options.

Abfraction is a type of noncarious cervical lesion (NCCL) characterized by loss of tooth tissues with different clinical appearances. Evidence supports that abfraction lesions, as any NCCLs, have a multifactorial etiology. Particularly, the cervical wear of abfraction can occur as a result of normal and abnormal tooth function and may also be accompanied by pathological wear, such as abrasion and erosion. The interaction between chemical, biological, and behavioral factors is critical and helps to explain why some individuals exhibit more than one type of cervical wear mechanism than others. In an era of personalized dentistry, patient risk factors for NCCLs must be identified and addressed before any treatment is performed. Marked variations exist in dental practice concerning the diagnosis and management of these lesions. The lack of understanding about the prognosis of these lesions with or without intervention may be a major contributor to variations in dentists' management decisions. This review focuses on the current knowledge and available treatment strategies for abfraction lesions. By recognizing that progressive changes in the cervical area of the tooth are part of a physiologically dynamic process that occurs with aging, premature and unnecessary intervention can be avoided. In cases of asymptomatic teeth, where tooth vitality and function are not compromised, abfraction lesions should be monitored for at least 6 months before any invasive procedure is planned. In cases of abfraction associated with gingival recession, a combined restorative-surgical approach may be performed. Restorative intervention and occlusal adjustment are not indicated as treatment options to prevent further tooth loss or progression of abfraction. The clinical decision to restore abfraction lesions may be based on the need to replace form and function or to relieve hypersensitivity of severely compromised teeth or for esthetic reasons.