Mei May L, Ito L, Cao Y, Lo Edward C M, Li Q L, Chu C H
Faculty of Dentistry, The University of Hong Kong, Hong Kong.
Faculty of Dentistry, The University of Hong Kong, Hong Kong; College of Stomatology, Anhui Medical University, Hefei, China.
J Dent. 2014 Apr;42(4):395-402. doi: 10.1016/j.jdent.2013.12.007. Epub 2013 Dec 25.
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.
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).
Micro-CT examination revealed a superficial opaque band approximately 150μm 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 150μm 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.
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 SDF application positively influences dentine remineralisation.
本体外研究比较了每半年用氟化银（SDF）治疗的乳牙与未接受此类治疗的龋牙之间的物理化学结构差异。
从6岁儿童中收集了12颗龋坏的上颌中切牙。6颗牙齿在每半年应用SDF 24个月后龋病静止，6颗在未进行局部氟化物治疗时患有活动性龋病。通过微计算机断层扫描（micro-CT）、能量色散X射线光谱法（EDX）、扫描电子显微镜（SEM）和透射电子显微镜（TEM）评估矿物质密度、元素含量、表面形态和晶体特征。
Micro-CT检查显示，在静止的空洞型牙本质病变上有一条约150μm的浅表不透明带。该带在活动性龋病病变中受限。EDX检查检测到，表面区域150μm处的钙和磷强度高于内部区域，但该区域在活动性空洞型牙本质病变中受限。SEM检查表明，在静止的空洞型牙本质病变中，胶原蛋白受到保护未暴露，但在活动性空洞型牙本质病变中则暴露。TEM检查表明，再矿化的羟基磷灰石在静止的空洞型牙本质病变中排列良好，而在活动性空洞型牙本质病变中的排列则呈随机的磷灰石排列。
在应用SDF的乳牙静止的空洞型牙本质病变上发现了一个富含钙和磷的高度再矿化区域。在静止的空洞型牙本质病变中，胶原蛋白受到保护未暴露。
临床应用SDF对牙本质再矿化有积极影响。
