Department of Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-Ku, Tokyo 113-8549, Japan.
Department of Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-Ku, Tokyo 113-8549, Japan.
J Dent. 2024 Jul;146:105041. doi: 10.1016/j.jdent.2024.105041. Epub 2024 May 16.
This study aimed to measure the distribution of silver ion (Ag), mineral recovery, and nanohardness in carious lesions and comprehensively evaluate the degree of dentin restoration.
Sixty human teeth with root caries were randomly assigned to the control, silver diammine fluoride (SDF) [Safo], and SDF+Glass ionomer cement (GIC) treatment [Safo+Fuji] groups. Micro-computed tomography (micro-CT) was performed at five time points for each sample before/after treatment to evaluate mineral density within and around carious lesions. Three months following treatment, 12 samples were selected for synchrotron radiation X-ray fluorescence analysis to evaluate Ag distribution, while 15 samples were selected for nanoindentation. Data were analyzed using Dunnett's T3 test for micro-CT and Wilcoxon rank sum test with Bonferroni correction (p = 0.017) for nanoindentation. The correlation between hardness and mineral change was analyzed using the Spearman rank correlation coefficient.
The Safo and Safo+Fuji groups showed significantly higher mineral recovery rates than did the control group (p < 0.001). In the Safo group, Ag accumulated in the deeper layers rather than the superficial layer of caries. In the Safo+Fuji group, Ag was found evenly distributed throughout caries, with only a few Ag detected in the GIC layer. Hardness in the Safo+Fuji group was significantly higher compared with the Safo group at depths in the range of 10-50 µm.
In the presence of GICs, SDF exhibited high remineralization capacity when diffusing throughout carious lesions over time. Combined treatment with SDF and GIC could strengthen root dentin even in the presence of caries.
We found that combination treatment with SDF and GIC could increase mineral density in caries and improve the hardness of the tooth structure compared with fluoride-based agents alone. These findings might pave the way for future clinical trials to determine the therapeutic potential of nanotechnology-based restorative materials.
本研究旨在测量银离子（Ag）的分布、矿物质的再矿化以及龋损中的纳米硬度，并全面评估牙本质修复的程度。
将 60 颗有根面龋的人牙随机分为对照组、银胺氟化物（SDF）[Safo]组和 SDF+玻璃离子水门汀（GIC）组[Safo+Fuji]。对每个样本在治疗前后的五个时间点进行微计算机断层扫描（micro-CT），以评估龋损内及周围的矿物质密度。治疗后 3 个月，选择 12 个样本进行同步辐射 X 射线荧光分析，以评估 Ag 的分布，选择 15 个样本进行纳米压痕分析。使用 Dunnett 的 T3 检验进行 micro-CT 数据分析，Wilcoxon 秩和检验（Bonferroni 校正，p = 0.017）进行 nanoindentation 数据分析。使用 Spearman 秩相关系数分析硬度与矿物质变化之间的相关性。
Safo 和 Safo+Fuji 组的矿物质再矿化率明显高于对照组（p < 0.001）。在 Safo 组中，Ag 聚集在龋损的深层而不是浅层。在 Safo+Fuji 组中，Ag 均匀分布在龋损中，只有少量 Ag 检测到在 GIC 层中。Safo+Fuji 组在 10-50µm 深度范围内的硬度明显高于 Safo 组。
在 GIC 的存在下，SDF 随着时间的推移在整个龋损中扩散时表现出很强的再矿化能力。SDF 和 GIC 的联合治疗即使在有龋的情况下也能增强根面牙本质的强度。
我们发现，与单独使用氟化物基制剂相比，SDF 和 GIC 的联合治疗可以增加龋损中的矿物质密度，并提高牙体结构的硬度。这些发现可能为未来的临床试验奠定基础，以确定基于纳米技术的修复材料的治疗潜力。
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