Almulhim Abdullah, Valdivia-Tapia Astrid C, Mao Xinyue, Alsahan Basma, Hara Anderson T, Wu Tong Tong, Xiao Jin, Li Yihong
Quintessence Int. 2025 Jul 21;56(7):556-564. doi: 10.3290/j.qi.b6335908.
Silver diamine fluoride (SDF) is increasingly recognized as a minimally invasive and effective treatment for early childhood caries. However, the dark discoloration from its application significantly limits its acceptability among parents, especially for anterior teeth. Zinc, with known antimicrobial and biofilm-modulating properties, has recently been proposed as a potential adjunct to reduce SDF-induced staining. This study aimed to evaluate the effectiveness of zinc pretreatment in reducing SDF-induced discoloration on primary tooth caries lesions that involved dentin. This study also aimed to examine surface morphology and elemental composition changes associated with zinc adjunct SDF treatments.
Extracted human primary teeth were allocated into three groups: untreated control, positive control (38% SDF alone), and experimental group (20 mol/L zinc pretreatment followed by 38% SDF). Tooth color changes were assessed using grayscale intensity analysis via standardized photography at baseline, immediately posttreatment, and up to 14 days. Scanning electron microscopy and energy-dispersive x-ray spectroscopy were employed to investigate morphologic and compositional changes in both sound and naturally carious dentin areas. Statistical analyses included two-sample t tests, linear regression, and likelihood ratio tests.
Teeth pretreated with zinc demonstrated less discoloration compared to the SDF-only group. Although this difference was not statistically significant (P = .125), it may have potential clinical relevance. Scanning electron microscopy images revealed modified silver deposition patterns characterized by dispersed and less densely packed silver aggregates in zinc-pretreated groups. Energy-dispersive x-ray spectroscopy analysis confirmed the presence of zinc, suggesting its interaction with silver deposition processes.
Zinc pretreatment effectively reduces SDF-induced discoloration in primary dentition, potentially improving esthetic outcomes and parental acceptance. This approach represents a promising advancement in minimally invasive pediatric dental care and warrants further clinical exploration.
氟化银（SDF）日益被认为是一种治疗幼儿龋齿的微创有效方法。然而，其应用导致的牙齿变黑显著限制了家长对它的接受度，尤其是在前牙治疗中。锌具有已知的抗菌和生物膜调节特性，最近被提议作为一种潜在的辅助剂，以减少SDF引起的染色。本研究旨在评估锌预处理对减少涉及牙本质的乳牙龋损中SDF诱导变色的有效性。本研究还旨在检查与锌辅助SDF治疗相关的表面形态和元素组成变化。
将拔除的人类乳牙分为三组：未处理对照组、阳性对照组（仅使用38% SDF）和实验组（先用20 mol/L锌预处理，然后使用38% SDF）。在基线、治疗后即刻以及长达14天的时间里，通过标准化摄影使用灰度强度分析评估牙齿颜色变化。采用扫描电子显微镜和能量色散X射线光谱法研究健康牙本质和自然龋坏牙本质区域的形态和成分变化。统计分析包括双样本t检验、线性回归和似然比检验。
与仅使用SDF的组相比，用锌预处理的牙齿变色较少。尽管这种差异无统计学意义（P = 0.125），但可能具有潜在的临床相关性。扫描电子显微镜图像显示，在锌预处理组中，银沉积模式有所改变，其特征是银聚集体分散且堆积密度较低。能量色散X射线光谱分析证实了锌的存在，表明其与银沉积过程相互作用。
锌预处理可有效减少乳牙列中SDF诱导的变色，可能改善美观效果并提高家长的接受度。这种方法代表了微创儿童牙科护理领域一项有前景的进展，值得进一步的临床探索。
