Effect of silver diamine fluoride (SDF) on the dentin-pulp complex: ex vivo histological analysis on human primary...

The aim of this study was to determine the effect of SDF on the dentin-pulp complex using two models: teeth after SDF application (ex vivo) and experimental animal molars. A descriptive study was performed using two models. In the first model, primary teeth (ex vivo) with enamel-dentin caries, without pulp involvement and previously treated with 38% SDF, were evaluated by means of two techniques: (a) Scanning Electron Microscopy (SEM) and energy-dispersive X-ray detector (EDS) to determine qualitative and quantitative composition, and (b) brightfield optical microscopy (OM) after decalcification. The second model used laboratory animal molars from 12 male Wistar rats. Standardized enamel-dentin cavities approximately 0.5 mm deep were made the distal fossa of the occlusal face of both first lower molars, to one of which a 38% SDF solution was applied, while the other was used as a control. Histological sections were prepared and dental pulp was evaluated qualitatively in both groups. SEM on ex vivo teeth showed areas of hypermineralization in the intertubular dentin and few blocked tubules, while EDS detected Ag in the center of the lesion (7.34%), its concentration declining at the edges (1.71%), with none in the areas farthest from the lesion. OM showed SDF sealing the tubules only at the site where it had been placed, with limited penetration beneath, the tubules appeared normal and the pulp tissue associated to treated caries showed chronic inflammatory infiltrate and formation of tertiary dentin, with no Ag precipitate. In the experimental animal model, pulp histology was not significantly altered in the molar cavities exposed to SDF. The observations using the different techniques on dental tissues suggest that SDF causes minimal adverse effects. The results of this study may contribute to further studies on the suitability of SDF as a cost-effective strategy for treating caries.