Effect of Discoloration Reducing Agents on Dentin Remineralization After Silver Diammine Fluoride Treatment

Purpose: To compare the effects of different agents on the reduction of discoloration and remineralization potential in artificial-dentincaries lesions treated with silver diammine fluoride (SDF). Methods: A total of 120 caries-free primary-molars were divided into 6 groups as follows: SDF-only: 38% SDF as the positive control; SDF+KI: SDF followed by potassium iodide (KI); SDF+HP: SDF followed by 40% hydrogen peroxide (HP); SDF+KI+HP: SDF followed by KI and then HP; SDF+GSH: SDF premixed with 20% glutathione (GSH); and SDF+GSH+KI: SDF premixed with GSH followed by KI. Following application of the materials to the artificial-dentincaries lesions, the samples were subjected to a 7-day pH-cycling protocol. Microhardness testing, spectrophotometry, and confocal laser scanning microscopy were used to analyze changes in the dentin. Data were analyzed using Kruskal-Wallis, Friedman, and Bonferroni tests (P<0.05). Results: All groups exhibited post-treatment increases in surface microhardness from the demineralized state (P<0.001), and post-treatment hardness values approached baseline (sound dentin; P>0.05). Betweengroup comparisons revealed no differences in post-treatment surface microhardness (P=0.454) or lesion depth (P=0.113). However, the SDF+HP group showed lower lesion fluorescence (P<0.001). Spectrophotometric analyses revealed that the KI (approximately 54%) and HP (approximately 41%) subgroups reduced post-treatment discoloration compared to the SDF-only group (P<0.001). Conclusions: None of the tested combinations had a negative effect on the remineralization capacity of silver diammine fluoride under the evaluated parameters. Potassium iodide and hydrogen peroxide effectively reduced SDF-related discoloration, improving its esthetic acceptability without compromising its therapeutic efficacy.