Silver diammine fluoride (SDF) is a caries-arresting agent for dentine lesions. This study investigated the effect of application frequency of SDF when used with glass ionomer cement (GI) for remineralising carious dentine.
Freshly extracted human posterior teeth with advanced caries were used. After superficial removal of infected dentine, single (G3), double (G4), triple (G5) applications of SDF (Advantage Arrest SDF 38 %) followed by a layer of GI (GC Fuji IX GP) were compared to no treatment (negative control-G2), and GI only (G1). All teeth were stored in artificial saliva between treatments and for 2-weeks after final treatment. Micro-computed X-ray tomography (NSI) scans were obtained at each stage and analysed to plot mineral density-depth profile, lesion depth (LD) and mineral loss (ΔZ). Data was statistically analysed at a significance level of 0.05.
Mean LD values were 837 μm, 735 μm, 841 μm, 1008 μm, 707 μm at baseline and 785 μm, 727 μm, 712 μm, 855 μm, 639 μm after treatment for groups G1 to G5, respectively. Mean ΔZ values were 6327 vol%μm, 5995 vol%μm, 10014 vol%μm, 7192 vol%μm, 5649 vol%μm at baseline and 3686 vol%μm, 5126 vol%μm, 5539 vol%μm, 2327 vol%μm, 3218 vol%μm after treatment for groups G1 to G5, respectively. Paired t-test showed that LD and ΔZ changed significantly within all groups from baseline to treatment weeks following storage (p < 0.05) except LD in the control (p > 0.05). ANCOVA showed significant difference among groups in net lesion depth recovery and net mineral gain (p < 0.05), and G3 and G4 showed the highest mineral gains.
One or two applications of SDF prior to placement of GI, were effective in remineralising advanced dentine lesions, while additional applications, when combined with GI, did not demonstrate additional benefit in this study.
This short-term laboratory research study showed that one or two applications of SDF followed by GI coverage could remineralise advanced dentine caries in the presence of artificial saliva. This procedure carries potential in the treatment of difficult lesions where conventional restorations would require significant tooth structure removal through traumatic procedures.

Two-photon fluorescence microscopy, in combination with tetracycline labelling, was used to observe the remineralising potentials of a calcium silicate-based restorative material (Biodentine(TM) ) and a glass ionomer cement (GIC:​Fuji​IX) on totally demineralised dentine. Forty demineralised dentine discs were stored with either cement in three different solutions: phosphate buffered saline (PBS) with tetracycline, phosphate-free tetracycline, and tetracycline-free PBS. Additional samples of demineralised dentine were stored alone in the first solution. After 8-week storage at 37 °C, dentine samples were imaged using two-photon fluorescence microscopy and Raman spectroscopy. Samples were later embedded in PMMA and polished block surfaces studied by 20 kV BSE imaging in an SEM to study variations in mineral concentration. The highest fluorescence intensity was exhibited by the dentine stored with Biodentine(TM) in the PBS/tetracycline solution. These samples also showed microscopic features of matrix remineralisation including a mineralisation front and intra- and intertubular mineralisation. In the other solutions, dentine exhibited much weaker fluorescence with none of these features detectable. Raman spectra confirmed the formation of calcium phosphate mineral with Raman peaks similar to apatite, while no mineral formation was detected in the dentine stored in cement-free or PBS-free media, or with GIC. It could therefore be concluded that Biodentine(TM) induced calcium phosphate mineral formation within the dentine matrix when stored in phosphate-rich media, which was selectively detectable using the tetracycline labelling.