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Release of fluoride from conventional and metal-reinforced glass-ionomer cements.

Fluoride was extracted by 1 or 50 ml deionized water from 0.3 ml samples of two conventional and three metal-reinforced glass-ionomer cements. The fluoride concentration was determined by electrode. It was found that the fluoride concentration around the glass-ionomer cements ranged 2-3 ppm after 15 min and 3-5 ppm after 45 min. The maximum fluoride concentration attained within 24 h varied from 15-21 ppm, while the total amount of fluoride released during 100 days varied from about 2 mg fluoride to 12 mg fluoride per ml glass-ionomer cement. An alloy reinforced cement and its conventional counterpart released the highest amount of fluoride whereas a glass-cermet type released the lowest amount. Within the premises of this study it was concluded that composition and handling of the cements are of importance for the release of fluoride, and that a caries inhibitory fluoride concentration can be established in the surroundings of all of the cements.

Cermet Cements↗

The silver-releasing foam dressing, Contreet Foam, promotes faster healing of critically colonised venous leg ulcers: a randomised, controlled trial.

The study compared the effect of a sustained silver-release foam dressing (Contreet Foam) with a foam dressing (Allevyn Hydrocellular) without added silver in critically colonised venous leg ulcers with delayed healing. The study was a multicentre, open, randomised, controlled study lasting for 4 weeks. Ulcer area and healing were assessed weekly. Odour, maceration, absorption capacity and leakage were evaluated at dressing changes. All adverse events were recorded. One hundred and twenty-nine patients were included (Contreet Foam: 65, Allevyn Hydrocellular: 64). The two groups were comparable in all respects. After 4 weeks, there was a significantly greater reduction in ulcer area in the Contreet Foam group (45%) than in the Allevyn Hydrocellular group (25%). After 1 and 4 weeks, odour was present in significantly less of the ulcers in the Contreet Foam group (17% and 19%, respectively) compared with the Allevyn Hydrocellular group (47% and 39%, respectively) and at the final visit there were significantly fewer leakages in the Contreet Foam group (19%) compared with the Allevyn Hydrocellular group (49%). Also, less maceration was observed after 1 and 4 weeks in the Contreet Foam group (34% and 37%, respectively) compared with the Allevyn Hydrocellular group (55% and 48%, respectively). The occurrence and cause of adverse events were equally distributed between the study groups. The present study provides evidence of the superior performance of the silver-releasing dressing, Contreet Foam, compared with a traditional moist foam wound healing dressing in the treatment of critically colonised, chronic venous leg ulcers. The results of this randomised, controlled study suggest an important role of sustained silver-releasing dressings in the treatment of critically colonised chronic wounds.

Adult↗

Atraumatic restorative treatment (ART): a three-year clinical study in Malawi--comparison of conventional amalgam and ART restorations.

OBJECTIVE: This study compares the quality of class I restorations made with the atraumatic restorative treatment (ART) technique and conventional class I amalgam restorations. METHODS: The study was carried out among secondary school students in Mzuzu, Malawi. First-year students in 1987 who needed at least two class I restorations were selected. Based on a split-mouth design, each participant received both ART and conventional restorations. The 89 pairs of class I cavities were divided randomly into two groups, since two different cermet ionomer cement (CIC) filling materials were used. Impressions of the restorations and subsequent models were made shortly after restoration, after six months, one year, two years, and three years. The quality of the restorations was determined on the models following the US Public Health Service criteria. Bulk fracture, contour, marginal integrity, and surface texture of the restorations were recorded and evaluated separately. Survival rates were determined by the resultant score of all criteria. RESULTS: Though conventional amalgam restorations performed better on all criteria, this difference was significant only for the contour criterion. The survival rates of ART restorations after three years (81.0%) were lower than those of amalgam restorations (90.4%) (P=.067). CONCLUSIONS: The quality of ART class I restorations is competitive with that of conventional amalgam restorations.

Adolescent↗

Pulp response in primary teeth with deep residual caries treated with silver fluoride and glass ionomer cement ('atraumatic' technique)

Histological assessment of the dental pulps of 55 carious primary teeth was carried out 3 to 58 months after treatment by the 'atraumatic' technique involving application of 40 per cent silver fluoride to residual caries followed by restoration with glass ionomer cement. Fifty of the 55 teeth examined showed a favourable pulpal response, inducing presence of abundant reparative dentine and a wide odontoblast layer. Histological comparisons were made between these teeth and others not treated with silver fluoride but restored with glass ionomer cement, amalgam or zinc oxide and eugenol. Possible mechanisms of the action of silver fluoride in arresting residual caries are discussed. The question of whether or not treatment of carious dentine with silver fluoride represents a biologically acceptable clinical procedure cannot be answered on the basis of pulpal histology alone. The very high concentration of fluoride in commercial preparations of silver fluoride raises several questions concerning its clinical safety.

Adolescent↗

Unacceptably high levels of fluoride in commercial preparations of silver fluoride.

Instead of expected fluoride ion concentrations of around 60,000 ppm, commercial preparations of 40 per cent aqueous silver fluoride were found to contain 120,000-127,000 ppm. Information received from the Western Australian Chemistry Centre which provided independent confirmation of the higher than expected [F] indicates that the currently available commercial preparations contain silver difluoride rather than silver fluoride. In view of the potential of fluoride-containing products such as dentifrices (1000-1500 ppm F) and topical fluoride gels and solutions (6000-12,000 ppm F) to cause adverse effects if excessive quantities are ingested, any product that contains 120,000 ppm [F] should be regarded as carrying a high risk of toxicity when used on young children.

Australia↗

Safety issues related to the use of silver fluoride in paediatric dentistry.

Due to its exceedingly high fluoride content, 40% silver fluoride solution has the potential to cause fluorosis when used in young children. In vitro testing conducted in the present investigation indicates that application of 40% silver fluoride to deep carious lesions or its use as a 'spot' application agent could result in 3 to 4 mg of fluoride reaching the systemic circulation. As scientifically-based clinical trials on the safety of 40% silver fluoride have not been conducted, it would be appropriate for it to be withdrawn from further clinical use until proper testing and evaluation have been carried out. In view of the possibility that lower strength solutions of silver fluoride (1-4%) may be just as effective as 40% in 'arresting' deep caries, testing should focus on such solutions, particularly as the potential for toxicity from their fluoride content would be reduced by a factor of 10-40.

Administration, Topical↗

Potential of 4 per cent silver fluoride to induce fluorosis in rats: clinical implications.

The Health Department in Western Australia uses a 40 per cent silver fluoride (AgF) solution for prevention and treatment of dental caries in children. Analysis of this solution has revealed high fluoride concentrations (75,000-120,000 mg/L), raising concerns of potential toxicity and prompting investigation of clinical protocols utilizing low-strength AgF in an animal model. A single topical application of 4 per cent AgF solution to Sprague-Dawley rats resulted in moderate to severe localized fluorosis in 24 per cent of animals. In a second experiment, caries was induced in rats aged 19 days; six weeks later, between one-four carious molar teeth from each rat were treated with 4 per cent AgF (atraumatic technique). A generalized form of fluorosis developed in the continually growing incisors of less than 10 per cent of animals which had one or two carious teeth treated, and in 70-90 per cent of rats which received AgF to either three or four carious teeth. These results confirm the potential of a 4 per cent AgF solution to induce fluorosis and support previous recommendations that AgF at its empirical concentration of 40 per cent should be withdrawn from clinical use.

Animals↗

An in vitro model to measure the effect of a silver fluoride and potassium iodide treatment on the permeability of demineralized dentine to Streptococcus mutans.

BACKGROUND: Diamine silver fluoride (Ag(NH3)2F), referred to as AgF, has been used to reduce the incidence of caries in primary dentitions but has been limited by the associated staining of both teeth and restorative materials. The application of potassium iodide (KI), following AgF prevents staining but its effects on the ability of AgF to reduce caries are not known. The aim of this study was to develop an in vitro model that would provide an indication of the permeability of demineralized dentine to Streptococcus mutans after treatment of the dentine with AgF followed by KI. METHODS: Forty dentine discs were bonded to the base of forty 5mL polycarbonate screw top vials (that had had their bases removed), filled with nutrient medium, sterilized and placed into a continuous culture of S. mutans. Samples were divided into four groups as follows: 10 samples of demineralized dentine as a control, 10 samples of demineralized dentine treated with AgF/KI, 10 samples of demineralized dentine treated with KI and 10 samples of demineralized dentine treated with AgF. After two weeks the optical density of the growth medium chambers was measured to determine bacterial penetration and growth. Cultures were plated out to determine migration through the discs by S. mutans. RESULTS: S. mutans migrated through all dentine discs. However, the samples treated with AgF and AgF/KI had significantly lower optical densities than the corresponding controls. The range of optical densities was least amongst demineralized samples treated with AgF/KI. CONCLUSIONS: Under the conditions of this study, treatment of demineralized dentine discs with AgF followed by KI allowed the penetration of S. mutans. Based on optical density measurements, the treatment resulted in significantly fewer microorganisms being present subjacent to the discs treated with AgF and KI than the control discs at the end of the experimental period.

Bacteriological Techniques↗

The effect of silver fluoride and potassium iodide on the bond strength of auto cure glass ionomer cement to dentine.

BACKGROUND: Diamine silver fluoride (Ag(NH3)2F), referred to as AgF, has been shown to reduce the incidence of caries in primary dentitions. The clinical application of this material has been limited by staining associated with both teeth and restorative materials. The application of potassium iodide (KI) after AgF eliminates stain formation. There is a lack of information as to how the addition of AgF followed by KI may affect the bond strength to dentine. The purpose of this study was to compare the bond strengths of auto cure glass ionomer cement to dentine surfaces that had been treated with AgF and KI and without treatment. METHODS: Ten recently extracted human third molars were embedded into methyl methacrylate resin and sliced to form a square block of exposed dentine surfaces. Each of the four surfaces were treated by one of the following procedures: (a) etching with 37 per cent phosphoric acid; (b) applying GC dentine conditioner; (c) etching, followed by application of AgF/KI then washing off the precipitate and air drying; and (d) etching, applying AgF/KI and air drying the reaction products on the surface. Fuji VII auto cure glass ionomer cement was bonded onto each sample and fracture tested. RESULTS: The dentine samples treated with AgF/KI followed by washing away the precipitate and air drying had bond strengths (2.83 MPa) not significantly different from samples that had been conditioned (2.40 MPa). Samples where the AgF/KI precipitate had been air dried onto the dentine surface had significantly lower bond strengths (1.49 MPa) than the washed samples. Samples that were etched had significantly lower bond strengths (1.91MPa) than the conditioned samples. CONCLUSIONS: This study found that the application of AgF/KI to etched dentine samples followed by washing off the precipitate, created bond strengths that were not significantly different to conditioned samples. Leaving the AgF/KI precipitate on the dentine surface significantly reduced the bond strength of auto cured glass ionomer cement to dentine. Washing away the reaction products and air drying is recommended as the clinical protocol for using AgF and KI on dentine surfaces prior to application of an auto cure glass ionomer cement.

Acid Etching, Dental↗

Ion uptake into demineralized dentine from glass ionomer cement following pretreatment with silver fluoride and potassium iodide.

BACKGROUND: Diamine silver fluoride (Ag(NH3)2F), referred to as AgF, has been shown to provide a pronounced antimicrobial action against caries. The clinical application of this material has been limited by the staining associated with both teeth and tooth coloured restorative materials. The application of potassium iodide (KI) after AgF eliminates stain formation. The purpose of this study was to determine if a prior application of silver fluoride and potassium iodine to demineralized dentine affected the uptake of strontium and fluoride from a glass ionomer cement restoration. METHOD: Three cavities were prepared in each of five recently extracted human third molars. The cavities were demineralized and treated as follows. In each tooth, one cavity was left as a control, one cavity was restored with glass ionomer cement and one cavity was treated with 1.8M AgF and a saturated KI solution and then restored with glass ionomer cement. The penetration of the various elements into demineralized dentine was measured by their relative percentage weights using electron probe microanalysis (EPMA). RESULTS: Fluoride uptake was significantly higher in the AgF and KI treated samples compared to the other two samples and significantly higher in the glass ionomer restored sample compared to the control. The application of AgF and KI did not significantly interfere with the transfer of strontium from glass ionomer cement into dentine. Silver and iodine deposits were present in the demineralized dentine treated with AgF and KI. CONCLUSIONS: The application of AgF and KI onto dentine prior to the placement of glass ionomer cement did not significantly affect the strontium uptake into the subjacent demineralized dentine and the fluoride levels in this zone were significantly increased.

Anti-Infective Agents↗

Triangular and Fibonacci number patterns driven by stress on core/shell microstructures.

Fibonacci number patterns and triangular patterns with intrinsic defects occur frequently on nonplanar surfaces in nature, particularly in plants. By controlling the geometry and the stress upon cooling, these patterns can be reproduced on the surface of microstructures about 10 micrometers in diameter. Spherules of the Ag core/SiOx shell structure, possessing markedly uniform size and shape, self-assembled into the Fibonacci number patterns (5 by 8 and 13 by 21) or the triangular pattern, depending on the geometry of the primary supporting surface. Under proper geometrical constraints, the patterns developed through self-assembly in order to minimize the total strain energy. This demonstrates that highly ordered microstructures can be prepared simultaneously across large areas by stress engineering.

Biophysical Phenomena↗