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Year : 2021  |  Volume : 32  |  Issue : 3  |  Page : 395-398
Comparative evaluation of shear bond strength of two adhesive materials on demineralized dentin treated with silver diamine fluoride: An in-vitro study

1 Department of Pediatric and Preventive Dentistry, Vinayaka Mission's Sankarachariyar Dental College, Vinayaka Mission's Research Foundation (Deemed to be University), Salem, Tamil Nadu, India
2 Department of Public Health Dentistry, Vinayaka Mission's Sankarachariyar Dental College, Vinayaka Mission's Research Foundation (Deemed to be University), Salem, Tamil Nadu, India

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Date of Submission16-Jul-2021
Date of Decision27-Oct-2021
Date of Acceptance27-Oct-2021
Date of Web Publication23-Feb-2022


Context: Early childhood caries (ECC) is one of the most common diseases in the children of developing countries, affecting their oral health-related quality of life. From an economic perspective, silver diamine fluoride (SDF) can limit the progression of active carious lesions. Aims: To estimate and compare the loss of shear bond strength among two adhesive materials on SDF-treated demineralized primary teeth dentin. Settings and Design: Laboratory setting and in-vitro study design. Methods and Material: For the in-vitro study, 40 primary teeth indicated for extraction were selected. The demineralization solution was 5% nitric acid. The samples were divided into four groups, Group 1 – GIC Type IX, Group 2 – Self-etch (SE) adhesive + G-Aenial Universal Flo, Group 3 – SDF + GIC Type IX, and Group 4 – SDF + SE adhesive + G-Aenial Universal Flo. Statistical Analysis Used: Descriptive analysis and analysis of variance with Tukey's Post hoc test. Results: The shear bond strength of GC G-Aenial Universal Flo (18.8165 ± 13.0448 MPa) found to be superior to GIC (5.7845 ± 1.8968 MPa). However, bond strength was significantly reduced with GC G-Aenial Universal Flo (34.0441 ± 14.1949/18.8165 ± 13.0448 MPa) compared to GIC (7.7956 ± 2.2804/5.7845 ± 1.8968 MPa) following the application of SDF. Conclusions: It was concluded that SE adhesive + GC G-Aenial Universal Flo is the material with better shear bond strength compared to GIC Type IX with and without SDF. Considering the severity and prevalence of ECC, socioeconomic strata of Indian population, the choice of material for masking the discoloration, and prevention of disease, GIC can be suggested as an alternative over GC G-Aenial Universal Flo.

Keywords: Silver diamine fluoride, demineralized dentin, GIC Type IX, GC G-Aenial Universal Flo

How to cite this article:
John J B, Gainneos PD, Mathew BM, Bharath C, Duraisamy V. Comparative evaluation of shear bond strength of two adhesive materials on demineralized dentin treated with silver diamine fluoride: An in-vitro study. Indian J Dent Res 2021;32:395-8

How to cite this URL:
John J B, Gainneos PD, Mathew BM, Bharath C, Duraisamy V. Comparative evaluation of shear bond strength of two adhesive materials on demineralized dentin treated with silver diamine fluoride: An in-vitro study. Indian J Dent Res [serial online] 2021 [cited 2022 Aug 17];32:395-8. Available from:

   Introduction Top

The burden of early childhood caries is one of the most frequently discussed topics in dental literature, especially in developing countries. The single most common childhood disease, due to chronicity, affects the food intake, sleep, and well-being of children, subsequently lowering their oral health-related quality of life. In the long run, it also influence the parents adversely.[1] Policies developed to reduce the chronic nature of ECC have evolved into the usage of minimally invasive methods that can treat the disease and not merely prevention.[2] Silver diamine fluoride (SDF) can arrest the progression of caries non-invasively supported by a sufficient number of clinical trials and systematic reviews.[3] It is an economical product used worldwide since the early 1960s in promoting dentin health in carious teeth owing to its safety and approval by FDA in 2014.

The effect of SDF seems to be associated with its antibacterial properties and chemical reactions with hydroxyapatite. Laboratory studies had shown a higher resistance to the development of secondary caries when applied to restorations under a cariogenic environment.[4] Unfortunately, blackish discoloration of tooth attributed to the formation of silver was the most discouraging drawback, irrespective of the concentration used. Various methods have been utilized in masking this effect of SDF including the application of silver precipitating agents[5] or simply restoring with an opaque material like glass ionomer cement. Resin-based restorative material was found to be a less effective, technique sensitive, and expensive alternative in masking discoloration.

Al-Qahtani YM concluded that improved bond strength and marginal microleakage scores were demonstrated by the demineralized dentin treated with 0.25% graphene oxide and 3.8% SDF when bonded to resin-modified glass ionomer cement.[6] Additionally, any agent applied to the dentine before a restorative procedure may impair the bonding of the restorative material. The application of SDF forms a surface layer of silver phosphate on dentine, silver particles extending into the dentinal tubules resulting in a total or partial obstruction reduced permeability, and lower bond strength of restorative material to SDF-treated dentine. The adhesiveness of restorative materials to tooth structure is important in current restorative standards. Studies have shown that the application of potassium iodide (KI) has not significantly improved the bond strengths irrespective of the restorative material used.[4]

SDF targets both organic and inorganic components in the carious lesion. Locally, the insoluble layer formed by precipitated oxidized silver (silver phosphate, silver oxide, and silver chloride) increases remineralization, obturates dentinal tubules, and inhibits enzymes that break down the organic dentin matrix, such as matrix metalloproteinases and cathepsins.[6] In vitro, SDF has an antibacterial action against Streptococcus mutans, Streptococcus sobrinus, Lactobacillus acidophilus, Lactobacillus rhamnosus, Actinomycesnaeslundii, and Enterococcus faecalis.[7]

The study aimed to estimate and compare the loss of shear bond strength among two adhesive materials on SDF-treated demineralized primary teeth dentin.

   Subjects and Methods Top

This is an experimental study conducted estimate and compare the loss of shear bond strength among two adhesive materials on SDF-treated demineralized primary teeth dentin. The study protocol was approved by the Scientific Advisory committee and Institutional Ethics Committee. The study was conducted and reported as per CRIS (Checklist for Reporting In-vitro Studies) Guidelines. Ethical committee approval was obtained, Date of approval: 25/07/2019.

Sample size was estimated using OpenEpi, Version 3 (open source calculator). The sample size per group was estimated to be 10 at 95% confidence interval and power of the study at 80%. The study sample included 40 primary teeth indicated for extraction. Teeth involving with preshedding mobility retained deciduous teeth and teeth with less than one-third of the root remaining were included in the study, whereas teeth with a grossly destructed crown and teeth with hypoplastic changes were excluded.

Specimen preparation

The samples were stored in distilled water.[8] The teeth were embedded in acrylic blocks and occlusal enamel was removed the using a diamond disc to expose the dentine [Figure 1]. To ensure that the surface was free of enamel, samples were examined under the microscope. The coronal dentin surface was polished with a silica carbide paper to ensure a smooth surface. All the teeth were then soaked for 3 h in 5% nitric acid for demineralizing the teeth (acid for demineralization and the duration of acid exposure were standardized through a pilot study). The samples were then divided into four groups.
Figure 1: Dentin exposed with a diamond disc

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  • Group 1 – GIC Type IX
  • Group 2 – Self-etch (SE) adhesive + G-Aenial Universal Flo
  • Group 3 – SDF + GIC Type IX
  • Group 4 – SDF + SE adhesive + G-Aenial Universal Flo.

The prepared surfaces of samples from groups 3 and 4 alone were air-dried and 38% SDF was applied for 10 s [Figure 2]. All samples (Group 1–4) were restored with 4 mm cylindrical blocks of respective restorative material and stored in artificial saliva for 3 days to simulate exposure to the oral environment [Figure 3].
Figure 2: SDF-treated (Left) and non-SDF-treated samples

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Figure 3: Samples stored in artificial saliva

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Assessment of shear bond strength

A Universal Testing machine was used to test the shear bond strength of the samples. Shear force was applied at the junction of the tooth structure and the restorative material of the sample loaded onto the machine using an enamel chisel attached to the upper component of the universal testing machine. Shear force was applied at a crosshead speed of 0.5 mm/min until deboning occurred, and the maximum load to failure was recorded.[9] The amount of shear force is measured and calculated using the “PC-based UTM Software” (Kalpak Instruments & Controls).

Statistical analysis was done using SPSS (Statistical Packages for Social Science) 21.0 version and P < 0.05 was considered statistically significant. Analysis of variance (ANOVA) with Tukey Post hoc test was done to compare the bond strength between the four groups.

   Results Top

The results revealed a significant difference in bond strength among all the groups with P < 0.001. The comparison of mean bond strength. Composites without SDF showed a mean bond strength of 34.0441 ± 8.2235 Mpa and with SDF the value was reduced to 18.8165 ± 8.4499 Mpa. Similarly, GIC without SDF and GIC with SDF had bond strength of 7.7956 ± 1.8711 and 5.7845 ± 1.1125 Mpa, respectively [Table 1]. Comparing all groups, composite specimens had the highest values with a mean difference of 34.0441 Mpa and were highly significant (P = 0.000). The decrease in SBS measurements following SDF treatment was more with Composite than GIC, though both were statistically significant (P = 0.001) [Table 2]. A statistically significant result was obtained when GIC with SDF and composite with SDF were compared (P = 0.001).
Table 1: Mean±S.D shear bond strength of all groups

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Table 2: Comparison of reduction in shear bond strength among groups

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   Discussion Top

The purpose of this study was to primarily assess the fall in shear bond strength and the masking property of the restorative materials after the application of SDF in primary molars. As it's a fact that SDF can arrest dental caries, we were concerned about its physical properties that may influence the clinical practice. Multiple materials are proved effective in either removing or hiding the discoloration of SDF are KI, glutathione (GSH), and opaquers. All these methods were time consuming, technique sensitive, or the outcomes were transient.[10],[11],[12] A systematic review and meta-analysis conducted by Fröhlich et al.[13] shows that previous application of SDF does not influence the dentine bond strength of glass ionomer cement but compromises the bonding of adhesive systems. Additionally, these modalities are expensive and inaccessible to a rural practitioner. Alternatively, opaque glass ionomer cement can be an effective mode of aesthetic restoration, this suggestion is in agreement with various systematic reviews.[4],[14]

The subsequent matter of concern is the loss of bond strength and its management. Multiple studies have displayed an equal deterioration of bond strength with SE as well as etch and rinse systems, throwing light towards the challenges of light cure restorative material in combination with SDF.[14] A study conducted by Siqueira et al.[15] found that diamine 38% showed a statistically significantly higher mean microtensile bond strength for both adhesives (Clearfil Universal Bond Quick and Scotchbond) in SE mode compared to diamine 12%. In the current study, G-Aenial Universal Flo was used with a SE adhesive for intragroup comparison with SDF. The analysis revealed a similar pattern of deterioration of bond strength.

A study conducted by Uchil et al.[16] showed that the application of SDF with or without acid etching and KI does not affect the bond strength of RMGIC to carious dentin of primary teeth. GIC is a versatile material with less technique sensitivity and in paediatric restorative dentistry, a relative preference is given over other materials owing to its fluoride release, chemical adhesion and ease to use in various clinical scenarios.[17] Based on the fact that the life of a restoration can be directly related to bonding, this study found a comparatively lesser drop in the bond strength compared to light cure composite material. This finding was in unity with the study by Quock et al.[18]

   Conclusion Top

From a clinical perspective, the study attempts to support the efficiency of GIC regarding its longevity. Though composite serves the best aesthetics, such inadequacies of GIC can be enhanced by using it with strip crowns offering full coverage and strength. Especially in an encircling pattern of decay in ECC in the cervical region, GIC with a strip crown would serve better in arresting its progression. In a child, SDF can avoid complex procedures under GA and increase overall quality of life. For a clinician, it can reduce chair side time and increase the acceptance to SDF. In conclusion, glass ionomer can be recommended as a cost-effective alternative for post-SDF application in carious primary teeth in a child.

Financial support and sponsorship

This is to acknowledge that the study was funded by VMRF-DU and performed in Vinayaka Missions Sankarachariyar Dental College (VMRF/Seed Money/Aug 2021/VMSDC-Salem/1).

Conflicts of interest

There are no conflicts of interest.

   References Top

Acharya S, Tandon S. The effect of early childhood caries on the quality of life of children and their parents. Contemp Clin Dent 2011;2:98-101.  Back to cited text no. 1
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Horst JA. Silver fluoride as a treatment for dental caries. Adv Dent Res 2018;29:135-40.  Back to cited text no. 2
Gao SS, Zhao IS, Hiraishi N, Duangthip D, Mei ML, Lo EC, et al. Clinical trials of silver diamine fluoride in arresting caries among children: A systematic review. JDR Clin Trans Res 2016;1:201-10.  Back to cited text no. 3
Knight GM, McIntyre JM. The effects of silver fluoride and potassium iodide on the bond strength of auto cure glass ionomer cement to dentine. Aust Dent J 2006;51:42-5.  Back to cited text no. 4
Patel J, Anthonappa RP, King NM. Evaluation of the staining potential of silver diamine fluoride: In vitro. Int J Paediatr Dent 2018;28:514-22.  Back to cited text no. 5
Al-Qahtani YM. Impact of graphene oxide and silver diamine fluoride in comparison to photodynamic therapy on bond integrity and microleakage scores of resin modified glass ionomer cement to demineralized dentin. Photodiagnosis Photodyn Ther 2021;33:102163. doi: 10.1016/j.pdpdt. 2020.102163.  Back to cited text no. 6
Ng E, Saini S, Schulze KA, Horst J, Le T, Habelitz S. Shear bond strength of glass ionomer cement to silver diamine fluoride-treated artificial dentinal caries. Pediatr Dent 2020;42:221-5.  Back to cited text no. 7
Lutgen P, Chan D, Sadr A. Effects of silver diammine fluoride on bond strength of adhesives to sound dentin. Dent Mater J 2018:2017-401.  Back to cited text no. 8
Zhao IS, Chu S, Yu OY, Mei ML, Chu CH, Lo EC. Effect of silver diamine fluoride and potassium iodide on shear bond strength of glass ionomer cements to caries-affected dentine. Int Dent J 2019;69:341-7.  Back to cited text no. 9
Sayed M, Matsui N, Hiraishi N, Nikaido T, Burrow MF, Tagami J. Effect of glutathione bio-molecule on tooth discoloration associated with silver diammine fluoride. Int J Mol Sci 2018;19:1322.  Back to cited text no. 10
Nguyen V, Neill C, Felsenfeld J, Primus C. Potassium iodide. The solution to silver diamine fluoride discoloration? Health 2017;5:555655. doi: 10.19080/ADOH.2017.05.5555655  Back to cited text no. 11
Darabi F, Radafshar G, Tavangar M, Davaloo R, Khosravian A, Mirfarhadi N. Translucency and masking ability of various composite resins at different thicknesses. J Dent 2014;15:117-22.  Back to cited text no. 12
Fröhlich TT, Rocha RO, Botton G. Does previous application of silver diammine fluoride influence the bond strength of glass ionomer cement and adhesive systems to dentin? Systematic review and meta-analysis. Int J Paediatr Dent 2020;30:85-95.  Back to cited text no. 13
Jiang M, Mei ML, Wong MC, Chu CH, Lo EC. Effect of silver diamine fluoride solution application on the bond strength of dentine to adhesives and to glass ionomer cements: A systematic review. BMC Oral Health 2020;20:40.  Back to cited text no. 14
Siqueira FSF, Morales LAR, Granja MCP, de Melo BO, Monteiro-Neto V, Reis A, et al. Effect of silver diamine fluoride on the bonding properties to caries-affected dentin. J Adhes Dent 2020;22:161-72.  Back to cited text no. 15
Uchil SR, Suprabha BS, Suman E, Shenoy R, Natarajan S, Rao A. Effect of three silver diamine fluoride application protocols on the microtensile bond strength of resin-modified glass ionomer cement to carious dentin in primary teeth. J Indian Soc Pedod Prev Dent 2020;38:138-44.  Back to cited text no. 16
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Berg JH. Glass ionomer cements. Pediatr Dent 2002;24:430-8.  Back to cited text no. 17
Quock RL, Barros JA, Yang SW, Patel SA. Effect of silver diamine fluoride on microtensile bond strength to dentin. Oper Dent 2012;37:610-6.  Back to cited text no. 18

Correspondence Address:
Dr. Basil M Mathew
Department of Pediatric and Preventive Dentistry, Vinayaka Mission's Sankarachariyar Dental College, Sankari Road, Ariyanoor, Salem - 636 308, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijdr.ijdr_724_21

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