title: Prevention of secondary caries using silver diamine fluoride treatment and casein phosphopeptide-amorphous calcium phosphate modified glass-ionomer cement.
abstract: OBJECTIVE
  To study the effect of silver diamine fluoride (SDF) treatment and incorporating casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) into a glass-ionomer cement (GIC) to prevent secondary caries.
  
  
  METHODS
  A cervical cavity was prepared on 32 premolars for the following restoration groups: group 1, conventional GIC restoration; group 2, SDF (38%) treatment and conventional GIC restoration; group 3, CPP-ACP (3%) modified GIC; and group 4, SDF treatment and CPP-ACP modified GIC. The restored teeth were thermal-cycled before undergoing a multi-species cariogenic biofilm challenge. The restored teeth were examined by micro-computed tomography (micro-CT), scanning electron microscopy with energy dispersive X-ray spectroscopy (SEM/EDX) and Fourier transform infrared (FTIR) spectroscopy. Data were analyzed by two-way ANOVA.
  
  
  RESULTS
  Micro-CT determined outer lesion depths for groups 1-4 were: 123±6μm, 87±7μm, 79±3μm and 68±5μm respectively. An interaction effect on the outer lesion depth was found between the restorative materials and SDF treatment (p<0.001). Both SDF treatment and modification with CPP-ACP had a significant effect on outer lesion depth (p<0.001). SEM/EDX showed an increase of calcium and phosphorus at the root dentine adjacent to the restoration in groups 3 and 4 (CPP-ACP modified GIC). FTIR revealed that SDF treatment and CPP-ACP modified GIC had a significant effect on amide I-to-hydrogen phosphate ratio on the material-root interface (p=0.001).
  
  
  CONCLUSIONS
  SDF treatment and incorporation of CPP-ACP into GIC restorative material can prevent secondary root caries development.
  
  
  CONCLUSIONS
  The results provide useful information to dentists in formulating clinical management protocols and material when treating root caries.
authors.affiliation: Faculty of Dentistry, The University of Hong Kong, Hong Kong, China. Electronic address: zhao110@hku.hk.
authors.forename: Irene Shuping
authors.initials: IS
authors.lastname: Zhao
authors.affiliation: Faculty of Dentistry, The University of Hong Kong, Hong Kong, China. Electronic address: mei1123@hku.hk.
authors.forename: May Lei
authors.initials: ML
authors.lastname: Mei
authors.affiliation: Melbourne Dental School, University of Melbourne, Melbourne, Australia. Electronic address: mfburrow@unimelb.edu.au.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Burrow
authors.affiliation: Faculty of Dentistry, The University of Hong Kong, Hong Kong, China. Electronic address: hrdplcm@hku.hk.
authors.forename: Edward Chin-Man
authors.initials: EC
authors.lastname: Lo
authors.affiliation: Faculty of Dentistry, The University of Hong Kong, Hong Kong, China. Electronic address: chchu@hku.hk.
authors.forename: Chun-Hung
authors.initials: CH
authors.lastname: Chu
mesh_terms: D001419:Bacteria / Q000187:drug effects; D001641:Bicuspid / Q000187:drug effects; D018441:Biofilms / Q000187:drug effects; D002118:Calcium / Q000032:analysis; D002364:Caseins / Q000737:chemistry / Q000494:pharmacology*; D003731:Dental Caries / Q000517:prevention & control* / Q000628:therapy; D003743:Dental Enamel / Q000737:chemistry / Q000187:drug effects; D003764:Dental Materials / Q000737:chemistry / Q000494:pharmacology; D005460:Fluorides, Topical; D005899:Glass Ionomer Cements / Q000737:chemistry / Q000494:pharmacology*; D006801:Humans; D066298:In Vitro Techniques; D008422:Materials Testing; D008855:Microscopy, Electron, Scanning; D010758:Phosphorus / Q000032:analysis; D000644:Quaternary Ammonium Compounds / Q000737:chemistry / Q000494:pharmacology*; D018030:Silver Compounds; D013052:Spectrometry, X-Ray Emission; D017550:Spectroscopy, Fourier Transform Infrared; D013997:Time Factors; D014089:Tooth Remineralization; D014092:Tooth Root / Q000187:drug effects; D055114:X-Ray Microtomography
chemical_list: D002364:Caseins; D003764:Dental Materials; D005460:Fluorides, Topical; D005899:Glass Ionomer Cements; D000644:Quaternary Ammonium Compounds; D018030:Silver Compounds; C447032:casein phosphopeptide-amorphous calcium phosphate nanocomplex; D010758:Phosphorus; C024633:silver diamine fluoride; D002118:Calcium
keywords: CPP-ACP; Caries; Glass-ionomer cement; Silver diamine fluoride