Comparative Evaluation of Tensile Bond Strength of Three Different Glass Ionomer Cements in Silver Diamine Fluoride Treated Carious Dentin: An In Vitro Study.

Abstract

Aim and background: Early childhood caries (ECC) is one of the most prevalent and significant public health problems impacting pediatric populations across both developed and developing countries. Given its profound effects on both oral and general health, contemporary strategies emphasize prevention as the primary approach rather than focusing solely on treatment. Silver diamine fluoride (SDF) has emerged as an effective preventive agent due to its caries-arresting property, thus inhibiting further decay. Building on this, the silver-modified atraumatic restorative technique (SMART) incorporates the use of glass ionomer cement (GIC) following SDF application. This technique not only helps to mask the black staining associated with SDF but also promotes sustained fluoride release, thereby enhancing its therapeutic benefits. Although some studies have examined the bonding of resin cements and GICs to carious dentin treated with SDF, comparative analyses of different GICs in this context are still lacking. To address this, the study was done to evaluate and compare the tensile bond strength of three GICs-a Type IX, a resin-modified, and a bulk-fill glass hybrid variety, EQUIA Forte, with SDF-treated carious dentin.

Materials and methods: A total of 54 freshly extracted, defect-free premolar teeth were collected for the study and stored in 10% formalin. The occlusal surfaces were flattened, and each tooth was embedded in an acrylic resin block. To simulate dentinal caries, an artificial lesion was induced using a 14-day pH-cycling protocol. The specimens were divided randomly into 3 groups (n = 18). The control group (group I) had tooth mounted with Type IX GIC following SDF application. Similarly, group II and group III were mounted with resin-modified glass ionomer cement (RMGIC) and EQUIA Forte, respectively, following SDF application. The completed specimens were stored in distilled water for 7 days and were tested for tensile bond strength using a universal testing machine. The bond failure at the restoration-tooth interface was recorded in MPa (megapascal).

Results: Group III showed significantly higher mean tensile bond strength (2.61690 ± 0.31105 MPa), followed by group II (2.397 ± 0.117 MPa), and the least for group I (1.57843 ± 0.09221 MPa).

Conclusion: Among the three tested groups, EQUIA Forte showed greater bond strength and retention to SDF-treated carious tooth than RMGIC and Type IX GIC. These findings suggest that EQUIA Forte can be effectively employed in carious primary teeth as part of the SMART, offering a reliable restorative option with improved clinical performance.