Microscopic evaluation of the dentin-pulp complex response in carious primary teeth after 38% silver diamine fluoride application: An ex vivo study.

Abstract

Background: Silver diamine fluoride (SDF) is widely used for caries arrest in pediatric dentistry; however, histologic evidence with larger samples regarding its effects on the dentin-pulp complex in teeth remains limited.

Methods: This ex vivo observational study included 35 carious primary teeth treated clinically with 38% SDF and extracted 6 months later. Histologic analysis was performed to assess silver penetration depth, dentinal tubule occlusion, tertiary dentin formation, pulpal response, and bacterial presence. Penetration depth was measured using digital image analysis software. Statistical analysis included descriptive statistics and nonparametric tests.

Results: Silver deposition within dentinal tubules was observed in all specimens. Penetration depth ranged from 230 through 1,132 μm (mean [SD], 541 [221] μm). Tertiary dentin formation was present in 27 of 35 (77.1%) samples, with thickness ranging from 21 through 55 μm. Of 35 specimens, 31 had preserved pulp architecture without inflammation. No bacterial infiltration was detected. Specimens exhibiting tertiary dentin formation had significantly greater SDF penetration than those without tertiary dentin (P = .004).

Conclusions: Within the limitations of this study, 38% SDF is considered a clinically suitable minimally invasive approach to the management of caries lesions in primary teeth to preserve tooth structure and maintain pulpal health.

Practical implications: The study findings support the use of 38% SDF as a safe and effective minimally invasive option for arresting caries while maintaining pulpal health when an adequate minimum remaining dentin thickness is present.