Title: 0806 - Silver Diamine Fluoride: One-Step Restoration - 250 Severely Decayed Adult Teeth
Michael Griffith (Presenter)
University of California School of Dentistry
This case series of 250 adult teeth (ave age 64) with deep decay (ICDAS-II #5 and #6) was undertaken to establish proof-of-concept using silver diamine fluoride for one-step indirect pulp caps, while simultaneously placing final restorations, a single entry approach, as a means of avoiding endodontia. As opposed to (“partial”) or nonselective (“complete”) removal of carious dentin, this trial attempted to achieve effective one-step treatment while treating residual decayed dentin with SDF, removing most of the carious dentin.
Methods: Methods: This 5-year case series from a private practice setting, utilized one operator. This series contained 250 teeth with decay at least 2/3 of the dentin, (ICDAS II, #5 and 6), many cavitated with radiolucency fully to the pulpal region. Caries removal was by conventional mechanical means, intending to stop short of exposing the pulp, but leaving minimal residual affected dentin, and treated with SDF once or twice for 25 seconds and exposed to a curing light. Teeth were immediately filled with dentin-bonded resins or amalgam, or glass ionomer, including directly over the pulpal area, and followed for 2-60 months clinically and radiographically (Ave=17 months).
Results: Results: Of 250 teeth with very deep decay, 94% have not required endodontia. 18 required endodontia (3 within two weeks) Most degenerated nerves occurred within 6 months of treatment, but one occurred after 5 years. Very minimal post-operative sensitivity. 14 of the106 deeper lesions resulted in direct pulp caps, of which 12 succeeded in maintaining pulp vitality. Age was not a factor in any results.
Treating residual carious peri-pulpal dentin with SDF offers a predictable, minimally traumatic excavation technique. Silver Diamine Fluoride shows promise for controlling deep caries in one appointment, minimizing the number of pulp caps, and avoiding endodontia.
The submitter must disclose the names of the organizations with which any author have a relationship, the nature of the relationship, and the clinical or research area involved. The following is submitted: None