Effect of Silver Diamine Fluoride on the Bonding Properties to Caries-affected Dentin

Purpose: To evaluate 1. the microtensile bond strength (µTBS) and in situ degree of conversion (DC) of adhesives applied using two bonding strategies after silver diamine fluoride (diamine) application on carious dentinal lesions, and 2. dentin etching patterns using SEM and energy dispersive x-ray spectroscopy. Materials and Methods: Human molars were randomly divided into 12 experimental groups according to: 1. application of a silver diamine fluoride solution (carious dentinal lesion without silver diamine fluoride treatment [control], with 12% silver diamine fluoride [diamine 12%] or 38% silver diamine fluoride [diamine 38%]); 2. adhesives (Clearfil Universal Bond Quick [CUQ] and Scotchbond Universal [SBU]); 3. adhesive strategy (etch-and-rinse [ER] and self-etch [SE]). After restoration, the specimens were sectioned and submitted to µTBS testing. Sticks from each tooth were used for DC evaluation. To examine the changes induced by diamine before and after phosphoric acid treatment, SEM/EDX analysis was performed. Data from the µTBS and DC tests were analyzed using three-way ANOVA and Tukey's test (α = 0.05). Results: Both concentrations of diamine resulted in a statistically significantly higher mean µTBS compared to the control (p 0.0001). Diamine 38% showed a statistically significantly higher mean µTBS for both adhesives in SE mode compared to diamine 12% (p 0.0001). The application of diamine to carious dentinal lesions did not significantly influence the mean DC values for either adhesive (p = 0.72). SBU showed a higher mean DC compared to CUQ (p = 0.03). After diamine treatment, there was an increase in the Ca peak intensity and the presence of residual silver ions mainly when diamine 38% was applied along with the SE approach. Conclusion: Independent of the adhesive application approach, the use of diamine may be a promising alternative to increase µTBS without jeopardizing the DC of the two adhesives in carious dentinal lesions. Keywords: silver diamine fluoride, adhesives, microtensile bond strength, dental caries, micro-Raman spectroscopy, SEM